EMR Training and moonlighting staffing changes

Another change I've noticed in hospitals that "go electronic", especially private hospitals (those without residents), is that the training needs are often hard to meet. I've heard this from several other CMIOs that I speak with.

The training needs for a hospital with an EMR are challenging. Not only is there the initial training (that most software vendors supply at your go-live), there is the training for every new physician you hire, and then there are training needs every time you update your software. In hospitals which employ a best-of-breed approach, which often have many clinical systems, sometimes the training challenges can be daunting.

So it's important for every CMIO to keep tabs of the "minimum training requirement" - That is, what does it take to initiate a new physician to your electronic environment?

Often, especially in a best-of-breed setting, it also means tailoring the training to the specific needs of the physician's clinical specialty.

The challenge, however, is that this training is often no small task. It's not unusual for it to take 3-5 hours as you introduce a new physician to :

1. Your overall electronic landscape and their passwords / accounts
2. Your key workflows that they will be operating in. (The main workflows are important, because they help a new physician trouble-shoot when a portion of the delivery system gets delayed)
3. Your particular EMR, Order Sets, CPOE, and Electronic Documentation
4. Any ancillary systems you may use (e.g. Dictation, Radiology, Billing, etc.)

The difficulty often arises, then, when you have a moonlighter who doesn't prepare for this training time. I'm not sure how the big staffing companies handle this in their contracts, but it seems many companies provide coverage with little advanced notice.

But how will you handle a moonlighter who shows up on the day they are supposed to provide coverage? Or what if you only use the moonlighter "in emergencies"? Or what if the moonlighter only works in your organization once every 3-4 months?

I think, in general, that moonlighting companies will need to respond to the pressures of increased EMR adoption by either :

1. Budgeting and writing contracts that allow the moonlighter for the necessary training time.

2. Perhaps allowing hospitals some preference for moonlighters who have experience with "their EMR"?

Will doctors start adding their EMR experience to their CVs, as a hiring qualification?

The EMR shadow is cast well-beyond the boundaries of the hospital setting! :)