1. Competency Based Training for Providers on Electronic Health Records David Marchant, MD, Erica DeMint, MS, Michelle Hilaire, PharmD, CDE

2. At the completion of this session, participants will be able to Understand the objectives and benefits of competency-based training in an ambulatory care clinic. Understand the objectives and benefits of competency-based training in an ambulatory care clinic. Describe methods for selecting the specific competencies learners need to demonstrate at completion of training that will allow them to successfully perform their jobs. Describe methods for selecting the specific competencies learners need to demonstrate at completion of training that will allow them to successfully perform their jobs. Identify remediation methods for learners not meeting competency standards. Identify remediation methods for learners not meeting competency standards.

3. Introduction Poudre Valley Health System and Fort Collins Family Medicine Residency Program Poudre Valley Health System and Fort Collins Family Medicine Residency Program Our history with Health Information Technology Our history with Health Information Technology Meditech-1982 Meditech-1982 LSS Data Systems-September 2005 LSS Data Systems-September 2005 LSS Medical Practice Management (MPM) Suite for the Electronic Health Record LSS Medical Practice Management (MPM) Suite for the Electronic Health Record Phased Rollouts Phased Rollouts Grant Funding Grant Funding Healthy Innovations Connections Grant from the Colorado Health Foundation Healthy Innovations Connections Grant from the Colorado Health Foundation

4. Introduction What we had been doing for EHR training What we had been doing for EHR training Small group or individual sessions Small group or individual sessions Provider Manual Provider Manual Updated during all provider meetings Updated during all provider meetings Learning “on the fly” Learning “on the fly” Why we decided to do the training sessions? Why we decided to do the training sessions? System functionality was complete and charts were no longer pulled for visits System functionality was complete and charts were no longer pulled for visits EHR chart audits-not being used to maximal benefit (or at all) EHR chart audits-not being used to maximal benefit (or at all) Support Staff calls increase Support Staff calls increase Informal Feedback –people were confused Informal Feedback –people were confused

5. Methods Implementation team prioritized 3 skill areas with highest impact on patient care Implementation team prioritized 3 skill areas with highest impact on patient care Documentation, disease management/order entry, messaging Documentation, disease management/order entry, messaging System review and competency testing System review and competency testing Clinic closed for half-day Clinic closed for half-day Group divided into thirds and rotated among skill stations Group divided into thirds and rotated among skill stations Skills briefly reviewed and then individually demonstrated to the instructor Skills briefly reviewed and then individually demonstrated to the instructor Learning enhanced for all users who could coach their peers through each of the skills. Learning enhanced for all users who could coach their peers through each of the skills.

6. Methods All providers (residents, attendings, midlevels) went through the half day training. All providers (residents, attendings, midlevels) went through the half day training. Providers not able to attend met with instructors to complete the competency on an individual basis. Providers not able to attend met with instructors to complete the competency on an individual basis. Providers filled out a survey and took a written quiz as part of the program evaluation. Providers filled out a survey and took a written quiz as part of the program evaluation.

7. Results All providers had completed the training All providers had completed the training IRB approval was obtained and we did a survey 6 months later to assess the “learned material” IRB approval was obtained and we did a survey 6 months later to assess the “learned material”

8. Format of Evaluation Chose to ask 2 questions from the three areas most pertinent to clinic usage: Chose to ask 2 questions from the three areas most pertinent to clinic usage: messaging documentation disease management/order entry Survey of learners for their opinion on how the training went

9. Messaging Sample Question While viewing a message, you can do all but the following functions: A) Launch the Office Chart Review screen with one click. B) Launch the Order screen with one click. C) Initiate a letter with one click. D) See the patient's phone number. E) All of the above.

10. Messaging Sample Question Using the Find Patient button from the Practice screen: A) Launches PCI. B) Launches the Office Chart Review screen. C) Selects a patient for the creation of a new message. D) Launches the Document screen. E) None of the above Using the Find Patient button from the Practice screen: A) Launches PCI. B) Launches the Office Chart Review screen. C) Selects a patient for the creation of a new message. D) Launches the Document screen. E) None of the above

11. Documentation Sample Question The following are true about the documentation tool and its use at FMC: A) The encounter number is the unique identifier for the visit document. B) Completed templated visits such as Well Child Checks and Procedures will flow automatically to the Workload sign list. C) Each encounter can have multiple documents. D) A and B E) B and C The following are true about the documentation tool and its use at FMC: A) The encounter number is the unique identifier for the visit document. B) Completed templated visits such as Well Child Checks and Procedures will flow automatically to the Workload sign list. C) Each encounter can have multiple documents. D) A and B E) B and C

12. Documentation Sample Question A provider is reviewing a WCC in the Document screen. An error is noticed in the Developmental Milestones section. To correct this, click: A) Enter New B) Edit/Amend C) Add Section D) Document E) Normal A provider is reviewing a WCC in the Document screen. An error is noticed in the Developmental Milestones section. To correct this, click: A) Enter New B) Edit/Amend C) Add Section D) Document E) Normal

13. Disease Management Sample Question Which field can not be manually manipulated in the Modify Health Maintenance screen for an immunization? A) Start Date B) Frequency C) Sequence D) Date Due E) Administered by Which field can not be manually manipulated in the Modify Health Maintenance screen for an immunization? A) Start Date B) Frequency C) Sequence D) Date Due E) Administered by

14. Disease Management Sample Question Concerning the disease management module, which of the following is NOT correct: A) It is driven by ICD-9 codes. B) It drives order prompts. C) Frequencies can be changed on the fly by provider. D) Providers must use all default items when disease management is activated. E) Disease management items have protocol text to assist with clinical decision making. Concerning the disease management module, which of the following is NOT correct: A) It is driven by ICD-9 codes. B) It drives order prompts. C) Frequencies can be changed on the fly by provider. D) Providers must use all default items when disease management is activated. E) Disease management items have protocol text to assist with clinical decision making.

15. Program Evaluation Results: Survey 5 pt Likert scale questions pertaining to Content and Presentation of the program

16. Program Evaluation from Providers

19. Written Comments from Training Program Could be improved by: Could be improved by: Training was fine, but I learn best by doing it so more one on one time in clinic. Training was fine, but I learn best by doing it so more one on one time in clinic. Ice-cream and belly dancers Ice-cream and belly dancers For the “1” with level of material presented-for those of us who can maneuver the system. An advanced course would be great For the “1” with level of material presented-for those of us who can maneuver the system. An advanced course would be great Additional Suggestions/Comments Additional Suggestions/Comments Have an instructional programmed powerpoint to go through on our own time. Have an instructional programmed powerpoint to go through on our own time. Attach a Wii to the computers Attach a Wii to the computers

20. Trainer Impressions Fewer providers in a panic in the clinic Fewer providers in a panic in the clinic Fewer repetitive questions from providers Fewer repetitive questions from providers This first year class has learned much quicker than in previous years This first year class has learned much quicker than in previous years Probably most significant method was having the providers demonstrate their understanding in front of their peers Probably most significant method was having the providers demonstrate their understanding in front of their peers

21. Discussion What we learned What we learned Modifications we would make Modifications we would make Your experiences with similar situations Your experiences with similar situations Questions? Questions?