M5- Assignment essay paper

M5- Assignment

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Main Assignment

Assignment Description:

Information Security in a World of Technology

Write an essay addressing each of the following points/questions.

Be sure to completely answer all the questions for each bullet point.

There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs.

Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper.

Support your ideas with at least three (4) scholarly citations using APA citations in your essay.

Make sure to reference the citations using the APA writing style for the essay.

The cover page and reference page do not count towards the minimum word amount. M5- Assignment

1. The textbook discusses several education methods. Discuss each method with an example of how the method could be used in the organization. Then discuss how you will evaluate the method and learning.
2. Healthcare continues to be a lucrative target for hackers with weaponized ransomware, misconfigured cloud storage buckets, and phishing emails. Discuss how an organization can protect patients’ information through:

1. • Security mechanisms
   • Administrative and Personnel Issues
   • Level of access
   • Handling and Disposal of Confidential Information
2. You are providing education to staff on phishing and spam emails. Using the different educational methods discussed in Chapter 12:
   • Provide examples of how each method can be used
   • How will the method and learning be evaluated? M5- Assignment

Start by reading and following these instructions:

1. Study the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
2. Consider the discussion and the any insights you gained from it.
3. Review the Assignment Rubric and the specifications below to ensure that your response aligns with all assignment expectations.
4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling, and review the rubric.

The following specifications are required for this assignment: M5- Assignment

• Length: 500 words per essay prompt/section (1500 total for this assignment); answers must thoroughly address the questions in a clear, concise manner
• Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. All APA Papers should include an introduction and conclusion.
• References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (4) scholarly sources to support your claims.

 

Reading assignment for this assignment. – Chapter 12

APA Citation of the book :

Hebda, T. L., Czar, P., & Hunter, K. (2018). Handbook of Informatics for Nurses & Healthcare Professionals (6th Edition). Pearson Education (US). https://bookshelf.vitalsource.com/books/9780134677064 M5- Assignment

Chapter 12

Workforce Population

Proficient use of health information technology (HIT) is essential to efficient and quality patient care. Developing a healthcare workforce to effectively utilize HIT requires computer literacy and skills, effective training of system use, and solid understanding and integration of policies and procedures into the training and end user practice. Strong computer ­literacy is positively correlated with increased satisfaction with computer systems in healthcare (­Alasmary, Metwally, & Househ, 2014).

By 2030, the baby-boomer generation will officially be over the age of 65, thereby increasing the demand to increase the healthcare workforce (Auerbach, Staiger, Muench, & Buerhaus, 2012). The United States will need an additional 35% more healthcare workers to support the ratio of healthcare providers to total population (Institute of Medicine, 2008). The National Council of State Boards of Nursing (NCSBN) and The National Forum of State Nursing Workforce ­Centers (The National Forum) released results of the 2015 National Nursing Workforce Survey (­Budden et al., 2016; National Council of State Boards of Nursing, 2016). This study provided a comprehensive picture of the ­registered nurse (RN) and licensed practical nurse (LPN) 2015 workforce. Approximately 79,000 nurses participated in the study between June 2015 and July 2015. Researchers were able to trend data based on their last survey, completed in 2013. Two trends identified were a growing number of male RNs and an emergence of a more diverse workforce. Interestingly, the study results showed the work setting has evolved beyond the bricks and mortar of acute-care hospitals due to the increasing use of information technology. Almost half of the participants in the study reported providing some type of nursing care using telehealth technologies. M5- Assignment

Nursing informatics has evolved into an important part of the healthcare system and plays a critical role in the development, implementation, evaluation, and enhancement of HIT systems (Hussey & Kennedy, 2016). The Healthcare Information and Management Systems ­Society (HIMSS) conducted a nursing-informatics workforce survey in 2014. The survey found the nurse informaticist “continues to play a crucial role in the development, implementation, and optimization of clinical applications” (p. 1). The survey results also suggest nurse informaticists have a solid education background, citing a 24% increase in post graduate degrees. Almost half of the respondents (46%) have at least seven years of informatics experience and over half (57%) are satisfied or highly satisfied with their career choice in informatics.

It is important to recognize that nurse informaticists traditionally support the informatics needs of the healthcare workforce (Table 12-1) in a variety of settings (Table 12-2); therefore, they need to have strong workflow-analysis skills to support leveraging information ­technology to support the diverse healthcare-workforce team.

Table 12-1 Healthcare Workforce Requiring Informatics Support M5- Assignment

Source: Data from Area Health Resource File, 2015.

 

Healthcare Workforce

 

Physicians

 

Speech-Language Pathologists

 

Advanced Practice Registered Nurses

 

Massage Therapists

 

Physician Assistants

 

Dietitians and NutritionistsM5- Assignment

 

Registered Nurses

 

Medical and Health-Services Managers

 

Licensed Practical and Licensed Vocational Nurses

 

Medical Secretaries

 

Dentists, General

 

Medical and Clinical Laboratory Technologists

 

Dental Hygienists

 

Medical and Clinical Laboratory Technicians

 

Dental Assistants

 

Cardiovascular Technologists and Technicians

 

Pharmacists

 

Nuclear-Medicine Technologists

 

Veterinarians

 

Diagnostic Medical Sonographers

 

Chiropractors

 

Radiologic Technologists

 

Optometrists

 

Emergency Medical Technicians and Paramedics

 

Opticians, Dispensing

 

Dietetic Technicians

 

Clinical, Counseling, and School Psychologists

 

Pharmacy Technicians

 

Mental-Health Counselors

 

Psychiatric Technicians

 

Rehabilitation Counselors

 

Respiratory-Therapy Technicians

 

Substance Abuse and Behavioral-Disorder Counselors

 

Surgical Technologists

 

Healthcare Social Workers

 

Medical Records and Health-Information Technicians

 

Mental Health and Substance-Abuse Social Workers

 

Medical Assistants

 

Physical Therapists

 

Pharmacy Aides

 

Physical Therapist Assistants

 

Personal-Care Aides

 

Physical Therapist Aides

 

Home Health Aides

 

Occupational Therapists

 

Nursing Assistants

 

Respiratory Therapists

 

Psychiatric Aides

 

Table 12-2 Settings Requiring Informatics Support

Source: Based on Area Health Resource File, 2015.

 

Healthcare Settings

 

Hospitals

 

Hospice

 

Long-Term-Care Facilities

 

Community Health Centers

 

Home Health Care

 

Psychiatric, Rehab, and Children’s Hospitals

 

Health Clinics

 

Primary Care

 

Ambulatory Services

 

Urgent-Care Centers

 

Workforce Population Current Knowledge and Skills

HIT has been deemed essential for improving quality of care, patient safety, and process efficiencies for all health professionals (American Academy of Nursing, 2015). Improving the patient experience and the health of populations while reducing the cost of healthcare is a common theme for informaticists who are leveraging information technologies to support practice. Efforts are being made to improve work environments though initiatives such as the American Academy of Nursing’s Technology Drill Down program. However, nurses struggle with the lack of interoperability, which prevents them from becoming proficient in the use of information technologies (Clancy et al., 2014). The American Nurses Association (ANA) incorporated informatics competencies into their 2008 publication on the scope and standards of nursing-informatics practice (2015). A Delphi study, now considered a classic resource, was used to identify informatics competencies for novice and experienced nurses, as well as informatics nurse specialists and nurse informatics innovators (Staggers, Gassert, & Curran, 2001). More recently, Abdrbo (2015) studied nursing informatics and patient-safety competencies in nursing students (third or fourth year) compared to nursing interns (graduate nurses fulfilling an internship for one year). He found both groups had equal proportions of individuals who completed an informatics course, and both groups reported equal competencies. However, the nursing students felt they played a greater role in clinical informatics than the interns. Interns had higher scores for applied informatics. Abdrbo recommended all baccalaureate nursing programs have a core informatics course instead of an elective.

Devising a Workforce Development Preparation Plan

The Health Information Technology for Economic and Clinical Health (HITECH) Act addressed barriers to health information technology and HIT’s potential to improve safety and quality in the healthcare setting (Sheikh, Sood, & Bates, 2015). Part of the act addresses the need for a well-trained healthcare workforce to implement the known science and best practices of electronic health-record system adoption. In order to develop a workforce plan, one must understand the needs of the educators who train the workforce. Using the funds granted through the HITECH Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) was able to fund selected curriculum development centers (CDCs) to develop curricula for use in health IT training programs based in community colleges. While the materials were well received, pilot testing illustrated the complexity of developing HIT curricula for a diverse workforce. ONC recommends that HIT initiatives be approached from an implementation-science perspective. One size does not fit all learners; therefore, a mix of models is necessary to complete a workforce-development plan.

 

Implementation science focuses on understanding how change takes place (Fisher, Shortell, & Savitz, 2016). There are four main groups of variables that act together to influence the adoption of innovations: the external environment, the structure of the organization, the characteristics of the innovation, and the processes used.

 

The most influential domain is related to the characteristics of the innovation being implemented at an organization. If adoption does not occur, individuals will resist the intervention, potentially leading to failure. In order to drive adoption, health professionals need to be engaged early in the process to help them understand the value of HIT solutions (Zimlichman et al., 2012).

 

Informatics nurse specialists need to understand how the external environment influences the internal environment when putting a plan together. Electronic medication reconciliation is an example of how information technology can fail or provide a false sense of security as patients cross the continuum of care. Lack of interoperability between information systems forces clinicians to work in a variety of systems that support an EHRS. Changes made to medications in one system are not necessarily shared electronically with other systems, placing patients at risk to have an incorrect current medication list and, potentially, leading to a medication error.

 

The structure of the organization and the individuals involved with the intervention or implementation process must be evaluated by the informatics nurse specialist. Organizational culture can play a big role in the success or failure of implementing an innovation. When implementing change, sabotage is always a risk, as clinicians do not necessarily want to change from their routines of working in a complex, high-risk environment. Emotions start to take over, and goals and objectives are easily overlooked. Informatics nurse specialists need to take a structured approach to being aware of emotions; modifying emotional reactions is a skill known as emotional intelligence (EI) (Savel & Munro, 2016). Using EI throughout the workforce-development plan and implementation can help clinicians function at their highest potential. The ability model defines a set of four EI skills: (a) identification of emotions in self and in others; (b) the ability to reason using emotions; (c) the ability to comprehend emotions; and (d) the ability to control emotions in self and in emotional conditions (Codier & Odell, 2014). An implementation-science approach helps take a variety of models and blends them together to help gain an understanding how change will successfully take place.

 

Identification of Educational Needs

An educational-needs assessment is an effective way to determine the educational opportunities for improving patient care and clinician processes, and is a requirement for organizations on the journey to American Nurses Credentialing Center Magnet designation (Winslow, 2016). A needs assessment can easily be obtained via a survey, either to a specific specialty or throughout the organization. The needs assessment should focus specifically on a topic of interest related to organizational goals and objectives. For example, if the organization is implementing an EHRS, the questions may focus on computer usage and comfort, knowledge of specific terms, workflow analysis, environment, and data analytics. Understanding the needs of the end users is an important focus. Education and process changes should be based upon known needs, but also on anticipated predictable new needs.

 

Voice of the End User

Subject-matter experts (SMEs) are identified at the beginning of a project. They are people who are considered knowledgeable in their specialty, work well with others in the workforce, and embrace change. These experts work closely with the project team to ensure new processes fit into end users’ workflow, or make suggestions on changes to increase workflow efficiency and predict impediments to patient care. SMEs become the voice of the end users by acting as the bridge between the end user and members of the project team.

 

Setting Goals and Objectives

Goal alignment is defined as linking individual goals with organizational goals. Alignment of priorities leads to increased performance. It is imperative to have clear goals and related objectives with any workforce-development plan. Individuals are more likely to be driven to achieve goals if they understand what is expected of them (Wilson, 2016). Goals should be measurable in order to determine success or failure. Objectives are actionable steps defined for each individual goal. In order for a project to be successful, the overall vision and work effort must be fully defined. This is achieved by breaking down the project into small, manageable, and actionable portions based on the project’s objectives.

Identifying the Scope of Efforts

With well-defined goals identified, the work on the process change begins. Projects are complicated. They consist of many moving parts and deliverables that need to meet specific time lines. Project scope is a defining metric that can help keep the project on a focused path. The scope of the project is defined through clear goals and outcome metrics. The scope provides the roadmap for project planning and execution. The project scope must be clear, with measurable outcomes. Without a clear focus, scope creep can occur, leading teams to feel overburdened with daunting challenges, and potentially ending in disastrous results (University Alliance, 2014). As additional requests are made during the project, project-team members can check those requests against the project scope; if the new idea is outside of the scope, it can be revisited after the completion of the original project.

 

At times, scope creep happens because of something identified during the project that was overlooked or underestimated, and may now put the project at risk. The team must re-evaluate and prioritize the project scope to ensure success. For example, during implementation of a new EHRS, consideration for device integration in the critical-care units was overlooked. A project-team member brought the concern of the critical-care nurses to the team, as the nurses felt this lapse would greatly impact their workflow, especially during a critical event, such as the resuscitation of a patient. The project team now needs to weigh the risk of patient harm versus the risk of adding additional work outside of the original scope of the project. If the risk leans to potential for patient harm, the scope of the project may be broadened or adjusted to ensure a successful implementation.

 

Safeguards for Privacy and Confidentiality

Adult learners perform best when training is based in the context of real-life application, including realistic names, healthcare settings, and health problems (Furlong, 2015; Hoyt, Adler, Ziesemer, & Palombo, 2013; Rashleigh, Cordon, & Wong, 2011). A training environment is a carefully planned replica of the HIT that will be used in actual practice. The training environment ideally should contain realistic patient-and-practice scenarios that mimic the real patient-care setting. Case studies and patient scenarios provide an excellent method for application of concepts. However, privacy and security of protected health information must be considered during training development and delivery, and care must be taken to disassociate any patient scenarios from information that could link the episode back to an actual patient. A well-designed computer-training environment will comply with organizational confidentiality and privacy policies and ensure that no identifiable patient information is included during training (Lee, Moy, Kruck, & Rabang, 2014).

 

Development of a realistic training database can be labor-intensive. Some organizations are able to copy actual patient records into a training database and remove patient identifiers, producing a very realistic training environment. Care must be taken to ensure that identifying information is removed not only from discrete data fields but from demographic information, such as phone numbers, and from any free-text areas within a chart. Keeping this in mind, the amount of work involved in scrubbing actual patient data for training use versus entering simulated patient data into a training database may be similar.

 

During instructor-led training, the instructors may be familiar with some of the patients or scenarios used in the training environment. Care must be taken to ensure that no actual patient information is revealed during the training process, and that no actual patient scenarios that can identify a real patient are discussed within the training room; learners should clearly understand that information used to create a training database cannot be linked to an actual patient, and students are able to integrate the privacy and confidentiality safeguards and principles into their own practice following training.

 

Introducing Information Policies

The number of HIT policies and procedures continues to expand to accommodate the many nuances of its use and abuse. Organizations should have policies and procedures governing secure system access, use of patient-health information, use of personal devices, system downtime, and equipment cleaning. Policies and procedures are best introduced during training so they can be integrated into the context of workflow. In addition, policies can support expected behavioral requirements and provide the basis of disciplinary action for lack of adherence. The training environment should be designed to replicate the live clinical system to support policy references and examples.

 

Policies addressed during training can include:

 

Patient privacy and security—Healthcare is dependent on an open relationship and communication between the patient and the healthcare practitioner. The patient must be able to trust that information shared with providers will remain confidential and secure. A lack of trust can result in decreased information sharing, and can result in a less-than-full picture of health status and behaviors of the patient (Bova et al., 2012; Brady, 2011; Murray & McCrone, 2015). In order to support this relationship of trust, organizations are required, by regulation, to protect patient information (Dooling, 2012; Peterson, 2012; Rights, T. O. f. C., n.d.). A chart-access policy addresses the user ability to access a patient’s healthcare record on a need-to-know basis, such that only persons directly involved in the care of a patient may access this information. Many health-information systems are able to block a caregiver’s access to patient records that have not been assigned to that particular caregiver, without that caregiver documenting the reason for the access. Additionally, a patient-focused, privacy-and-security policy should address proper storage and disposal of paper-and-electronic documents containing protected patient information.

 

Downtime—This policy addresses the procedures to follow during planned and unplanned information-system downtime, and may include the specific paper forms to be completed during this time or the alternate electronic database that must be used. The policy may also specify timeframes for when certain actions must be completed or when forms should be used or not used. Downtime procedures should be introduced at the time of training and reviewed on a routine basis with end users.

 

Email—Email is a valuable time-saving tool for communication that can also provide opportunities for breaches of patient privacy and security (McGraw, Belfort, Pfister, & Ingargiola, 2015; Murphy, 2000). Email policies should include indications and encryption requirements for outgoing email containing patient information, or alternate procedures for sharing patient information with approved recipients.

 

Cleaning and care of equipment—HIT equipment can become a vector for disease if not properly cleaned. In addition, use of the wrong cleaning products can damage the hardware. Cleaning policies will specify when and how equipment should be cleaned.

 

Information downloading and uploading—Downloading or uploading information into the computer systems of an organization represent a security risk that includes misuse of patient information and violation of patient privacy, as well as the opportunity for malicious applications to infect the organizational system. Although many organizations have configured individual computers so that universal serial bus (USB) devices and disk drives cannot be accessed, a policy provides an additional level of safeguard.

 

Password security—The lack of password protection can produce unauthorized access into secured health information and the potential for user fraud if one user is able to access a system, patient chart, and functionality of a role through password theft. Password policies not only stipulate protection of personal passwords, but also may define the length and complexity of a password and the frequency of password changes.

 

Pictures and cameras—Most people carry smartphones with camera functionality. When staff have access to this technology while providing patient care, the potential exists for photos to be taken and shared that violate the patient’s right to privacy. Camera policies are designed to eliminate unauthorized photographs, while providing the use requirements for appropriate use of photos for patient activities, such as wound documentation.

 

Removing devices from secured areas—Many data breaches occur when mobile computing devices are removed from secured areas and are then lost or stolen, resulting in potential access to patient information, which may include names, addresses, social security ­numbers, and other information. Device policies cover both the portability of organizational devices and data protection, as well as specifications for software that can be used to wipe data from devices that go missing.

 

Screen security—Computers used for patient care are often located in areas where patients, families, and others can view protected patient information if the screen is not secured from view. Screen security policies address the timing of screen lock, the use of screen guards, and other aspects of security that protect patient information from casual or purposeful snooping.

 

Smartphones—Smartphones are often used for communication during patient care, and many organizations allow staff to carry personal smartphones on their person during work hours. Smartphone policies provide boundaries and guidelines around the use of personal or company-owned phones, including camera use, texting, and disinfection.

 

Social media—Several recent cases of improper disclosure of patient information on a social-media site have drawn the attention of the media (Polito, 2012). Social-media policies govern the use or non-use of social media for staff, and often expand to cover patient and family use as well.

 

System-error correction—Errors can be made during electronic charting, and error mitigation and correction is covered by policy, which may include the proper methods to change erroneous information, the timeframe allowed for correction, and the error-­correction escalation process.

 

Use of home equipment—Because of the risk to patient privacy and security, organizations have implemented policies around the use of home equipment, such as personal laptop computers, personal tablets, and personal phones.

 

Prior to the end of training, learners will be provided with their personal system identifiers and passwords, which are typically accompanied by confidentiality agreements that require signatures. Integrating policies and procedures into the training process can add context to proper use of HIT and reinforce the consequences of improper use.

Target Technology and Related Competencies

Information technology (IT) is a broad topic. It includes technology involving the development, maintenance, and use of computer systems, software, and networks for the processing and distribution of data. The field of HIT is rapidly growing in areas traditionally not involving clinical informaticists. However, since the information technology is intersecting with clinical teams, nurse informaticists are sought to be part of a variety of teams evaluating and implementing the new technology.

 

Information Systems beyond Clinical Documentation M5- Assignment

Electronic health record systems are much more than the documentation provided by clinicians. The integration of multiple information systems is key to viewing the complete legal healthcare record. Take a planned surgical case as an example of the complexity of the EHRS and the multiple modules used to help ensure the patient travels though the health system safely. The outpatient record documents the patient history and need for the surgical procedure. The patient is registered in the registration module for all downstream systems to identify the patient as pre registered to have surgery on a given day. In order for the patient to move forward in the electronic system, a preapproval for the surgery must be obtained from the insurance company and documented in the financial system. Once this is completed, the patient can be scheduled in the operating-room (OR) scheduling system to synchronize with the registration that was completed earlier. The patient now needs preoperative documentation from nursing staff and anesthesiology. Upon arrival for surgery, the patient is admitted through the registration system. Documentation of the patient’s arrival is displayed on a large OR-based tracking board for everyone to view. The patient travels through the perioperative arena as the nurses, physicians, anesthesiologist, and technicians document the journey. In some areas, device integration has been established, which automatically feeds vital information to the EHRS. The patient is recovered and discharged to home, with homecare follow up. The visit is coded and billed. The homecare agency gets insurance approval to visit the patient, documents the visit in the homecare EHRS, bills for the visit, submits the bill, and tracks the agency-nurse’s travel and visit time. To follow up on the details of the surgery, the patient can log into a personal health portal from the comfort of home. This is an example of potential touch points and systems that need to be maintained, enhanced, and upgraded. These touch points all involve information technology that needs informatics-nurse input on building, testing, implementation, and support.

 

Bedside Technologies

Information technology at the point of care is becoming common.

 

Televisions in patient rooms now act as learning centers for the patients. Disease-specific education is automatically assigned to the patient, based on clinical documentation. The televisions are interactive and have interfaces to document viewing of the lesson and post-test in the patient’s EHR.

 

Call-bell systems help communicate what a patient may need. Instead of a light and alarm to summon the nurse to the patient room, the call bells can now send specific text messages to patients’ care providers, such as “I am in pain” or “I need something to drink,” helping care providers anticipate and prioritize their response to the call bell.

 

Smart beds help reduce patient complications. These beds have the ability to turn patients, provide pulmonary toileting, initiate alarms based on patient movement to help prevent falls, reduce pressure points, and gather clinical data, such as patient weights.

 

Smart pumps aid the nurse in delivering intravenous medications by signaling an alert if a rate is outside of set defined parameters.

 

Audiovisual (AV) monitors are deployed to the rooms of patients at high risk for falls. Instead of having a technician sit with each patient, multiple patients can be remotely monitored via AV monitors at a central location. This device offers bi-directional communication and alarms to alert the nurse if a patient is at imminent risk for falling.

 

An electronic intensive-care unit (EICU) is a trend that initially began to help care for critically-ill patients in rural hospitals that did not have access to intensivists. It was proposed as an alternative solution to allow critical-care nurses and physicians to monitor ICU patients off site (Kowitlawakul, Baghi, & Kopac, 2011). Rooms are equipped with AV and physiological-monitoring equipment that interfaces to a remote location for continual monitoring and analysis by specialty trained nurses and physicians who alert and guide care providers in real time of any critical patient concerns.

 

Bedside technologies continue to grow; they interface with smart phones and other devices to improve communication and, ultimately, patient care. Nursing informatics plays an important role in developing, evaluating, implementing, and enhancing information technology. Leveraging nursing-informatics skills to bring the latest information technology successfully into the workflow of clinicians has been demonstrated to be best practice.

 

Wearable Technology

Wearable technologies (wearables) are not new, but are becoming more affordable and readily available. Patients are proactively choosing to wear new technologies or download applications to track their own data, before doctors even think to prescribe wearables as potential preventative measures. Children with geriatric loved ones are seeking new solutions to keep their loved ones healthier and safer. Wearables are part of the solution. Wearables may be the popular Apple Watch, or other innovations, such as socks that sense movement; underwear that detects moisture; radio-frequency devices to track a loved ones’ locations because they are confused and wander; or necklaces that have a charm that rests on a person’s chest, containing an implanted stethoscope to detect the early sounds of a wheeze before it progresses into a full-fledged asthma attack.

 

Nurses need to consider how this type of information technology will impact their practice. This type of technology requires data storage and surveillance. An informatics nurse can help to identify areas where data can be stored and accessed so as to develop workflows that support routine surveillance of these wearables, including creating indicators to prioritize some types of patient interaction with a clinician.

Education Methods

Training and education are often used interchangeably; however, the purpose, approach, and outcomes of these two methods of delivering information are quite different. ­Education is associated with the development of a theoretical and knowledge-based foundation intended to prepare the learner for understanding and applying concepts (Pignataro et al., 2014; Van Melle et al., 2014). An example of this are physicians who attend medical school to gain ­foundational knowledge, and then participate in residency training to gain skills in the ­application of knowledge and information (Bray, Kowalchuk, Waters, Laufman, & ­Shilling, 2012; Crofts et al., 2015). Training provides the skills needed to perform a task (Chen et al., 2015; Guppy-Coles et al., 2015). The ability to utilize HIT in practice requires a ­training approach to identify, develop, and utilize skills needed in the application of learning (­Forsberg, Swartwout, Murphy, Danko, & Delaney, 2015; Schaeffer, 2015). Training can be provided without the concepts found in education, and education can be provided without the skills application found in training.

 

Due to the applied nature of HIT, provision of skills training plays a critical role in adoption and maximized use of HIT (Dastagir et al., 2012; Peck, 2013; Sorensen, 2013; What training resources are available for electronic health record implementation?, n.d.). Nurses, physicians, allied healthcare professionals, and healthcare support staff must become skilled in both the use of computer technology and the use of health-information systems; effective training is a key piece of this process (IT training, 2009; Kulhanek, 2011; Simon et al., 2013). Although training plays a critical role in the successful use of HIT, it consumes a large portion of a technology-implementation budget. There are numerous training-delivery methods, and costs for training differ for each method. Carefully matching training needs, end user characteristics, organizational resources, and training budgets to the best training-delivery method can help to manage and control training costs.

 

Instructor-Led Training

Classroom or instructor-led training (ILT) is delivered by an instructor to an audience of learners who are present in the classroom or connected via AV technology. Development of ILT content requires the least amount of work hours, averaging around 100 hours of development per hour of delivered instructional content (Kapp & Defelice, 2009), but does not include time needed to prepare the information technology for training. Development of instructional content can include resources, such as manuals and handouts, the facilitator guide, sign-in sheets, learner exercises and scenarios, class evaluations, and notes pages.

 

ILT provides a kinetic learner experience, which requires both computer hardware and a training database that mirrors the actual information-technology environment. ILT provides an opportunity for learners to interact and ask questions during the training process and can be a useful tool for change management (Celia & Rebelo, 2015). ILT is often the most expensive training-delivery method; costs include, not only trainer and material costs, but also end user wages, technology, and facilities. Costs for ILT include:

 

Trainers. Trainers are responsible for the delivery of ILT, and spend time in learner assessment, preparation for training, and formative and summative training evaluation, and may also be accountable for training development, communication, and scheduling.

 

Support staff. Support staff may be used for printing, collating, and preparation of training materials for each class session, scheduling and tracking end users, and managing class attendance, room logistics, and any refreshments for the class.

 

End users. Employees attending ILT may be salaried or hourly. With careful scheduling, salary costs for training may be paid as a regular workday. Scheduled development should be flexible so that overtime is avoided for hourly employees. Training schedules should be published far enough in advance so that managers and supervisors can plan for training needs and replacement staff.

 

Technology. A training classroom that mimics the real information-technology environment will include computer monitors, keyboards, and other equipment for each end user in the class. In addition, each learner will need access to any peripheral devices such as bar-code scanners. This equipment may need to be purchased or leased for training purposes, and costs will include the time and labor for set up and testing.

 

Replacement staff. Coverage is needed for patient care or other duties while a regularly scheduled employee is attending training. Salary costs for training will include both the replacement employee performing patient care, and the employee attending training.

 

Facilities. Organizations may not have the available facilities to host ILT classes that would support a quality learning experience. Space may need to be acquired at off-site locations, such as hotel training rooms or conference centers. Costs for these facilities, which may require daily setup and cleanup, are included in training costs.

 

Materials. Learners attending ILT may be supported with binders, paper manuals, handouts, assessments, job aids, and evaluation forms. Training-material needs must be identified, stock ordered, and the final product prepared for classroom use.

 

Instructional designers. The design and development of training may be performed by instructional designers, who are specialists in instructional and learning theory, and training best practices. Instructional designers work with subject-matter experts to develop training content and materials so that trainers deliver the content. Costs for training-materials development by professional instructional designers may be less than the costs associated with paying high-salary healthcare staff to perform this function.

 

Because ILT is designed to be presented to a live audience, this method of training is best suited for a larger-scale training effort. HIT undergoes frequent updates and changes, making it difficult to repeat ILT training on a regular basis for newly hired employees. Large amounts of effort must be focused on ensuring that materials, and the training environment, continue to reflect the system and processes that are used in the live clinical setting.

 

The key to the success of ILT is the training schedule. Schedules need to accommodate all staff work shifts and include make-up sessions for those not able to attend the regularly scheduled classes. Training schedules for ILT must be developed and communicated early in the planning process so that leaders can accommodate vacations and staffing levels during training. Class length is dependent on the amount of content to be delivered. Sessions can range from one to eight hours and, if scheduled during patient care shifts, replacement staff will be needed for adequate coverage. Classes scheduled before or after work shifts may contribute to decreased concentration and lack of attention to the training due to fatigue, resulting in decreased learning and retention of content.

 

Training should be delivered as close to the implementation date as possible; when training is delivered too early, the end users will not retain information. The ideal timeframe for training is to deliver content no more than a month before implementation (Peck, 2013). The most successful training strategies make use of dedicated training days and times, when participants are not scheduled for clinical shifts, and expectations about class attendance are communicated and reinforced at the highest levels of leadership (Simon et al., 2013).

 

Training in a classroom requires suitable accommodations with enough space for the end users, technology, any included peripheral devices, and a screen and projector for the class to view, as well as space for the instructor to stand and move about. If suitable space is not available within an organization, the training rooms may need to be rented, as noted earlier. If space is rented, additional resources will be needed to deliver, set up, and test the training equipment prior to class. Wireless connections will need to be present and reliable, and facilities will need to include adequate parking, restroom and break facilities, and security—so equipment left overnight is safe.

 

As noted earlier, information technology used in training should include the same computers, keyboards, monitors, processes, and peripheral equipment that will be used in the clinical environment. The training environment may be created using real patient data copied into the training environment and cleansed of any patient-identifiable information. The process of copying live information into the training environment may need to be completed or refreshed just prior to when training begins to reflect the latest functionality in the software applications. If the clinical system changes, or is updated during training, the training environment should be updated as well to reflect the most accurate processes. The log-in process should be similar to the real log-in process, and end users should receive and test their personal log-in IDs and passwords at the end of the training session, necessitating the need to connect with the live clinical system from the training classroom.

 

Trainers can be employees of the organization who are either involved in education or function as super users. Trainers may also be contracted from vendors or training organizations, who are either involved only in delivering classroom instruction, or the entire training design-and-development process. Vendor trainers may train internal-organization trainers who will then conduct the end user classes. Just as staff must be scheduled for training, a schedule must be created for trainers, so all shifts and classes are accommodated. Depending on the knowledge level and experience of the end users, classes may require multiple trainers—one to present the materials and one or more to assist end users who might have questions or get lost during the instruction.

 

Most often, trainers are responsible for developing the training data, consisting of realistic patient-care scenarios, which is loaded into the training environment. The training data must meet the learning needs of all of the disciplines and roles represented by employees attending training. Learning needs or issues may emerge during each class, and trainers must have a plan to address or document issues, and communicate these with other trainers and training designers to improve ongoing classes. It may be helpful to establish a method or location for trainer communication and updates, such as a wiki site, group email, or intranet folder. M5- Assignment

 

Training data must be comprehensive enough to address the needs of all learning scenarios presented during training, and enough examples must be present for multiple classes to use fresh examples each day. Data includes de-identified patient, employee, and physician databases; student log-in IDs and passwords; orders for procedures, communication, and medications; system alerts; and admission documentation, test results, and other care documentation for the training patients. The training database should also include alerts, error messages, and decision-support tools seen in the live clinical environment. Development and maintenance of the training database will require collaboration between the training and information-system teams. Trainers must be included in information-system, project-change communication to ensure that all production, application, and environment changes, such as code and software updates, are reflected accurately within the training environment.

The transfer of learning from the classroom to practice is supported by activities designed to keep staff engaged through hands-on practice and problem solving (Adams, 2000; Brady, 2011; Furlong, 2015; Gardner & Rich, 2014). Realistic patient scenarios are first presented using a step-by-step demonstration, followed by hands-on replication of the activity. Scenario-based training places learning into the context of patient care by presenting an end-to-end process, such as a client admission through discharge, which is broken down into smaller learning segments, each building on the prior segment to support completion of the entire scenario.

 

Ideally, scenarios should be designed to trigger the alerts, error messages, and decision-support notifications that are seen in the live clinical production environment. The scenario method of training supports the various learning-style preferences of the end users through auditory instructions, visual demonstrations, and kinesthetic replication of the presented process (Anderson, 2007; Chai, 2006; Middleton, 2012). Improved learning retention and validation of skills can be accomplished by including exercises into each segment of training. This allows the end users to work through a scenario independently after proceeding through the guided phase of training and through the presentation of specific problems, requiring the end users to access help resources and other tools to resolve the presented issues.

 

Classroom training is a high-cost, labor-intensive means of end user training that is best used for large-scale software implementations that require a large amount of knowledge dissemination, as well as interaction with and support of end users during learning. One risk of classroom training is there may be variation in the training delivered by different instructors, which can result in inconsistent training results. Classroom training is also difficult to continue for new employees. However, instructor-led training can allow for the flexibility needed when there are frequent changes to a new software application that cannot be taught using other training methods.

 

eLearning M5- Assignment

A lower-cost training alternative that can be used alone, or in combination with other training-delivery methods, is provided by eLearning, which is the presentation of learning content through information technology, such as a computer or handheld device (Hainlen, 2015a, 2015b). It is developed using applications that can provide content and interactivity; some applications are able to realistically simulate processes seen in the EHRS and other HIT. It also allows for asynchronous training: end users can access training when they are ready and able to learn. The effectiveness of eLearning as a training delivery method equal to ILT is supported by research (Ahlers-Schmidt, Wetta-Hall, Berg-Copas, Jost, & Jost, 2008; Buckley, 2003; Hall, 2015; McLoughlin & Lubna Alam, 2014). This modality can be used as an adjunct to other learning-delivery methods by providing an opportunity for pre-learning and preparation for validation of knowledge.

 

Development of eLearning requires an instructional designer with a specialized skillset. Instructional designers work with SMEs to develop a curriculum, identify key learning outcomes, and validate workflows and processes. Each hour of eLearning that is produced typically takes from 100 to 150 hours to develop (Kapp & Defelice, 2009). Costs for the development of eLearning include the time of the instructional designer, the time of SMEs, the cost of the eLearning application, and any specialized software or hardware needed to produce the finished eLearning product, such as video encoders or professional recording microphones and editing software.

 

Applications for eLearning can range in price from a few hundred dollars for PowerPoint to several thousand dollars for applications such as Adobe Captivate, Lectora®, or Articulate. For professional eLearning development, a specialized computer with enhanced memory and graphics, along with a large high-definition monitor, may be required. Despite the higher costs of acquiring eLearning-development technology, the learning materials are easily reusable with little to no maintenance, providing an ideal tool for training new employees. In addition, employees are often able to complete eLearning during slower periods in a regularly scheduled shift, eliminating the need for replacement staff during class or for overtime pay. Many learning-management systems can track the time that end users spend in each learning module, their completion rates, and their quiz or test scores. Test questions can be randomized to reduce or eliminate issues of dishonesty, which can occur with unmonitored learning evaluation.

 

A well-designed eLearning program will contain elements that engage the end user through interactive simulations, activities, questions that check knowledge, sounds, and motion (McLoughlin & Lubna Alam, 2014). It may be tempting to include all of the bells and whistles available in an eLearning application into the training; however, research shows that unnecessary images, motion, colors, and other features can cause cognitive overload and decrease learning (Blayney, Kalyuga, & Sweller, 2015; Fraser et al., 2012). In a seminal work, Clark and Mayer (2008) noted that including both audible voice and written words in eLearning decreases learning and increases cognitive overload. Clark and Mayer noted that information obtained through either the ears or the eyes as spoken words or pictures, are processed in a single area of the memory system, which can attend to only one input at a time.

 

Applications for eLearning can typically be viewed on any computer with access to the learning-management system (LMS) where the eLearning content is housed, and many applications are scalable for viewing on a mobile device. End users may have difficulty viewing eLearning content on computers in patient-care areas if the computers do not contain sound cards or plug-ins that support the other application. Prior to release, eLearning modules should be tested on a variety of computers to ensure that end users have an optimal training experience.

 

eLearning is less flexible than classroom training, and frequently updating training modules to reflect system changes is not recommended. For this reason, development of eLearning content requires a broader approach to training than classroom training does. SMEs play an important role in the development of effective content. Rather than providing simulation of every detail for every step in a process, SMEs can identify key steps in a process, eliminating the smaller transition steps that are intuitive to the end user and are subject to frequent changes. eLearning can realistically simulate HIT, allowing the end user to see, hear, and perform actions based on realistic patient scenarios. Using this technology, end users can also repeat sections of training if desired or proceed faster through areas where they are familiar. If eLearning is used as an adjunct to classroom training, modules can familiarize end users with system functionality and basic processes, paving the way for shorter classroom time that is focused on the application of learning.

 

Developing eLearning content requires instructional designers with specialized skills, and the input of SMEs to design learning that focuses on the most important aspects of HIT processes. Due to the inflexibility of eLearning applications once developed, care should be taken to present key concepts, rather than all parts of a process. Evaluation, which will be discussed later, can be used to ensure that eLearning design is accurate, and that end users are demonstrating the desired learning objectives upon completion of the learning.

 

Self-Guided Learning

Although not frequently used, self-guided learning is a training-delivery method that utilizes text-based training manuals or materials that the end user can follow to learn a new system or process. Costs to produce a self-learning guide can range from stapled copies of paper or digital training manuals on the low end of cost, to professionally printed and bound manuals on the high end of cost. Learning guides can be a useful resource as staff are initially learning to use HIT, but are best used for limited changes rather than full-system implementations.

 

Drawbacks to self-guided training include:

 

Little-to-no ability to monitor compliance with training.

 

Quickly outdated printed materials unless electronic versions are available.

Lack of control of printed materials: outdated resources may surface years later to guide incorrect processes.

 

No instructional interaction with end users.

 

Due to the static nature of the content with this training-delivery method, best uses should be limited to short job aids for new functionality or for reminders on how to complete ­infrequently performed tasks in the HIT system.

 

Just-in-Time Training

Just-in-time training is a method often preferred by physicians and other providers who are reluctant to spend time in a training classroom or viewing eLearning that is perceived as not relevant to their job function, preferring to incorporate their learning into daily practice (Catapano, 2012). Training delivered this way enables the physicians to place the process in the context of their daily patient-care activities, and, with a few repetitions of a process, they often feel comfortable performing it on their own. Just-in-time training results in greater efficiency and less non productive time for busy physicians and other providers, does not require classroom or scheduling resources, and supports greater adoption of information technology through training that is targeted to the immediate needs of the learner.

 

Just-in-time training involves the use of a trainer or super user who can be physically present with the providers to walk them through the processes they feel they need to understand, at the time they are completing the processes. Just-in-time training, however, may result in excessive downtime for trainers, with short periods of time when many providers need assistance simultaneously. Resources can be maximized by assigning these trainers to tasks that can be performed in patient-care areas, such as monitoring user reports, or auditing charts while waiting to assist providers with questions and training needs. Although the expertise of just-in-time trainers is strongest around physician workflows and processes, these trainers can also assist clinical staff with questions and workflow while in patient-care areas.

 

Additional drawbacks to this training method include gaps in training: the physician seldom sees the entire flow of a process and all of the steps involved from beginning to end. In addition, this type of training does not allow for problem-solving or addressing system alerts, or providing guidance as seen in a carefully planned class.

 

Blended Learning

Blended learning combines elements of several different training-delivery methods in order to maximize learning and application, while minimizing expensive time spent in a classroom. The blended-learning training model utilizes independent web- or print-based instruction as preparation for an interactive instructor-led training that focuses on integration of concepts, learned by the end user during the independent study, into the context of practice. The classroom portion of this training model can be used to validate skills, present practice scenarios, provide discussions that stimulate critical thinking, and reinforce knowledge gained during the independent portion of training. Costs for blended learning are typically less than classroom training, due to a decreased or eliminated requirement for replacement staff. Blended learning is more easily replicated for training incoming staff on an ongoing basis, due to the reusable materials that support independent study.

 

Adjunct Training Materials

Training can be supported by a variety of adjunct resources, including job aids; email reminders; ongoing training tips; easily accessible audio-video clips; and the ongoing presence of trainers and super users in work areas, department meetings, and other locations where caregivers gather. For tasks that are complex, infrequently used, or where accuracy is critical, printed job aids provide an additional level of support (Martin, Silas, Covner, Hendrie, & Stewart, 2015). Care should be taken to keep job aids and reference materials to a minimum, because end users will have difficulty locating and accessing these documents in a newly paperless environment where there may be little space for storing paper documents. Critical job aids can be laminated and affixed to computers so that they are readily available when needed.

 

Specific types of job aids are correlated with the types of information and task needs. As an example a task that must be completed in a particular sequence should have a job aid that depicts each step. When sequence does not matter a checklist is adequate. Other types of job-aids include decision tables, flow charts, and reference sources. Job aids may also be developed in response to practice gaps that are identified after EHRS training and implementation (Lear & Walters, 2015). Over time, the need for job aids, and the presence of the materials in patient-care areas, will decrease. Care should be taken to keep electronic copies of adjunct training materials easily accessible to staff hired after the initial system implementation, and to periodically review materials to ensure that they accurately reflect current system processes.

 

Training is most effective when the hardware, software, and training environment closely match what will be used in the clinical setting. Development of training content, the technology, and resource materials used to support training requires close collaboration between educators, informaticists, and those managing and updating the HIT system used in production.

 

Training staff to use HIT is critical to its successful use. Training can be time-consuming and expensive, necessitating careful consideration of all training-delivery options in order to match training to the situation and need. In addition to matching the training-delivery method with the training need, there is some evidence to suggest that certain groups of learners learn best under certain training conditions. New research suggests that rather than a one-time process, training should be regularly offered, and repeated approximately every three years to address declining perceptions of benefits; this helps to improve quality (Juris Bennett, Walston, & Al-Harbi, 2015).

Training Resources

According to the HIMSS EMR adoption model, 93.6% of US hospitals have adopted an EMRS that includes nursing documentation (HIMSS Analytics, 2016). As the initial rush of system implementation winds down, some training resources are now available that offer the chance to reuse content. The federal government, HIT or EHRS vendors, training-development vendors, and professional organizations all provide some form of educational content. Certain professional organizations such as HIMSS, AMIA, and ANIA promote instructional best practices for maximized learning outcomes.

 

Professional organizations with a focus on training and development provide a rich variety of resources and support for trainers and instructional designers. These organizations include the Association for Talent Development, the International Society for Performance Improvement, and the Association for Nursing Professional Development, most of which offer memberships at a reasonable cost.

 

The Association for Talent Development (ATD) (2016) is a professional organization that provides networking, research, and resources for professional training and development practitioners around the world. Just as healthcare has best practices and evidence-based care, training and instruction is based on theories and research that provide training best practices. ATD is focused on research and education that supports trainers, instructional designers, and talent-development practitioners with the latest evidence and resources that guide and support best practices for instructional development and delivery. The organization provides courses and certifications in learning design, eLearning, training, and other topics. It also hosts regular webinars and training events, as well as a yearly conference, eLearning resources, publications, and events held at local ATD chapters.

 

The International Society for Performance Improvement (ISPI) focuses primarily on human performance improvement by examining the most cost-effective interventions that influence human behavior, including training. Courses offered by ISPI look at all aspects of human performance improvement rather than just the development and delivery of training.

 

The Association for Nursing Professional Development (ANPD) focuses on the specialty of nursing professional development in order to enhance healthcare outcomes. ANPD provides rich experiential resources, links to additional resources, and the opportunity to communicate and collaborate with other clinical educators.

 

The federal government and some educational institutions provide open-source training materials focused on HIT and the regulatory environment driving change. These materials are useful for providing background and rationale for specific EHRS and information-technology functions within an organization. The Department of Health and Human Services, in collaboration with the Office of the National Coordinator, has developed a complete set of curricula designed to facilitate growth of the HIT workforce (Department of Health and Human Services, 2016). The current curriculum is undergoing an update, which should be available in late 2016 or early 2017. Additional workforce-training materials, such as the Open Learning Initiative launched by Carnegie Mellon University, can provide publicly available content that can be integrated into specific training programs.

 

An HIT or EHRS vendor may offer training for a client organization through the train-the-trainer method. Using this training method, the vendor trains select internal trainers, who then provide training for all of the end users. The vendor may provide the instructional curriculum, the organization may customize content provided by the vendor, or the organization may develop all of the content internally. Vendor training typically reflects a generic and standard use of information technology, not the customizations and workflow processes used within a specific organization. Customization of curriculum and workflow is often necessary to align the training with the work processes used in an organization.

 

Many training-development organizations have emerged since the explosion of EHRS implementations. These organizations specialize in providing instructional design, ­training, and support services to organizations with training needs. These vendors will work with SMEs within an organization to develop custom training that matches the workflow and functionality of the information technology. Training vendors can produce professional ­quality eLearning that can meet training needs for several years, while eliminating the need to develop internal expertise in the development of eLearning.

 

Although there are many resources available to produce HIT training, customized work is necessary in order to accurately capture the workflow and functionality of an organization’s EHRS. Professional organizations provide resources that support the development and delivery of training by using evidence and best practices. Publicly available HIT workforce-training materials are available on the Internet, and the detailed and customized training that is needed for learning to use an EHRS is available through vendors and training-development organizations.

Evaluating Success

HIT training should focus on producing end users who are competent in using selected information technology, with the assumption that proficiency will occur over time with use. Successful training programs incorporate formative and summative evaluation to determine the effectiveness of the training program, and students’ success at accomplishing learning objectives. A training program without evaluation can result in a large expense with little to no benefit. Evaluation should be planned when training is designed and developed.

 

Formative Evaluation

Formative evaluation assesses the effectiveness of the selected training-delivery method, the content, and the success of the training design to meet the needs of the learners (Flora & ­Marquez, 2015; Holden et al., 2015; McGowan, Cusack, & Poon, 2008). Formative ­evaluation can be conducted by involving SMEs and naïve end users in a systematic review of the ­training content at certain points in the development process. Tools used for formative evaluation can include focus groups, pre- and post-tests after content review, and evaluation of the ability to use the EHRS after completion of the draft version of the training materials.

 

Formative evaluation can also be conducted during the training process. Review of post-training evaluations and tests may highlight a pattern of learning that points to a gap in the training curriculum, the training-delivery method, or even the instructor. When conducted early in the training process, formative evaluation of training will allow for rapid, on-the-fly changes that increase the effectiveness of ongoing training.

 

Summative Evaluation

Summative evaluation assesses the success of the training program in enabling students to meet the learning objectives. Summative evaluation can be used to demonstrate reactions to training, knowledge gained during training, application of training on the job, the value of the training program to stakeholders and the business, and ultimately, to determine the return on investment of the training program.

 

Reaction Evaluation

Evaluation of response, or reaction to training, is the most commonly used method of summative evaluation. In this evaluation, the learners provide immediate feedback about how they liked the training program, how effective the training program was, and the perceived relevance to the work of the learners. Reaction evaluation can help to identify areas for improvement with instructors, class length, content delivery, and other logistics. However, Phillips and Stawarski, in their classic work, noted there is no evidence that a positive reaction to a learning program will result in successful application of learning on the job (2008). Learners can enjoy a training program and never apply the learning to their daily work. When learners are asked a question in an evaluation, there is the expectation that something may change as a result of the time and effort the learner puts into providing feedback. Be careful to only ask questions around items that you have the power to change. A question about the training room might elicit great feedback; however, the trainer may have little to no ability to change the size or other specifics of the training facilities.

 

Knowledge Evaluation

Knowledge evaluation is the assessment of how the learner has gained new information and knowledge during the training session. This type of information is typically collected during and immediately after training, using methods such as quizzes, post-tests, return demonstrations, or completion of presented scenarios. Although the learner will not be successful without the acquisition of knowledge during training, gaining knowledge alone does not correlate to successful application of knowledge (Phillips & Stawarski, 2008). The ultimate goal of any HIT-training program is to produce an effective on-the-job application of learning.

 

Application Evaluation

Collection of data used to evaluate the application of learning can occur both during the training session and a period of time after training, when the learner has had the opportunity to apply the knowledge gained in a real-life setting. Application-evaluation data requires more effort and time to collect, and may require chart audits and system reports designed to capture workers’ use of key functionality. Very few organizations evaluate the application of learning due to the time and effort needed to collect this information; however, application evaluation and correction measures are the best way to ensure accurate and efficient use of health information technology.

 

Business Evaluation

The business evaluation, or value evaluation, examines the impact of training on the business of healthcare. This type of evaluation can be difficult to collect in a healthcare environment because the benefits of HIT training are difficult to separate from the benefits of the implementation of the information technology itself, and the impact on quality, error rates, and other business measures. More information about business evaluation can be found in these two classic models: Phillips training ROI model (Phillips & Phillips, 2008) and the Kirkpatrick four levels of evaluation model (Kirkpatrick & Kirkpatrick, 2006).

 

Return on Investment

The final level of training evaluation focuses on determining the value, or cost of each dollar spent on training for an EHRS implementation project—the return on investment (ROI). Data collection includes all of the summative evaluation data, all of the costs of training, any financial business impact as the result of training, and any intangible benefits, such as user- or patient-satisfaction scores. For more information on the ROI process, the Phillips training ROI model is presented in detail in the ROI Fundamentals series (Phillips & Phillips, 2008).

 

Training evaluation can provide information to improve training content and delivery methods through formative evaluation, while summative evaluation is used to evaluate the success of the training program in meeting the learning objectives. Learning objectives should be written prior to training development and used to guide both the development of the training materials and content, as well as the evaluation of the success of the training program.

When Information Technology Fails (Training on Backup Procedures)

Education on downtime procedures is necessary so staff are able to continue providing safe patient care and other clinical operations without access to HIT systems. In addition to providing information on where to locate data, how to communicate, and where to document when a system is unavailable, downtime procedures must also include parameters for when data is to be entered back into the computer system.

 

The latest generation of healthcare workers includes staff who have never used paper to manage patient care. One of the benefits of HIT is that information is contained in one location that is accessible from diverse remote locations. When a downtime event results in documentation of information on paper, the electronic document becomes an incomplete record, which may be missing information that is key to patient care and safety. Even the most reliable HIT system will occasionally experience both planned and unplanned downtime. Downtime planning should include:

 

Forms for alternate documentation.

 

Alternate sources of data.

 

Communication processes.

 

Data to be reentered into the chart after downtime—and, who will do the entry.

 

Schedule for routine downtime drills.

 

Policies and procedures.

 

Schedule for planed downtimes that has the least impact on care.

 

Methods for storing and accessing backup data.

Future Directions

Proficient use of HIT is dependent on effective training for all members of the workforce. As HIT progresses, advances in training technology keep pace. Just as healthcare strives to utilize best practices and evidence in the provision of care, best practices and evidence exist for training design and delivery. Sources, such as The Association for Talent Development and the Department of Health and Human Services, contain resources that can be easily accessed and implemented to guide training.

 

In the future, HIT training may need to be considered as an ongoing process, that includes updates on technology and workflow changes. Training in the future may be less disruptive to patient care when supported by the latest training delivery methods. Sustaining a culture of safety requires competent understanding and use of health information technology.