Transitioning your staff from PHR (paper health records) to EHR (electronic health records) in the Era of BH Redesign

Jason R. Angione, MS

Child & Adolescent Behavioral Health

Where ‘s your staff in the process of change?

Pre-contemplation What. There’s the problem?

Contemplation Oh man, do we really have to change?

Preparation Yes. Change is coming and we need to get ready.

Action Change is upon us!

Maintenance Keep on, Keepin’ on!

Relapse Oops! Let’s get back on track.

Prochaska & DiClemente

Change is… Difficult and painful

Scary

Dreaded

Fun!

Needed

Eagerly Anticipated

BUT not matter how one feels,

it is happening!!

Training at a Glance

EHR Training

Why

Who

WhenWhere

How

Structuring Your Training Program Super User Training

Determining who is going to train End Users

Initial End User Training

Continued Trainings after Go Live

In-Person Support

Phone/Text/Email Support

Ongoing “Office Hours/Fix-It” Sessions-Group & Individual

Updating Job Aids, etc. and distributing

Why do we have to do this EHR Stuff?

We need to keep up with the times It is a federal mandate from the American Recovery and

Reinvestment Act of 2009 for all providers who accept Medicaid funding to adopt Electronic Health Records (EHR)

It is designed to: Improve quality, safety, efficiency, and reduce health

disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information

Federal Mandates for Healthcare: Digital Record-Keeping Will Be Required of Public and Private Healthcare Provider: There's a high demand for professionals with knowledge of both healthcare and information

technology; University Alliance on February 08, 2013

And now introducing BH Redesign! By all accounts, BH Redesign goes into effect July 1st, 2017.

BH Redesign will require the same things that documentation has always required but also more. Think “Interactive Complexity”, “Explicit evidence based interventions”, “Discharge Planning”.

BH Redesign has new payment rates and structuring that will require not only efficient care but also efficient documentation.

New CPT codes will likely additional attention to detail.

The more fluent your staff in EHR, the more quickly they will be able to complete documentation.

Who’s in the room? Visual Learners

I like to see things

Auditory Learners

I like to hear things

Kinesthetic Learners

I like to do things hands on

Group Learners

I learn best in a group

Individual Learners

I learn best on my own

In-Person Learners

I learn best when I’m in the room

Online Learners

I learn best on the computer

Confident Learners

I got this!

Insecure Learners

I’ll never get this!

Super User to End User to Client Who are your Super Users and who trains your End

Users? Super Users are typically excited about EHR

Super users are usually tech/computer savvy

Super users are usually the ones who train the End Users

Super Users will be around for a while!

The most effective trainers for End Users are PATIENT Super Users

The better your End Users are trained, the better clients will feel when with the staff, and the better the client’s progress will be documented!

Remember the 80/20 rule. 20% of staff will be your EHR Champions

60% of staff will be EHR Accepters

20% of staff will be EHR Resisters Note: I have found that resisters are not necessarily those that

do not like computers. They are the ones that don’t like change no matter what.

We typically spend 80% of our time trying to convince the 20% of staff who resist that they need to get on board…but chances are they will continue to resist.

Instead, shift that focus to spending 80% of your time on the 60% of your staff that will move EHR use in your organization forward.

When do you do your training? As much as you can before Go Live!

You may need to do continual trainings after Go Live!

Break up training sessions into small manageable chunks

Offer multiple trainings days/times to meet the needs of your providers/End Users

Encourage everyone to be “On Time”

Keep client needs/productivity requirements in mind

Keep “busy” times in mind

Where do you do your training? Large Group settings in spaces that have plenty of

access to electricity-power strips, tables, chairs, projector, clear visibility of projected images

Small Group settings in spaces that have plenty of access to electricity-power strips, tables, chairs, projector, clear visibility of projected images

Individual settings in smaller spaces such as a provider’s office

Create “Buy In” This is key! Be excited about the change over to EHR Validate people’s fears and anxieties around EHR Promote End User confidence

“You don’t have to have confidence that you know HOW to use the system right away, but just confidence that you CAN do it.”

Promote benefits of EHR No more searching for the chart Continual access to client charts Collaborative Documentation-Engage the client Carry around less paper and PHI Protects against HIPAA violations

Assess Staff Readiness for EHR 1. First please read ALL directions carefully. 2. Select a response to the following statements in bold. 3. For each statement indicate your answer. 4. Add the numerical values of each of your answers to determine your

Grand Total. 5. Once you have determined your Grand Total, select the Workshop

strand that best suits your needs. * Overlapping Grand Totals indicate that your ratings may be on the

cusp of a Workshop strand. Use your best judgment to decide which strand will most likely provide a positive experience.

6. Go to Page 2 to select the Workshop (and Trainings), then click on the Relias E-Learning link or got to the Relias website in your “Favorites” menu on Internet Explorer .

7. Sign in and Register for the Trainings and Workshops that work best for you.

EHR Self Assessment-Cosmo Quiz Time

EHR Self Assessment-And Now for the Results!

Job Aids, Cheat Sheets, Help Guides, & Manuals Job Aids

Developed by Topaz. Usually come with pictures. Sometimes they are easy to follow and at other times not.

Cheat Sheets Created by individual organizations to meet the needs of your

staff. Usually augments a Job Aid.

Help Guides Created by individual organizations to meet the needs of your

staff. Very specific directions.

Manuals A compilation of all of your printed materials to aid in

learning and retention of learning.

To Print or Not To PrintPros Cons

Printed Materials

~No “Power” Needed~Gives providers ready access to training materials~Helps providers feel more confident~Offers a place for providers to take notes~Helps to create “Buy In”

~Someone has to write the printed materials unless you only use the Job Aids provided~It costs money to print, especially if you use color. But the nicer they look, the more they will be used~It takes a lot of time to print, organize, and put materials together~Printed materials get “out dated”

Digital

Materials

~Topaz Job Aids are already developed and ready to go~Can be emailed, stored on computers, or stored on staff accessible server/drive~Easier to change “out dated” information

~Must have access to “Power” and/or network~Additional help aids must be developed by someone~Staff don’t always check their email, save materials, or know how to access server drives~Providers may not organize the materials in an efficient way

Learning & Teaching Your confidence level sets the tone

Learning styles vary from person to person

Adult learners like to be treated like adults

Respect their time, trials, & tribulations

Adult learners really appreciate empathy and validation

BE PATIENT!!

Everyone likes snacks and treats!

If you are training post-Go Live, you may want to offer training sessions where staff can actually get work done

Who, What, Why of Trainers If you can have 2 trainers at once, that is a fantastic idea!

A Techie person and a Clinical Person make a great pairing

Take the opportunity to teach the functionality of the template (Techie) along with a review/introduction of the content (Clinical) that goes into the various sections of the template.

Templates lend themselves to CBT documentation beautifully but your providers will need to flesh out the content. IE. There are no intervention checklists on the template.

BH Redesign and Medicaid Managed Care will impact how and what is documented.

Training Schedule

The Training Session Introduce yourself (and your co-leader if there is one)

Even if everyone knows you.

Perhaps a small ice breaker Ie. Introductions with a “Silly” Question. Name, “What’s your favorite Super Hero power?”

Introduce the topics for the day You may even want to develop a syllabus

Demonstrate the function or template* You may want a “driver” while you train

Offer plenty of Q&A There will be lots of questions and even some “push back”

Utilize “Teach Backs” Have a staff member teach back what was just learned

Give feedback/rewards-Remember Unconditional Positive Regard Incentives work for everyone!

Get feedback Use an evaluation form

*Breaking It Down Keep it brief and relevant

Train staff in the functions that are most relevant to their job duties

All-ROI’s, Non-Billable Contact Notes

Assessors-Comp Assess, Prog Note Eval, Staffing Notes, BHSP, Discharge Summary

Therapists and CPST: Progress Notes, Contact Notes, Staffing Notes, BHSP, Discharge Summary; Prog Note Grp for therapists who do group

Intake-Referral Demographics, Intake PreScreen

Medical Services-Psych Eval Main, Nurse Doc

*Breaking Down Some More Keep Training Time frames to 1 ½ to 2 hours. You can do

longer but give a break at some point if you do. Be aware of the Saturation point!

Not only will you be “re-orienting” your current staff to EHR and your organizational workflow, but you will also have new hires to orient and train in the ways of your organization

So that EHR trainings are “hands on” and, hands down, more effective(!), it is most beneficial that if prior to any training staff, including new hires, are licensed in NextGen and have been issued organization network access and/or equipment

Training Evaluation

Structuring Initial and Ongoing Trainings

Pros Cons

Large Group ~Time Saving ~Same Info, Same Time~Others Think of Things

~Schedule Coordination~Focus Difficulties~Easier to Get Off Track~Afraid to “Look Dumb”

Small Group ~Can Be Time Saving~Mostly Same Info, Same Time~More Comfortable Asking~Easier to meet needs

~Need more training sessions~Greater chance of info variation~Still afraid to “Look Dumb”

Individual ~Individual gets needs met~Less afraid to ask questions~Easier for individual to schedule

~Time consuming for trainer(s)~Loss of “synergy” of group training~Greatest chance of info variation

Structuring Initial and On-going Trainings

Pros Cons

Mandated ~Definitely the way to go for initial training~Everyone gets the information~Increased expectation of usage

~Staff can feel pressured~Staff can feel overwhelmed~Potentially takes time away from productivity

By Choice ~Staff feel empowered ~Everyone loves choice~Sessions can be more focused to meet the needs of staff

~Staff may miss out on information~Staff will almost always choose productivity over training.

What Not To Do Condescend or Diminish End Users anxieties/concerns

Use Training sessions as Workshopping/Brainstorming sessions

Assume staff know how to type or use computers fluently

Go too fast

Assume that you know all of the answers. Instead admit you don’t know but you will find out the answer-This actually increases your credibility

Take things personally

Q&A/Notes