Train without pain: Doing what it takes to make your office staff tech-savvy

When you hire or promote employees, you must train them to use billing systems, electronic medical records and other software applications you use to run your practice. More than likely, you will have to train them yourself -- or find someone on your staff to handle the training.

Because every office customizes software and does business differently, it's best to train employees internally so they perform computer tasks exactly the way you want, according to physician offices that train in-house. The only time you should go outside for training is when buying a new billing or clinical system or using an application no one on staff has experience with, experts say.

Unless you can afford to routinely pay a vendor at least $1,000 a day plus expenses or $100 to $400 for employees to attend a class to learn Microsoft applications such as Word or Excel, it's more cost-effective and efficient to train employees internally.

Here are a half-dozen strategies you can use to train staff while minimizing disruption at the office.

Assess employees' computer skills -- even before they're hired

Michael J. Tyler, practice administrator of a two-physician family practice in Rosenberg, Texas, doesn't hire people lacking basic keyboard and computer skills. When he interviews job applicants, he hands them a document and asks them to type, save and print the file using Microsoft Word. He also asks them, unless they're applying for a nursing position, to create an Excel spreadsheet.

"I'm not as much interested in them knowing Excel because we rarely do those types of calculations, but they better know Word," Tyler said. "I just want to know where they are in terms of their math skills and their ability to maneuver from field to field."

He requires employees to know their way around a keyboard because they must type and send messages electronically via Microsoft Outlook, he said. The office's policy prohibits employees from writing down messages on paper because paper messages tend to get lost and don't come to a physician's attention as quickly, which could potentially harm patient care and create legal problems, Tyler said. "I can't have someone sit there, peck and take 10 minutes to take down one message," he said.

He also requires typing skills because employees have to use a practice management software system to schedule patient appointments, create and send bills to insurers electronically, print out schedules for physicians and do other tasks.

Northeast Cardiology Associates, a 20-doctor cardiology group practice in Bangor, Maine, also hires only potential employees who have basic computer skills and knowledge of Word, said Tim Ward, the group's computer trainer.

Those skills offer a good starting point for the practice to train employees, he said. The practice also prefers to hire people with basic skills rather than extensive skills because the latter are accustomed to using the software a certain way and likely would have to be untrained, said Ward, who teaches employees how to use the group's practice management software system, EMR and other software applications.

Some groups, however, have successfully hired and trained people who lacked computer skills. "It would be great if someone has them, but I'm not against hiring someone who doesn't have those skills, because sometimes it is easier to train [that person]," said Judy Harris, office manager of Southway Internists, a four-doctor group practice in Lewiston, Idaho.

Designate an in-house trainer

After your office staff has been trained by a vendor to use a practice management software, EMR software or both, it's a good idea to designate someone to train new employees. That employee -- or employees -- should be someone who knows the system well and comes from the same department the new hire will be in, Ward said.

Tyler, for example, appointed himself as the office's trainer because he has the inclination, aptitude and knowledge. "I want to have [the job] done a certain way," he said. "A lot of this stuff I'm capable of teaching them myself because I've been at it such a long time."

His practice uses a software application until it becomes obsolete and he is forced to upgrade, Tyler said. At that time, he will spend two to eight hours going over the software upgrade to determine what the new features are and whether employees need to know specifics for their job.

"The application isn't going to change that much when a new upgrade comes out," Tyler said. If something stumps him, he seeks the help of a computer consultant who charges him by the hour.

Standardize and structure training

"When I do the training, I do it the same way each time so that depending on what department the person is training for, they are trained the same way [as others who have the same job]," Ward said.

"We do job-specific training. If your training is consistent and issues are cropping up, that way you will know it's not because someone is doing something in a different way."

Besides making it easier to troubleshoot problems, standardized training also is necessary because Northeast Cardiology's electronic data collection depends on employees doing their jobs in a specific manner, Ward said.

To foster standardization, he said he creates and hands out written material because it makes classes go more quickly than teaching on the fly.

Rosemarie Nelson, a senior consultant for Medical Group Management Assn., recommends that physician offices create a checklist of items for the trainer and trainees. "It's especially helpful when they get a new employee and they will both know it's an important task that they have to remember to do and how," she said.

Although experts recommend a structured, classroom training approach, some practices have found that unstructured, on-the-job training has worked for them.

For example, Harris, Southway Internists' office manager, trains new employees how to bill or set up schedules by having them observe her doing those tasks using the group's practice management system.

"They sit with me for a good week to watch me, and I watch everything that they do [on the system during the second or third week]," Harris said. "Then we check everything before it goes out. ... They won't go off by themselves until we feel comfortable they are ready to do that."

She also encourages them and tells them not to be afraid to ask questions. "It's a lot easier to get it done right the first time than it is to have to research and find out why a claim wasn't paid [later]," Harris said.

Break it down

"Have you heard of the slogan, 'Keep it simple, stupid?' I don't try to teach them everything [there is to an application]," Tyler said.

"I think that the mistake a lot of offices make is they try to train everybody on everything instead of teaching them only what is applicable to their job. They don't need to know more than that."

Tyler said he intensely trains employees for several hours each day during their first week on the job, teaching them different things each day about the software applications.

St. Joseph Regional Medical Center, a health system in South Bend, Ind., routinely uses that approach when it trains the 50 doctors and more than 100 employees at its 20 outpatient sites.

When it began implementing an EMR earlier this year at those sites, it broke down the training into four phases -- scheduling, messaging, prescribing and clinical documentation. It teaches each phase on separate days instead of cramming it all into one day.

"It's a great deal of information, and if we tried to give them all four components at the one time, it wouldn't work," said Margaret Lynch, St. Joseph's director of technology learning. "Sometimes learning even one step can be very overwhelming, and we needed to give them time to absorb that."

Train one-on-one or in small groups

To minimize disruption and loss of productivity, Northeast Cardiology usually trains employees individually or in small groups, Ward said. More often than not, he does one-on-one training because staff turnover at the practice is low, with not more than one employee starting a new job at any given time.

Ward also works closely with the office manager to coordinate training for employees, he said. That way the manager can arrange for someone else to cover for whoever is being trained because he tries to keep classes to one hour.

He holds the same class at different times in one day so he can get different groups to attend each session, which avoids disrupting the office's operations. "We use that number only because we're able to cover various departments for that length of time without being strapped," he said.

Pair trainees with experienced employees

As she is training employees, Harris looks for signs that will help her judge whether they are ready to start using the billing system before she turns them loose on their own.

"Are they comprehending what I'm saying and showing them?" she said. "Are they asking enough questions?"

She also checks their knowledge by taking a charge slip and asking trainees what information they need and how the bill should be entered into the computer system.

After Ward finishes training employees, he has them "shadow" and work with someone else in their department for about a week. "If there are specific issues, we would retrain," he said.

He keeps an eye on employees after they are on their own to see how they are doing, answer questions, provide support and retrain them if necessary. He also asks physicians whether they noticed areas of weaknesses in the new employees and whether the latter accurately entered information into the computer.