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An Effective Strategy for Long-term Epic Training

Posted on January 27, 2017 I Written By

The following is a guest blog post by Chris Cooley, Training Advisor at Pivot Point Consulting, a Vaco Company.

Ensuring that you have enough staff to cover day-to-day, new-hire, remedial, and monthly EHR update training is not an easy task. At the most recent Epic User Group Meetings and Spring Councils, sessions dedicated to building steady training teams were among the best attended. To be sure, Epic training is a hot topic in healthcare organizations—particularly as it relates to new hires. Here are some best-practice suggestions to help establish a long-term and successful Epic training program.

The Necessary Evils

Many organizations are opting for eLearning in lieu of classroom training to reach multiple groups. The difficulty with this approach is the inability to truly know if the participant grasped the material. Most participants can pass a quick post-exam without completely understanding or retaining the information.

Timing is also an issue. Even a two-day lapse between an eLearning session and practicing the learned material can pose the risk of an 80 percent information loss, requiring retraining or additional support during the first shift following training. That said, when used correctly, eLearning can be quite effective when used in conjunction with traditional classroom training and immediate practice.

For those familiar with Epic, an interactive eLearning session that speaks to the specifics of your organization can easily be implemented in lieu of classroom training. When using eLearning, make sure to follow adult learning principles. Keep courses short, interactive, and challenging to keep end users engaged. To help participants retain information, include built-in exercises to prevent advancing without completing an action.

Classroom Training
In a preceptor-led training model, about four to eight hours of classroom training should be sufficient. Stick to the basics of navigation, terminology, and one or two main workflows to get comfortable working in the system.

For physicians, schedule a one-on-one follow-up with the trainer to set up preference lists and customizations within the same week. Avoid doing this day one or two, as the physician will need to be familiar with the existing orders and sets before customizing further.

Beyond the Classroom

Routine Training Integration
Standard training and orientation programs offer great opportunities to incorporate Epic-specific training elements where applicable. Nurses, for example, have a day or more of skill validation when starting a new position. For every skill they perform, an Epic training opportunity exists. Have participants find the order in Epic, perform the skill, then document the appropriate procedure and follow up. Collaborate with the education department and affected department leaders to add Epic workflows into routine training outlets.

Learning happens best when on the floor, in the department, or repeatedly completing a task. Assign new hires a preceptor who is well versed in Epic and department workflows. Have them log in and perform the work while the preceptor guides them through their duties. After two to three days of side-by-side work, your new employee should be off and running.

Draw preceptors from within the new employee’s department and remove them from their daily duties when onboarding new hires. Choose your preceptors wisely. Just because Jane Doe is the resident Epic expert on your floor doesn’t mean she’ll be the best preceptor. Look for someone who embodies your organization’s culture, is a cheerleader for Epic, and has the patience to answer the same question multiple times.

Other Considerations

Materials must be well written, well organized, and—most important—accessible. Often, materials are outdated, in print form only, or not easily found by the end user. The use and regular maintenance of Learning Home Dashboards can ensure the latest materials are organized, intuitive, and available.

Consider turning tip sheets into two-minute-or-less video snippets. More often than not, watching and then repeating a process is preferable to deciphering a tip sheet and/or screen shots—especially for physicians and millennials looking for the quickest answer.

Remedial Training
While new hires account for about 30-50 percent of a trainer’s time, some individuals or departments will always need a little extra help. For example, evaluating a workflow to offer a faster/easier process, retraining, or providing additional one-on-one time with the end user can account for another 20 percent of a trainer’s time.

Update Training
Each month, a new set of Epic updates must be showcased to employees. This can be accomplished via monthly training or eLearning. In my experience, the time to coordinate and deliver monthly update training accounts for about 10 percent of the trainer’s time.

End users often struggle in silence. When my trainers are not actively training, or working on materials, they are rounding in the departments they support looking for opportunities to strengthen knowledge. In addition to rounding, trainers attend huddles and meetings, offer help, and bring vital intel about updated or ill-working workflows to the principal trainer’s attention.

Help Desk
Trainers will also spend a good deal of time working “tickets” to assist end users (and often analysts) in identifying and communicating problems and resolutions.

Learning Management System (LMS) Administration
Hundreds of small details go into ensuring that Epic training is meeting the needs of an organization.  Who is expected in training? When and where can training be held? Who has completed training and can be activated in the system? It is imperative to dedicate at least one full time LMS administrator or coordinator to these ongoing Epic needs. Depending on the organization’s size, this may require up to four full-time resources.

Effective Coverage 
The number of Epic trainers needed will vary according to the organization’s size and hiring volume. Depending on the application and the hiring schedule, your principal trainer may be able to handle all training without the support of additional resources. However, I recommend having at least one credentialed trainer available for backup—to cover vacations, assist in remedial training, etc. Consider cross-training to make trainers versatile in related apps. Maintain expertise amongst your trainers by limiting cross-training to three areas of focus.

The example below includes enough trainers to cover the needs of a two hospital system and surrounding clinics in the same geographical location.

CT2 ClinDoc, Stork, Orders
CT3 ClinDoc, Beaker, Orders
CT4 Ambulatory, HOD, Cadence
CT5 Ambulatory, HOD, Cadence
CT6 Radiant, Cupid
CT7 Beacon, Willow


PT1 GC, Cadence
PT2 Ambulatory, HOD
PT3 ClinDoc, Stork
PT4 Orders, ASAP, Beaker
PT5 OpTime, ANA
PT6 Radiant, Cupid
PT7 Beacon, Willow

Creating partnerships throughout your organization, along with a steady, recurring training schedule, is the key to running an efficient, low-budget training team. With exceptional, easily accessible training materials and operational preceptors, training can be efficient, low-cost, and have employees in their positions with minimal classroom time.

About Chris Cooley
Chris Cooley is a Subject Matter Expert for the LIVESite division of Pivot Point Consulting, a Vaco Company. Previously, she worked as a full-time training manager, with 14 EMR implementations under her belt. With a combined knowledge of adult learning principles, technical writing, project management and the healthcare world, Chris is known for her creative solutions.

Every Hospital Should Adopt EHR

Posted on March 13, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While I’m sure this tweet will rub many the wrong way, I found it incredibly thought provoking. I have no idea who this person is that tweeted it, but I think that his tweet represents the majority of Americans who know very little about EHR and Health IT.

From a layman’s perspective, in every industry the use of IT has benefited that industry. Those not living in the EHR world just automatically think that by applying IT to something that we’ll see a huge benefit. Those of us in the EHR industry no doubt have a much more nuanced feeling about the benefits of EHR. I’m sure the guy who tweeted above won’t be happy with the meaningful use hardship exemptions which will defer organizations from being #finedheavily.

While I agree with the idea that we need broad EHR adoption, I think we have to be careful trying to rush any EHR implementation. A rushed EHR implementation is far worse than no EHR.

CMS Now Auditing Meaningful Use Documentation

Posted on August 15, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

It’s been a while since our beloved Recovery Audit Contractors (RAC) were on the front page of the trades every day, but they’re far from gone.  In fact, CMS has started to get aggressive in a few new ways, according to the Fox Group:

  • Meaningful Use Attestation Audits:  So you’ve collected EMR data, you’ve attested, and you’re waiting for your check. All is well, right?  Not necessarily. CMS has begun requesting documentation from providers that supports  the attestation, largely data from your EMR but also possibly info from internal audits you’ve conducted to see that you’re meeting objectives.  This is big stuff; if you fail your audit by CMS, there goes your money. And in the future, if you fail multiple audits, you could be seen as submitting false claims. Mega-ouch.
  •  MACs Look At Documentation:  Medicare Administrative Contractors (MACs) have been auditing medical records for years to make sure documentation supports the services billed. Now, they’re going to start looking at “auto-generated data” produced by EMR medical record documentation systems.  If the auto-documentation looks “cookie-cutter” and possibly out of line for some specific patients, providers could be in trouble.

And if you somehow get entangled with a RAC investigation, don’t count on carefully-spelled-out EMR documentation to save you. According to a recent study by the American Hospital Association, 77 percent of claims denied by RACs were restored upon appeal, suggesting that most of the time, claims targeted by the RACs weren’t bad to begin with. In other words, I think it’s fair to say that they’re out for blood, so prepare yourself.

An internal audit of your documentation can work wonders, Fox Group suggests. And keep an eye out for copy-and-paste documentation across bunches of patients; it’s gone from questionable to perilous.

Top HIS Vendors By 2011 Revenue: Cerner Corp. (CERN)

Posted on April 23, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Today it’s back to our countdown of the top five HIS vendors, with data courtesy of HealthDataManagement magazine. Today we’re focusing on Cerner, which according to the magazine’s calculations ranks second for HIS sales, edged out only by McKesson.

Cerner claims to be the top EMR vendor in the U.S., despite competitor McKesson’s much larger size, since McKesson is in so many other lines of business. As with McKesson, we’re going to share a very quick overview of Cerner’s position in the overall HIS market, which as noted previously embraces not only clinical tools like EMRs, but also HIM, revenue cycle and access tools.

Cerner holds a very tasty 18 percent of the HIS market, by HDM consultants’ calculations. More interesting, to this audience at least, is that it’s gotten there with a big helping hand from its suite of EMR products. Here’s more to chew on, below.


Cerner Corp. (CERN)
2800 Rockcreek Parkway
North Kansas City, MO 64117
Phone: 816-221-1024

Products:  For the purposes of this discussion, let’s just be cute and say “everything HIT.”  That includes its popular Millennium suite of EMR products which are really seeing a big uptake in community hospitals, especially its remote hosted solutions.

2011 HIS Revenue: $2.2 billion

2010 Revenue: $1.85 billion

Summary:  From 2010 to 2011, Cerner’s  HIS revenue grew by 20 percent as Millenium sales yielded annual revenues of $2.2 billion.  Cerner’s overall profit margin for last year was, wait for it, just about 14 percent — and over the last 52 weeks its stock is up 34.3 percent. Yeah, yeah, I’ve been an editor for 20 years but now I know I’m in the wrong business.

Interesting facts:  Cerner has a strong international presence, from Belgium to Bangladesh, the Middle East and South America. Also, it now is offering “Community Works” to Critical Access Hospitals under 25 beds (a move your editor wouldn’t have expected given the predictably high cost of solutions from a company that size).

Top HIS Vendors By 2011 Revenue: McKesson Corp. (MCK)

Posted on April 16, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Knowing which vendors have the highest revenue doesn’t have an immediate impact on your HIS installation, but somehow it’s fascinating anyhow.  Besides, knowing who’s solvent and what projects they’re pursuing never hurts.

So over the next few weeks, we’re going to share the names and details on the five top earners isolated by HealthData Management magazine, with some details on what they sell, how they’re doing revenue wise and whenever we can, what their market position is. Be sure to check out our full list of Top HIS Vendors.

Bear in mind that by HDM’s definition, we’re talking about vendors who cut across the whole suite of HIS services, from EMRs to revenue cycle management and departmental applications.  In most cases, the article hasn’t broken out EMR revenue from its overall revenue projections for each company.  But that being said, there’s still some really interesting data here.  All estimates are from sources indicated, as compiled by HDM.


McKesson Corp.
One Post Street
San Francisco, CA 94104

McKesson is a $112 billion public company (MCK: NASDAQ) with a hand in most key healthcare sectors. There’s  medical supply and pharmacy distribution, HIT solutions which include an EMR and a clinical decision support system, pharmacy automation and medical claims management software….you get the picture. We’re talking a scary big octopus here.

While it continues to be a pharmacy giant, one has to wonder whether McKesson will shift more effort and dollars into HIT when you consider this stat: HIT generated an estimated 44 percent of  the company’s profit last year, though it accounted for less than 1 percent of its revenue. Wow.

2011 HIS Revenue: $3.2 billion

2010 HIS Revenue:  $3.12 billion

Interesting fact:  Believe it or not, MCK has been in business for 175 years; It began as a medical goods supplier in Ye Olde Days.

HIEs May (Or May Not) Lower Volume of Physician Lab Tests

Posted on April 9, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Can you really generate a significant medical cost savings by making patient test history available electronically? The answer seems to be a ringing “maybe.”

Two studies from highly prestigious journals seem to have drawn far different conclusions as to how having data available on a patient’s test history affects their propensity to test further. I’d argue that some of the controversy is out of line — that the two tests really seem to be looking at different issues — but controversy there has been.

First, in early March, a paper came out in Health Affairs which concluded that the physicians studied were ordering more tests when they had access to a patient’s previous imaging and blood tests via an EMR. The study found that doctors with access to imaging and lab results online led to a big uptick in new imaging and blood test orders. (Interestingly, the researchers attributed the uptick in part to a “convenience” effect engendered by the EMR — that the doctors would get their results for new tests  far more quickly when delivered to them electronically.)

Then, a study came out last week in the Archives of Internal Medicine which found that physicians with HIE access ordered less tests for patients with prior test results than their peers without HIE access. The researchers based their study on data from more than 117,000 patients treated in the HIE-linked outpatient departments of Boston-based Brigham & Women’s and Massachusetts General Hospitals between 1999 and 2004.

So, what do we have here? The Archives study seems to imply that doctors felt they needed less input to treat when they had the tests, while the Health Affairs study suggests that archived patient test data encourages doctors to drill down further.

Honestly, I think we’re looking at two different phenomena here. The first study, as I see it, suggests that doctors are more likely to test when you embed testing orders and results reporting in their workflow, particularly the workflow as they treat known patients. (Improving workflow is largely what EMRs are for, right? Oh wait, different story.)

The HIE study, on the other hand, implies that these networks can do what they’re supposed to do, which is to increase doctors’ understanding of a patient’s baseline or recent problems, cutting down on needless tests.

Honestly, I don’t see the contradiction that others see here. Do you?

Can iPads Make Docs More Efficient? There Are Many Views

Posted on March 14, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

As some may recall, I wrote a piece a couple of months ago about a disastrous iPad implementation at a Seattle hospital. The doctors all gave back their tablet, saying that they couldn’t work with it, and the hospital ended up implementing a thin client solution.

Here’s an interesting follow-up, in which the iPad came out looking great.

A new study published this week in the Archives of Internal Medicine found that a group of internal medicine students actually did become more efficient by slinging iPads. Researchers with the journal surveyed 115 internal medicine residents affiliated with the University of Chicago before and after giving them iPads to access EMRs, the hospital paging system and medical publications,  Reuters reports. Ninety-five percent of  students said the set-up improved their efficiency.

How did the hospital make the iPad set up work?  According to a piece in, U of C took great care to help make the iPad integrate well, including the following:

User support

— Used Citrix to grant access the hospital’s Epic system

— Documented carefully how Epic works with Citrix, including materials showing residents how to find local printers

— Spelled out some advantages of an iPad/Epic marriage, including addressing patient issues while in conference the capacity to discharge patients on rounds


— Explained how to address the problem if the resident’s iPad is stolen, including a policy that residents couldn’t store patient data on the iPad

Obviously, one prominent success and one prominent failure aren’t going to settle the issue of whether iPads are the future of medicine.   And while Android isn’t getting a lot of talk  in medical circles, I wouldn’t count out Android apps by a long shot. Plus, I’m sure John would passionately argue for a native iPad EHR app versus a Citrix connection.

Still, it’s interesting to see a case study in which doctors are neither frustrated nor burnt out by iPad use. I’m not sure if conditions can be replicated — after all, interns are young, eager and more prone to be tech-friendly — but it’s worth considering all the same.

More Mobile Questions: Do Your Devices Play Nicely?

Posted on December 21, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Today I had a very interesting conversation with a health IT exec (full disclosure: a client) about the future of mobile devices in hospitals. His perspective, which sounded dead-on to me, was that while mobility is great, making sure your mobile and point of care devices work together is even more important.

Let’s look at the patterns emerging in clinical data access. Here’s some big pieces to consider:

* EMR: First, of course, the EMR. You’ve spent hundreds of thousands, or in some cases millions, to put your EMR in place (and in most if not cases, you’ll be spending big dollars on integration too). But having done that, you’re still not home. These days, you have to look at how doctors and nurses will access EMR data on the fly as well as in the office.  In other words, mobility is a must-have, not nice to have.

* Tablets: Clinicians are very excited about using tablets, especially the glamourous iPad. But sometimes, reality intervenes. In some cases, clinicians are satisfied with using them — take fellow contributor Dr. Michael West — even if their EMR might not have a native client available for the platform. But many other physicians and nurses have found them exasperating or even unusable given the volumes of data they’re managing.

* Smartphones:  Obviously, it’s great to let doctors access EMR data wherever they are, and in some cases, that works fine.  Smartphones are already in wide use by doctors,  70 to 85 percent of whom have one, according to various sources. Not only that, they’re light and portable. But given their small screens, smartphones aren’t the ideal vehicle with which to access detailed clinical data.

*Point of care devices:  The old faithful of portable data, point of care devices on carts were there long before newfangled smartphones and tablets made the scene.  You may have more confidence you can manage them, and depending on the specifics, you may save money on the front end. (Integration and support are a separate issue.)  The question is, are they going to meet the needs of doctors who don’t spend a lot of time on the hospital floor?

I’ve outlined these options as though they’re mutually exclusive, but the truth is, they’re all likely to pop up in your hospital, and more. Doctors and nurses carry smartphones and iPads of their own, you probably have COWs in place already, execs and clinicians tote laptops around and you probably have some wall-mounted computers or displays in place too. In other words, your real choice isn’t whether you mix and match mobile and point of care device, it’s how you manage them as a group.

Integrating this mix of device is a big technical challenge, a support headache, a security problem, and probably a Meaningful Use issue too. But you’re stuck with it. Now, how are you going to handle it?

HIT Bigshots Tackle Post-Hospital Care Coordination, Miss The Point

Posted on October 13, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

I’d be a pretty shallow gal, I would, if I didn’t take the problems patients face when transitioning from hospital to another setting seriously.  But I swear I’m not being flip when I say that holding another conference on how HIT can solve the problem is, uh, a bit lame.

The conference in question, which will bring together some bigshots in healthcare policy, politics and health IT, includes speaker spots by Farzad Mostashari, MD, National Coordinator for Health IT, Health Affairs Editor-in-Chief Susan Dentzer and Todd Park, CTO  of HHS. Wow. And that’s just some of the headliners.

The participants will cover some of the critical ways HIT can support seamless transitions from hospitals to a patient’s next location, including standards, interoperability, exchange and Meaningful Use, the event’s press release notes.

OK. Fine. I get it — to coordinate care, EMRs and other HIT systems have to be individually robust and share data fluidly. Providers have to get on board. And it’ll all work if everybody adopts the right technology and plays nicely with their pals.

It’s telling, though, that event leaders aren’t promising much talk on how patients and their families can leverage IT to help make this happen. It isn’t about empowering patients to access their health information, communicate with doctors as supportive team members or even about patient education. It’s all about making sure the machines and software do their job. A brilliantly orchestrated, thoughtfully developed, boundlessly powerful set of machines and software solutions, but technology nonetheless.

So count me as impatient. Until policy types and health IT gurus get their heads out of the enterprise IT, networking and software business, they’re going to talk around the real care coordination issue. And that’s not only a bore, it’s a dangerous waste of time. We’re fighting for people’s lives here.

Hospitals have and arguably have had for some time more than enough firepower to solve their end of the problem. But historically, they’ve done little to involve patients and families in managing their conditions once they’re gone. Discharge summaries are perfunctory at best, particularly given how much info hospitals have at their fingertips, and virtually no education takes place throughout a patient’s visit. Once they leave, it gets far worse. “Out of sight, out of mind” may be a bit too strong but I’m sure you see what I mean.

If they want to be part of the solution, hospitals will need to think about how they can support the patients directly through smart IT use, especially super-smart new mobile options and remote monitoring of chronic or emergent conditions in the home.  Otherwise, patients are likely to remain sick, puzzled and likely to fall between the cracks.

Would An EMR Have Improved My Son’s ED Care?

Posted on September 6, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Sure, EMRs can make some care processes better, but do they have an impact which patients would notice quickly from their first moment on?

After watching my son spend about seven hours in a pediatric ED waiting to be admitted – as part of a seemingly EMR-free process – I found myself wondering whether the presence of one would have made a difference.

The facility itself is a very reputable children’s hospital, one which attracts not only top physicians but also some of the sharpest pediatricians-in-training to its residency programs. And it doesn’t lack money to throw at EMR adoption. But from all appearances, digitizing records isn’t high on its agenda.

During our visit, the staff was very attentive, paying minute attention to my little one’s concerns despite his being in a particularly fractious mood.

At each stage in his evaluation, I had the sense that staff members had shared information effectively with each other (though admittedly, three different people did have to photocopy his insurance card).

The on-call resident summoned to evaluate him for admission was even lower-tech, if possible. During her interview with him, she took only a few brief notes on sheet of paper covered with jottings of various kinds.  She seemed to capture everything necessary for planning his care.

As I had questions, I stuck my head out into the old-fashioned workstation area and lobbed them over to the charge nurse. She found out whatever I needed to know, and when I had a bit of extra background to offer, she captured it quickly.

Of course, there was plenty of high-tech equipment in the ED, and it played a role in my little man’s encounter. But during his entry process, at least, information was gathered, summarized and shared effectively using purely old-fashioned methods.

If his care had been documented with an EMR, I know things might have worked a bit more smoothly during future visits, as the facility would already have the basics of his background on file for easy reference.  But wouldn’t a robust PHR do the job just as well?

Any physicians involved in his care would probably access the old triage and interview notes via their iPad or smartphone, making them more prepared when they arrived to chat.  Still, the resident on his current case knew nothing when she got here, and things went fine.

The hospital, and physicians, could use the data on his case to gather a better picture of how they’re treating kids with his diagnosis.  Not much to gather in this case, though. Does the possibility of adding him to some registry or dataset justify the expense of doing so via a Cerner or Epic investment?

Ultimately, I can’t think of any way an EMR would have offered a direct, concrete benefit to him this time around.  If not, why should I care that nobody involved in his care used one?  More importantly,  for this forum,  why should the hospital care?