General

Training and support are a continuum from the start of your planning process and continues as long as you us the electronic health record. In the beginning it is more training, but the training team (and build team) soon morphs into your support team during the go-live and beyond. There is always a need for the training team as new staff come on board and as new features are implemented.

A successful suppport model is established early in the implementation process and must include adequate, committed resources who provide the same level of support from the first provider through to the final adopter of the system. The individuals providing support should have a clear understanding of their role as well as time committment. Inadequate end user support during the CPOE implementation can become a significant barrier to the success of the implementation.

Tailoring the support

Support should be tailored to the workflow of the users

Nurses

During initial go-live, support will need to be 'round the clock to accommodate documentation and medication administration, etc.
All shifts will need to be covered until a level of comfort is achieved, with special attention to the night shifts which typically have fewer resources available overall.

Physicians

During initial go-live, support will need to be physically present during all potential rounding times. Typically, this is 24x7 for several weeks.
This schedule can be decreased after several weeks, based on rounding patterns and the composition of the medical staff; for example, how often physician groups rotate members through the hospital.
It is often possible to target prime rounding times by securing each practices rounding schedule, surgical schedules etc.

Physician unique issues

Accommodation for physicians who round infrequently. Some large groups may rotate rounds on a four or five week basis. Thus, even though support was 24x7 for the first several weeks, if a physician is making rounds for the first time on week five, he/she will require the same level of support as those on day one.
Physicians won’t wait – support should be “at the elbow” in an ideal situation; provided by very knowledgeable staff, who truly understand the system. Physicians will not tolerate if the on-the-unit support person has to call the help desk to find someone who knows the answer.
If the CPOE system is not mandatory on initial go-live, the support team will need strategies for physicians who initially refuse to use the system because they are “too busy.” Consider scheduling specific time to support the physician (“I’ll meet you on the unit tomorrow when you’re not as busy”).
Consider offering to have a support team member round with a difficult or challenged physician for an entire rounding session. This will provide intense support and is usually well received by the physician.

Phone support

Physicians will not wait to navigate through the typical help desk system. Rather than wait for someone to call back, or for someone to find the answer, the physician will handwrite the orders and blame the system and the support for “forcing” him/her to do this. Consider having direct paging or contact to the CPOE support team. As with on-site support, the CPOE team will have to be very knowledgeable of the system and be able to answer most user questions quickly. Additional ongoing considerations for post Go Live support are to have a process for the help desk line that allows a provider call to go to the top of the queue.

Vignettes

During the initial go-lives, CPOE was not mandatory. The support team on the units noticed that one physician, who was difficult to train, would arrive on the unit via the back stairwell, would grab the patient chart and run into the patient room, handwrite his orders in the paper chart, and would quickly drop the chart at the nursing station and rush off the unit via the back stairwell. The support team intercepted him the following day and scheduled a time to meet him and work through the orders on several patients.