Creating Effective Training and Workflows to Improve Care Coordination

To provide coordinated care that meets patients’ needs, many communities are developing information systems to share data across clinical and social service settings. In order for these systems to be effective in connecting patients to the right services at the right time, care teams need to adjust their workflows to incorporate this new data into their current practice, often at several different organizations.

Introducing new technologies or procedures into established workflows can present many challenges, especially when a system has several different types of users with varying roles and perspectives. To explore how communities are approaching information systems training for end users and workflow adoption, All In: Data for Community Health hosted a webinar featuring three local projects, who gave the following advice to communities in the early stages of this process.

1. Follow established guidelines

When Susan Richardson, Research Specialist at the Vermont Child Health Improvement Plan (VCHIP), was developing a plan to help practices integrate a new cloud-based information platform called ACT.md into their work, she started by looking towards already established guides for help. One guide that she found useful was AHRQ’s Workflow Assessment for Health IT Toolkit, which helps practitioners develop the “who, what, where, when and how things get done in your clinic.”

2. Understand the staff you are training and meet them where they are

Clinical Educator Sharon Bearor, who leads the clinical implementation of Maine HealthInfoNet’s health information exchange (HIE) and analytics tool, emphasized the importance of understanding the roles of the staff she trains, including their current processes and responsibilities, how they are using the HIE, and any concerns or educational gaps that the program can help address. Coming from a nursing background, she has been on the other side of these trainings and understands the need to be patient, understanding, and flexible as the staff adopts a new approach.

Richardson agreed that taking time to become familiar with what’s currently happening at a clinical practice is key to success. In advance of launching the ACT.md platform, VCHIP gathered workflow perspectives from multiple roles within the clinic and synthesized them to understand how each part of a practice would be impacted. Each site practiced with a demo version beforehand to give the staff ample time to ask questions and work out any kinks prior to launching with real data.

3. Tailor your approach to different users

Before Nate Tyler, Chief Operating Officer of SimplyConnect HIE, began training providers within the Altair Accountable Care Organization (ACO) to implement a new e-health infrastructure to coordinate primary care and behavioral health services for people with disabilities, he took the approach of conducting a “full-fledged marketing program” to educate everyone involved about the project, their specific role, and how they fit in to the bigger picture. Stakeholders received educational materials tailored to their specific roles, including parents and guardians, people receiving the services, case managers, and care coordinators.

HealthInfoNet and VCHIP also provide specialized outreach for different types of providers to give them concrete examples of how the electronic shared plan of care adds value to their work. For example, when VCHIIP meets with a pediatric endocrinologist, they might provide examples of practices that have the same patients in common, or show them how they can use the platform to communicate with other providers or collect information from families in between appointments.

4. Use incentives to reinforce desired actions

Presenters suggested using incentives to encourage staff to attend trainings or maintain new protocols. Through Maine’s nursing association, Bearor is able to offer continuing education units (CEU) for nurses who attended her trainings to make them an even more valuable use of time. Tyler also worked with two ACO members that offered gift cards to employees that adhered closely to the new protocols for conducting behavioral health assessments.

5. Offer online trainings and materials to supplement in-person sessions

Although Bearor likes the interaction and feedback that she gets through in-person trainings, she is the only the only trainer in the entire state of Maine, making it difficult to be there in person when new staff members are hired or users who have already attended the initial training need further support. To deal with turnover and follow-up trainings, she provides coaching through virtual webinars.

VCHIP’s Boston-based ACT.md platform also offers remote trainings for practices located in Vermont, using a screen-sharing tool to address technical issues and posting all training materials online so that organizations can easily access them to solve issues or onboard new employees.

6. Cultivate “super-users” and “champions” that can help maintain buy-in

At in-person trainings, Bearor always tries to identify “super-users” who are actively engaged and interested in understanding the ins-and-outs of the analytics tool. She explained, “When users have buy-in and enthusiasm, it makes my job a lot easier.” One tactic that worked well was holding webinars to connect new users to organizations who have already had success incorporating the tool into their work.

Altair ACO has focused on cultivating “champions” at every level that understand the core benefits of the project and advocate for it within their organizations. The project team holds monthly meetings with CEOs of the ACO member organizations to make sure leaders understand what’s happening and what they are getting out of participating.

7. Follow-up regularly, monitor usage, and share results

Presenters agreed that post-training communications and monitoring were essential to support users during the implementation phase. Two weeks after an initial training, Bearor conducts an audit to ensure users are all connected and using the analytics tool, assess issues or barriers, and provide coaching for those who need additional support.

ACT.md works with VCHIP to regularly monitor user activity and share analytics related to user response, logins, and updates to care plans. They will soon be sharing progress reports to give users regular analytics feedback.

In addition to sharing numerical results, Altair ACO finds that sharing real stories of how the program is making an impact on the lives of people they are supporting is very effective in maintaining buy-in for the project. Every month, project managers at each site receive a list of “wins” or patient success stories, which they can share at their staff meetings to motivate the rest of their team.