Train more in less time!

Understanding physician training; Common challenges and strategies for success.

By Dr. Andres Jimenez

Confidential, do not duplicate, copy or share without prior written permission from ImplementHIT

Hundreds of millions of dollars have been spent on ineffective training that doctor’s just don’t complete. Why? For starters, they don’t want lengthy online courses, they want 5-minute long, “Bite-sized” training, that is high-yield & targeted to exactly what they do. Let’s review common pitfalls & how they relate to effective physician training.

Time is scarce for physicians. According to the 2014 Physician Foundation survey of more than 20k physicians, 80% are at or beyond full capacity at work.

On average physicians work 53 hours per week.

Making matters worse, many physicians are unhappy about the current state of medicine, feel their autonomy is limited and decisions compromised.

Furthermore, the benefits of the programs they are being asked to adopt such as ICD-10, are not always apparent, putting into question why they are being

asked to commit to change.

Physician Foundation Survey (2014) 20k physicians

Feelings impact motivation for learning, as well as the ability to capture the learner’s attention

44%Positive moral &

feelings about current state of

medicine

69%Clinical autonomy is sometimes / often limited & decisions

compromised

50%ICD-10 will cause

severe administrative

problems in their practice

EHR

ICD10CDI VBP

ACA

MUE&

MACA

P4PPACS HIE

There is greater pressure to learn than in most other industries, and a lot is at stake. For instance there are new regulatory initiatives, and clinical software applications that

physicians and nurses must incorporate into their practice, in addition to the exponential expansion of medical knowledge.

1hour

1day

2 days

6 days

31 days

REINFORCEMENT

The majority of training these days is still delivered in a classroom. There are two problems to be aware of with classroom training, the first is related to this Ebbinghaus

forgetting curve, which visually displays information forgotten over time. In a week, about 75% of information learned is forgotten. It is expensive to corral physicians in a

classroom for several hours of training, and even more painful when you learn the value is limited because most of what they learned is forgotten.

33.7%

27.8%

25.4%21.1%

44.2%

On-the-JobCompetence

ContinuousImprovement

POST-IMPLEMENTATION

Copyright 2013 ImplementHIT

1 Week 2 Weeks 3 Weeks 4 Weeks 5 Weeks 6 Weeks 7 Weeks

NU

MBE

R O

F LE

ARN

ERS

TO T

RAIN

4 hours of training

8 hours of training

12 hours of training

The second problem with classroom training is it’s a bottleneck. The greater the number of learners to train, and the longer the training curriculum, the further out

training must be scheduled to ensure everyone gets trained before an implementation. The further out from training you ask the learner to perform, the less

likely they will effectively apply what they learned, because they forget.

Think Click Think Click Think Click Think Click

Patient has new complaint

of muscle pain…What

medications is she taking?

I see the patient is taking a

Statin…when was it

prescribed?

She was started on the

statin three months ago. What is her

last LDL level?

I should probably DC the Statin…

Where do I click to see/do?

Where do I click to see/do?

Where do I click to see/do?

10 sec 10 sec 10 sec

Training must fit the desired skill set. A different type of training is needed for EHRs in particular, one with the goal of “Fluency” (accuracy + speed). Most EHR training

programs focus just on accuracy, leaving physicians to struggle in practice because seconds per click quickly add up! Despite completing 8-12 hours of training for a

typical EHR deployment, in many instances physicians felt like they were not trained.

When did you learn most (about the EHR)?

0%5%

10%15%20%25%30%35%40%45%50%

Before Implementation

After Implementation

(During First Month)

After Implementation

(After First Month)

We conducted a survey of 230 physicians who were 2-24 months post implementation of their ambulatory EHR. Over 80% learned the most about their new EHR, AFTER go

live, not before. Despite this, most organizations never deliver effective POST-implementation training to drive learner proficiency beyond the basics.

Train more in less time!

Strategies to improve physician training at your organization

Rapid Learning Institute (RLI) Survey published at 2014 ASTD Conference and Expo, polled learning professionals attending the conference.

94%

E-learners prefer modules <10 min

65%

Typical elearning module presents too much

information

Physicians prefer 5 minute, “Bite-sized” training modules, and they are not alone. Across all industries e-learners prefer shorter modules, yet typical elearning modules tend to have too much information, and most organization’s modules are longer than

10 minutes. When it comes to physician learners, the attention span is even more limited because of the lack of time, and therefore, “Bite-sized” is best!

88%

Their organization’s modules are >10 min

Role

Performance

Specialty

Targeting is important because it increases motivation and attention, both of which tremendously impact learning. Imagine delivering EHR training on ordering

immunizations to a Cardiac Surgeon? Now imagine delivering that same training to a Pediatrician…instantly the training module becomes more effective, because it is more

relevant. Using big data, training can be targeted and personalized at the individual level, based on their performance, and across all physicians in a health system.

Impact Analysis

No Training CompletedeLearning

CompletedeLearning& Mobile

Fibrinolytic Therapy Received within 30 min of Hospital Arrival

CHAN

GE

IN P

ERFO

RMAN

CE O

VER

TIM

E

NO CHANGE

xx

xx

xx

xx

xx

x xo

o

oo

oo

o

o oo

o oyy

yyy y

yy

y yy y

yo

x

IMPROVED

WORSENED

Big data is helpful to analyze the ability of your training program to impact performance on metrics such as those tied to value based payer models (VBP, P4P,

etc..). Over time, better understanding of the relationship between training and performance will allow organizations to optimize training and performance in unison.

TRAIN TRANSFER

BASELINE PERFORMANCE

50%

150%

200%

IMPL

EMEN

TATI

ON

ON

TH

E JO

B CO

MPE

TEN

CY

SUSTAINO

N T

HE

JOB

COM

PETE

NCY

50%

Performance support is a process, where just-in-time, just-enough information is instantly available. This supports the learning transfer process after pre-

implementation training. In fact, across all industries, performance support has been shown to decrease time to on the job competency by 50%. Post-implementation

support MUST be part of your overall training curriculum!

Often times the greatest challenges with physician adoption of new technology, is purchasing the required devices, and getting the learners to actually use it. Physicians

already carry these devices in their pockets, frequently use them, and are very supportive of mobile learning.

Manhattan Research / Physician Channel Adoption Study (2012)

Go MOBILE, physicians already carry and use these devices!

87%Owned a smart phone or tablet80% of physicians age 55 and older have one

48%Time on mobile spent searching

Professional apps consume 38% of their

time

80%Own an IPhone

Remaining physicians use an Android device

“How should I document breast cancer to support ICD10”

Most mobile devices are voice enabled, supporting voice driven queries and delivering back answers with greater accuracy than Siri. This is the ideal application of performance support, and in most instances the mobile device can speak the answer

back to you.

Learning on a mobile device, including tablets, can and should take place every where, at any time. It becomes even more powerful when it is CRITICAL, RELEVANT and

TIMELY, and very effective at improving performance on the job.

Train more in less time!

What set’s ImplementHIT apart when it comes to physician training?

“ImplementHIT has fundamentally changed the

way we prepare providers for EMR

implementation.”Joseph Colorafi MD, CMIO, Dignity Health

At some of the largest health systems in the US and Canada, we cut training time in half, by delivering targeted “bite-sized” training, prioritized by the learner’s proficiency level, and by incorporating post-implementation performance support. Our company

was founded by a physician, and this type of training is our specialty!

Our Clients

Our Partners

Our clients (including over 500 hospitals and large physician practices), and our partners are serious about physician training, and so are we!

Both our core learning management system and our mobile enterprise training platform were built specifically to train physicians. We have robust libraries of “Bite-sized” training supporting the learning needs of most physicians, that organizations

can leverage alongside their own content, all from one place!

“Bite-Sized” Content Libraries

• ICD10• E&M Coding• VBP• Readmission Penalty• Value Modifier• Medicare Coding• And much more!!!

ImplementHIT was founded by a physician with one purpose in mind, to improve physician training by ensuring it is targeted, personalized and above all, doesn’t waste time. That’s why our motto is to, “Train more in less time!”

Train more in less time!

About the author: Andres Jimenez MD

Dr. Jimenez is a nationally recognized physician and nurse training expert, and Founder / CEO of ImplementHIT. Dr. Jimenez is the lead author of the AHIMA Clinical ICD-10 training program for Physicians and nurses, and has been invited by CMS and other leading authorities to speak on the topic of physician and nurse training.

Dr. Jimenez was the former Allscripts clinical director of content and online training, completed an educational leadership fellowship at USC school of Medicine, and a PhD Candidate in Education who spent five years researching more effective ways to train physicians and nurses before launching ImplementHIT as a solution to many of the training challenges in healthcare he studied. Dr. Jimenez has participated in hundreds of EHR & ICD-10 training implementations across many practice settings (ambulatory, acute, large academic centers to small physician practices), involving the leading EHRs (Allscripts, Cerner, and Epic), and key healthcare initiatives (ICD-10, MU, VBP, P4P). The ImplementHIT training software is currently used in over 500 hospitals and large physician practices in the US and Canada.

Dr. Jimenez went to Dartmouth and Brown for medical school, continued onto General surgery at Emory, and completed an educational leadership fellowship at the USC School of medicine. Dr. Jimenez was a PhD candidate in education before leaving the program to launch ImplementHIT. He authored two books that provides guidance to premed and medical students who dream of becoming doctors one day. Dr. Jimenez is still clinically active, with medical licenses in New York and Georgia.