Post-Pandemic Electronic Health Record (EHR) Training Methods and Associated Decision-Making Processes

The purpose of this study was to explore factors and personnel involved in the decision-making process used to determine electronic heath record (EHR) training methods employed by healthcare organizations in 2023. Additionally, the purpose was to learn more about EHR training leaders’ perspectives of various training methods, and to determine how and to what extent EHR training methods were impacted by the COVID-19 pandemic. Bounded rationality and the theory of transactional distance were the two guiding theories for this study.This mixed-methods action research study was conducted in a virtual setting and included 47 EHR training leader participants who worked at various health systems across the United States. Data was collected via an 11 item EHR training methods survey. Quantitative data was analyzed through descriptive statistics and a Wilcoxon rank test was used to analyze changes in EHR training methods in 2019 and 2023. Qualitative data was reviewed, coded, and analyzed in such a way as to be consistent with the grounded theory approach. Data was triangulated to corroborate findings. Results indicated that the pandemic, or other contributing factors between 2019 and 2023, had a statistically significant effect on EHR training methods. In addition, the majority of EHR training leaders felt that the most effective training method was a majority in-person with some virtual/remote/eLearning, and that the most efficient training method was a majority of virtual/remote/eLearning with some in-person. EHR Training Directors, EHR Training Managers, and Executive Leaders were the most identified roles involved in the decision-making process which typically involved collaborative meetings and discussions with various stakeholders. Furthermore, resources, cost, and effectiveness were the most identified driving factors related to EHR training method decisions. The discussion focuses on answering the four guiding research questions and provides implications for practice including suggestions for organizations to minimize cognitive limits in the decision-making process, re-evaluate EHR training decisions to ensure appropriate decision-makers were involved and that decisions aligned with their goals, and consider if resources and cost should be the leading driving factors related to EHR training methods.