In general practice, staff use electronic patient records every day. So, our GP columnist wonders, why don’t we add creating a standard training programme or competency framework to our to do lists?
At our local extended hours hub, we recently took on a nurse who was a GP out of hours regular. Our manager asked her – “Do you know EMIS?” Yes, was the reply. Yet when she turned up for her shift, it quickly became apparent that while she’d heard of it and knew bits about it she’d never actually used it. Luckily the shift was quiet and there were some very experienced staff on, so no harm done.
My practice took on a new admin person a year or so ago who had worked previously in a GP practice that used EMIS. While she was experienced and knew her way around it, her former employer seemed to use it in a different way to us, and it took some time for her to get used to the way we worked.
At a recent practice meeting, one of our partners was surprised to learn he could look up a mobile phone number on a referral screen. He’s been using EMIS for 20 years.
We have a quite a few members of staff who need to write searches and do reports. Some are very bright and computer literate, but learning how to do them is often more of a trial and error approach than anything else.
Why no defined list of competencies?
Basically, the point I’m trying to make is that to my knowledge there is no structured training programme or competency framework for primary care EPRs or software in general. OK, I’m most familiar with EMIS so others may have this and I’ve missed it. But there is no defined list of competencies – for example: able to change a mobile phone number, able to issue a prescription, able to send a task, able to create a concept.
Years ago, everyone was encouraged to do Microsoft Office and Windows training. It had some catchy name that I cant remember. I don’t tend to hear anything about it these days. Perhaps it’s still running, or perhaps there is an assumption everyone can use IT now. Personally with the number of IT problems people appear to have, I still think it’s a good qualification to have.
But I wonder why it never developed to cover software that we use more often. To be fair, on EMIS’s site there are quite a few webinars you can join and watch on a variety of topics. Some are very good but there aren’t really what I mean.
Let me give an example. I’m the principal investigator at my surgery for a lot of drug trials that we do; some commercial, some academic. One recent commercial study required me to do an hour-long online training programme covering how to use their website.
Testing times
Now I’m probably one of the most IT literate people out there. I was writing 6502 assembly language aged 14. If there is anyone who doesn’t require a test on on how to use a browser-based piece of software it’s me. But the organisers of the study want everyone to pass the test, and be 100% correct on the way in which they enter data. So, everyone sits the test and has to pass.
Can you imagine that if we did that in our normal practice? My practice QOF lead tears her hair out that, 10 years into the programme, some of our staff still free code some information that should be coded. Imagine if everyone was trained the same way.
There are a range of ways of offering training and ensuring a consistent approach. Online seems the most sensible. When I taught myself how to program the iPhone I used a web service called Lynda.com. It’s since been bought out, and there are of course other services available. When I used it, Lynda.com consisted of videos broken down into chunks, each chunk showing a feature. There was a great index and the ability to rewatch. The system didn’t have great tests built in, but others do.
Locally we are trying to work at scale, get practices to perhaps share staff or jointly employ them. Perhaps insource, but it’s difficult to do these if different staff and practices work in different ways.
I’m in the middle of putting in a bid to get some funding to work up a competency framework for IT – not just for EMIS, but for all the things we do in primary care. It’s with a view to creating standardised certification that means we can accurately judge the skills of two members of staff and use it as the basis of a training and education programme for them. I’m keen to hear people’s views or experiences – or just point me to one that already been done!
13 August 2018 @ 12:41
One of the problems with NHS IT has always been a total lack of agreement about how EPRs (however defined) should be used – even in general practice, where the requirements are arguably more uniform than in secondary or tertiary care.
System suppliers provide training on how to use the software, but not how to manage the EPR – and in the absence of any centrally – or even locally – agreed guidelines, practices have been left to develop their own systems , which might have suited the needs of the individual practice but with the development of electronic transfer of records (GP2GP) and virtual interoperable records, problems have been revealed which were not apparent initially in the 1980s or 1990s – when the GP EPR was coming into widespread use!
The NHS Education and Training Programme in Information Management and Training for Clinicians commisioned a workshop on Informatics in Undergraduate Medical and Dental Curricula in December 1995. AFAIAA none of the recommendations were put into action – and IM&T for Clinicians was abolished shortly afterwards.
It seems to me that there are two major hurdles to be overcome: agreement on how the EPR ought to be used followed by developing suitable detailed training material – and then persuading practices who have systems which suit their own business models to adopt the changes!
May I offer sympathy to all concerned?
Managers – IT, clinical or administrative – in all organisations who have new staff unfamiliar with yhe IT and other systems in use within the organisation(s)
New staff – both clinical and other – faced with working with systems on which they have not been trained, in organisations with which they are unfamiliar, and where training is not part of induction (or where service demands and overload with other information means that IT/EPR training is inadequate)
And abover all with locums, junior doctors and agency or other temporary workers where any knowledge acquired in one post is unlikely to be useful in the next!
13 August 2018 @ 11:18
Agree with your comments Neil. I think also as we are looking at the integrated care that hospital and GP IT training could be held together in the same buildings so they can understand and appreciate the differences in IT systems. I have worked in both environments and I have found GP systems generally better in the design and storage of information. I think competencies great idea and maybe invite some portfolio GPs views who can add in their perspectives of working across the different systems.
13 August 2018 @ 07:49
A standard e-learning package would be ideal really, not having to spend time away in a classroom increases uptake. It should form part of mandatory training alongside Information Governance – it is not that difficult, a few weeks work – I would have thought the local CSU would be able to sort this with relative ease??? As you say it would be good to have a recognised assessed/accreditated level on top of this. The trust I work for at present has a policy of ‘no training, no access’, and we have a web based elearning environment – i do suspect this isnt always the case in other organisations.
11 August 2018 @ 21:11
You are absolutely right Neil
This is long overdue and could make a massive difference in standardising processes/ improving efficiency in primary care . Emis Web training is often at the point of installation then it’s up to the practice to develop their own champion.
9 August 2018 @ 15:20
It is really disappointing to hear about this lack of training availability. The PCT I used to work for had a small but effective in house IT training team who delivered bespoke courses on all the clinical systems used in the PCT’s area (EMISweb, LV, PCS, INPS, SystemOne, Lorenzo), as well as basic PC skills with ECDL and Microsoft Office Specialist. The IT Training team were highly regarded by the local GP practices and also brought in revenue by offering these services to local secondary care organisations. It is sad that this appears to have fallen by the wayside when the CSU’s were formed, all about priorities I guess……
11 August 2018 @ 11:14
agree – however – as well as lack of proper training – my point is there are no standards to match someone to. they may have had some training.. but do i know what they means?
7 August 2018 @ 19:18
so you are saying you let people loose on your EMIS system without formal training for your own site?
you don’t have SOP’s? Each practice will in a different way so SOP’s are an essential part.
Who’s fault is it when someone makes a mistake without being trained on using the system whether that be TPP, EMIS or some other clinical system?
seems dangerous tbh, we ensure staff are trained on systems before access is granted
in secondary care things are slightly different, most large trusts have training departments that provide training on their epr’s and clinical systems.
10 August 2018 @ 15:55
“in secondary care things are slightly different, most large trusts have training departments that provide training on their epr’s and clinical systems.”
…until such time (all the time these days) that there is a shortage of clinicians and the organisation decides that it takes too long to get doctors trained on the system when they need to be on the wards seeing patients, and so instead run with ‘local risk’ that the clinicians can access EPRs without first completing any formal training…oh and if it’s locums, they simply get handed a ‘pack’ which contains a whole host of generic usernames and passwords so not only are they not trained, they aren’t audited either.
11 August 2018 @ 11:18
yes.. there is no formal training – that’s my point. there is no nationally agreed accreditation. I might say im an expert but not know how to do X or Y. We dont just let people loose we give on the job training – i suspect more than some hospitals give – i cant believe every hospital staff isnt allowed to work before they pass a IT test… however what concerns me is that 2 surgeries give their version of the training and people learn bad habits or the wrong way to do things. I think there should be a nationally assessed core knowledge. perhaps the PHCSG of BCS might be a good group to supervise this?