My own Electronic Health Record system Training

As part of integration into Permanente medicine, I asked to go through Kaiser Permanente’s training for its electronic health record system, (KP HealthConnect™) with other Permanente clinicians joining the medical group, and was luckily able to do this here in the mid-Atlantic region.

As I normally do with my activities, I posted my status as a trainee on Twitter, starting with this tweet., and received interesting questions from a Twitter user in Switzerland. The conversation provided me interesting food for thought:

Reply to me: “and, what are you learning?”

My response (on Twitter): “Learning how new Permanente physicians experience the comprehensive electronic health record”

Their reply: “interesting. How do they experience it? elation? Resistance? Paradigm shift?”

My final response: “Well these are clinicians new to the medical group, so I would say, “glad to be at a place where this is already implemented.”

And we were. Here’s why.

The training was 2 days, a far cry from the 4-6 weeks required when I first trained on the same system in 2004.

A lot of things that were trained to me with certainty in 2008 were things that we didn’t know how to manage when I helped implement a system like this in 2003 – we have come a long way. This included things like developing, using, and sharing clinical content, and correctly routing information between members of care teams. I know from experience that a training curriculum is often the distillation of many thousands of people’s experience, and it showed. There were less guesses and more pieces of practical guidance. Questions posed about why the system was set up this way or that had pretty solid answers.

Within Kaiser Permanente, the Mid-Atlantic Region has been known for being among the most innovative in customizing the application (where possible – each region has the ability to innovate, and then share nationally) for a good user experience. These user-experience touches were visible throughout, with helpful (secure, based on the role of the user) 1-click access to relevant parts of the patient record set up where it made sense.

If there was uncertainty about things, I would say it is about the implicit knowledge that comes with joining a new practice – which features does this Department use regularly, for example? These are the things that come with experience next to other clinicians, and here again, the maturity of the training curriculum showed, because our trainer knew which things were system related and which required local interpretation.

For this type of interaction, the social part of using systems, Kaiser Permanente is piloting the use social networking applications within the organization. I hope to blog more on this work as it develops, and it’s a huge interest of mine, as part of the “what next?” part of maintaining and developing health information technology within health care.

It was overall impressive to see how the comprehensive electronic health record has settled in to this organization. As someone who has actively participated in implementations, I could appreciate the hundreds if not thousands of little decisions that have been made to support the best patient care experience into the system that I received training on. My trainer did a great job of representing the system as not the future, but the present, of medical care within this organization. A clinician new to the organization may not appreciate how much work it takes to get to this point, and I don’t think there’s a need that they should, but I definitely do!


Nice insight on this process. Perhaps post should be titled, Even uber-users should get trained..

Question on the curriculum: did it include content or perspective

1. that documentation is also for patient consumption

2. about using secure messaging – do's/don'ts and best use

Our clinical training programs need so much more of this.


Great comment and questions, because, as a matter of fact I did provide feedback that while the training was really good, none of the "test" patients in our training system had active accounts, so we could not have the discussion about #1, or practice #2. I thought this would be very useful for new medical staff.

I hesitated to include this info in my post because as I later learned, the classroom training is supplemented with two half-days of training-in-situ, which is were medical staff can operationalize the basics from the classroom, and presumably the patients are activated for online use and their messages do flow in (securely) into the KP HealthConnect system.

What I am thinking about, along the same lines as you, is about the opportunity to embed the patient interaction curriculum into the EHR curriculum. A good next step would be to ask the person within the Permanente Medical Group who has done so much in this area, Paulanne Balch, MD, to see how they handle this in the KP Colorado Region. I will send her a tweet and ask her to comment here.

As you allude to, I think this is fertile ground, especially within leading edge organizations. I am about to post a review of a paper from Vanderbilt about the impact of residents leaving EHR-rich environments after graduation, and in that paper, interestingly, they did not associate "better communication with patient and family" with their EHR use, nor did they point this out as an important outcome,


Great writeup. Interesting to see an experienced EHR users perspective on training. You point out some common questions I get when training new medical staff on an EHR. The questions of when should I do this. Not being medical I balance a fine line of being able to answer a clinical question and telling them the technical answer of what is possible with the EHR.

I look forward to hearing more about your experience.

Hi John,

Thanks for the endorsement, and I would like to endorse back that training really is an art, and the balancing you are talking about takes a lot of skill. The people you are training in their minds are tying many of the concepts to other messages they are getting from/about the organization about how they should carry themselves (e.g. is this behavior incentivized?), and a good trainer has to help them organize this information.

I'm very convinced that a strong training system is critical to the implementation and ongoing maintenance of health information technology, and the organizations that are the best at HIT are the ones that resource this function adequately,


Ted Eytan, MD