Evaluation of EHR Training as a catalyst to achieve clinician satisfaction with technology in acute

160 Pages·2013·1.64 MB·English

Evaluation of EHR Training as a catalyst to achieve clinician
satisfaction with technology in acute care setting

By

Walid Youssef
MBBCh, Ain Shams University, 1993
MD General Surgery, Ain Shams University, 2000

A Thesis Submitted in Partial Fulfillment
of the Requirements for the Degree of

MASTER OF SCIENCE

in the School of Health Information Science

 Walid Youssef, 2013
University of Victoria

All rights reserved. This thesis may not be reproduced in whole or in part, by photocopy
or other means, without the permission of the author.
ii
Supervisory Committee

Evaluation of EHR Training as a catalyst to achieve clinician
satisfaction with technology in acute care setting

By

Walid Youssef
MBBCh, Ain Shams University, 1993
MD General Surgery, Ain Shams University, 2000

Dr. Omid Shabestari, School of Health Information Science
Supervisor

Professor Abdul Roudsari, School of Health Information Science
Departmental Member
iii
Abstract

Dr. Omid Shabestari, School of Health Information Science
Supervisor

Professor Abdul Roudsari, School of Health Information Science
Departmental Member

Training for Electronic Health Record (EHR) has been recognized as a key facilitator to
ensure optimum use and satisfaction with technology. However, research on the ways in
which training can promote user satisfaction with technology and a smooth transition to
EHR is lacking. This study aims to expand the available literature on the delivery of
effective EHR training. End-users may still not perceive the values that EHR can bring to
healthcare by improving quality of care and streamlining the delivery of services,
although these values are well established. Several barriers can account for the lack of
perception, including limited resources, lack of organizational support, and poor clinical
ownership of technology. Training provides an excellent tool to communicate the
initiatives behind technology implementation, to help users understand the benefits that
EHR can bring, and ultimately to improve the satisfaction of the end-users with
technology and enhance their adoption. The organizations implementing EHR need to
focus on delivery of effective training by allocating sufficient time and resources to
training. Trainers need to link with users by understanding different learning styles and
adult learning principles, and practicing these principles to support different training
methods.
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Table of Contents

Supervisory Committee ...................................................................................................... ii

Abstract .............................................................................................................................. iii

Table of Contents ............................................................................................................... iv

List of Tables ..................................................................................................................... vi

List of Figures ................................................................................................................... vii

List of Abbreviations ....................................................................................................... viii

Acknowledgments .............................................................................................................. ix

Dedication ........................................................................................................................... x

Chapter 1: Introduction and Problem Statement ................................................................. 1

Chapter 2: Literature Review ............................................................................................ 10

A- Adult Learning ......................................................................................................... 10

B- Learning content ...................................................................................................... 23

High-level functional specifications of the software ................................................ 24

Clinical information systems integration .................................................................. 25

Business rules in health information systems ........................................................... 25

Clinical information systems and patient outcomes ................................................. 26

C- Training Methods ..................................................................................................... 29

Chapter 3: Research Methods ........................................................................................... 36

Research Setting ............................................................................................................ 36

Project Summary ........................................................................................................... 36

1.
  Background ........................................................................................................ 36

2.
  Purpose ............................................................................................................... 37

3.
  Training Plan ...................................................................................................... 38

4.
  Training Objectives ............................................................................................ 39

5.
  Training Strategy ............................................................................................... 40

Data collection .............................................................................................................. 43

Data analysis ................................................................................................................. 45

Ethics Approval ............................................................................................................ 48

Chapter 4: Results ............................................................................................................. 49

Questionnaire Respondents’ Demographics ................................................................. 51

Questionnaire Results ................................................................................................... 55

Summary of survey questionnaires’ results: ................................................................. 59

Interviewees’ demographics ......................................................................................... 60

Interview results ............................................................................................................ 61

4.1 Challenges in current training ............................................................................. 62

4.2 Opportunities in training ..................................................................................... 70

4.3 Incorporating learning styles and adult learning principles ................................ 74

Chapter 5: Discussion ....................................................................................................... 87

Aligning the study with the literature review: .............................................................. 88

5.1 Challenges to effective EHR training: .................................................................... 88

5.1.1 Resource Availability ....................................................................................... 89

5.1.2
  Implementation climate ................................................................................ 92
v
5.1.3
  Management support ..................................................................................... 92

5.2 Training methodologies .......................................................................................... 94

5.2.1
  Classroom training ........................................................................................ 95

5.2.2
  E-Learning .................................................................................................... 96

5.2.3
  Blended learning ........................................................................................... 99

5.3 Incorporating adult learning concepts and learning style in training .................... 101

Conclusion on how the framework aligns with findings from the literature review .. 104

Addressing the Research Questions ............................................................................ 104

Limitations .................................................................................................................. 107

Generalizability and Credibility .................................................................................. 108

Chapter 6: Conclusion ..................................................................................................... 109

Recommendations for future training projects ........................................................... 111

Future Directions ........................................................................................................ 112

Bibliography ................................................................................................................... 113

Appendix A - Letter of Invitation to participants ........................................................... 127

Appendix B - Baseline, Post-training Questionnaire and Interview Questions .............. 131

Appendix C - Consent Form for Participants ................................................................. 140

Appendix D - Ethics approval ......................................................................................... 149
vi
List of Tables

Table 1: Learning level hierarchy, .................................................................................... 14

Table 2: Timing summary, ................................................................................................ 48

Table 3: Baseline and post-training survey questionnaire results, .................................... 52

Table 4: Reliability statistics results, ................................................................................ 53

Table 5: Crosstab statistics results, Improved safety and reduced errors versus super-user
age, ...................................................................................................................... 54

Table 6: Sufficient technical support in results in the pre and post-training surveys, ...... 55

Table 7: Crosstab statistics results, sufficient technical support pre versus post-training
surveys ................................................................................................................ 55

Table 8: Correlational statistics results among different ordinals in the pre versus post-
training surveys ................................................................................................... 56

Table 9: Crosstab statistics results, improved communication, patient transfer versus
computer literacy and comfort using the computer ............................................ 57

Table 10: Crosstab statistics results, Faster recording of patient symptoms, Faster patient
discharge in the pre versus the post-training surveys, ........................................ 58

Table 11: Crosstab statistics results, the role of the trainer being clinician and corporate
staff in the pre versus post-training surveys, ...................................................... 58

Table 12: Crosstab statistics results, supporting the organization change, supporting the
organization change versus computer literacy in the pre versus post-training
surveys, ............................................................................................................... 59

Table 13: The interviewee demographics, ........................................................................ 61
vii
List of Figures

Figure 1: Maslow’s hierarchy of needs, (Adler, S., 1977) ................................................ 11

Figure 2: Self-regulatory hub, ........................................................................................... 13

Figure 3: Flow diagram showing participants recruitment ............................................... 51

Figure 4: Subthemes contributing to organizational support, ........................................... 67

Figure 5: Training challenges, .......................................................................................... 69

Figure 6: Training opportunities, ...................................................................................... 73

Figure 7: Classroom training, ........................................................................................... 80

Figure 8: Web-based training, ........................................................................................... 81

Figure 9: Complementary training methods, .................................................................... 84

Figure 10: Blended learning, ............................................................................................. 85
viii
List of Abbreviations

C&W Children and Women’s Hospital
CIS Clinical Information System
CPOE Computerized Provider Order Entry
DI Diagnostic Images
EHR Electronic Health Record
HCO Healthcare Organization
HIMSS Healthcare Information and Management Systems Society
HIT Health Information Technology
ISD Instructional Systems Design
IT Information Technology
PHSA Provincial Health Services Authority
RIS Radiology Information Systems
VIHA Vancouver Island Health Authority
BCCH British Columbia Children’s Hospital
BCWH British Columbia Women’s Hospital
BC British Columbia
EVE Electronic Viewer for Everyone
ix
Acknowledgments

I would like to acknowledge my supervisory committee for their enthusiasm and
dedication to the field of health informatics. Particularly, I would like to express my
deepest gratitude to my supervisor, Dr. Omid Shabestari, for his valuable guidance,
support, and encouragement. Special thanks to Professor Abdul Roudsari for his unique
perspective, interest, and feedback, as well as Dr. Karim Keshafjee for his suggestions
and feedback, which increased the quality of this thesis. I also wish to thank my
managers, Shannon Malovec, Dhalie Patara, Adrienne Cousines and my colleague Shadi
Melhem and all the CIS team at PHSA for their support, and expert help.
x
Dedication

To the soul of my mother, to my family and my best friend Khaldoun