Information Security in a World of Technology Write an essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be thr

Information Security in a World of Technology Write an essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be thr
. Workforce Development ses need to consider how this typ . Nu! f hn 1 e of inform ti ,r1,,is type o tee o ogy requires d t a on technology will· th . . 1w a a storage impact eir prac- tice- 1-dentify areas where data can be t and, surveillance An inform ti’ 1 to s ored and · a cs nurse can ~e P ort routine surveillance of these wearabl . acces~ed so as to develop work.flows that !PP f ti’ t · t · . es, mcludmg · • . 5 h!Oes o pa en m eraction with a 1 · • . creating indicators to prioritize 5oitl e • , r c lillcian. education Methods ,~,ng and education are often used int h frau …… – ere angeably· h h d utcornes of these two methods of deliv . . ‘ owever, t e purpose, approach, art o ermg informati . ociated with the development of th . on are quite different. Education •sass a eoretical and k 1 d . 1 ded to prepare the learner for und t d” now e ge-based foundation . ten ers an mg and 1 . if 4; van Melle et al., 2014). An example of this ap_ p_ymg concepts (Pignataro et al., , zol . foundational knowledge a d th -~e physicians who attend medical school to gain plication of knowledge, : . tn pa~hcipate in residency training to gain skills in th~ ap 2012 · Crofts et al 201S)anT ~ ~rmation (Bray, Kowalchuk, Waters, Laufman, & 5)lilling, ‘ ., · raining provid th k”ll 1 2015· G C 1 es e s i s needed to perform a task (Chen et a ., ‘ uppy- 0 es et al., 2 0l5). The ability to utili HIT · ti · . . proach to identify, d 1 . . ze m prac ce requires a training ap ‘ eve op, and utilize skills needed in the application of learning (Forsberg, s_wartwout, Murphy, Danko, & Delaney , 2015; Schaeffer, 2015). Training can be vided without the concepts found in d ti” . pro . . . e uca on, and education can be provided without the skills application found m training. Due to the applied nature of HIT provision of skills t · · 1 “ti” al 1 · . . , rammg p ays a en c ro e m adoption and maximized use of HIT (Dastagir et al., 2012; Peck, 2013; Sorensen, 2013; What training resources are available for electronic health record implementation?, n.d.). Nurses, physicians, allied healthcare professionals, and healthcare support staff must become skilled in both the use of computer technology and the use of health-information systems; effective training is~ key piece of this process (IT training, 2009; Kulhanek, 2011; Simon et al., 2013). Although training plays a critical role in the successful use of HIT, it consumes a large por­ tion of a technology-implem e ntat ion budget. There are numerous training-delivery methods, and costs for training dif fer for each method . Carefully matching training needs, end user characteristics, organiz ati onnl reso urces, and training budgets to the best training-delivery method can help to m an ae;e and contro l training costs. INSTRUCTOR-LED TR AINlt-JG Cfossroom or instructor-led training (ILT) is delivered by an instructor to an audience of learners who are present in the classroom or connected via AV tech­ nology. Development of ILT c on tent require s the least amount of work hours, averaging around 100 hours of development per hour of delivered instructional content (Kapp & Defelice, 2009), but does not include time needed to prepare the information technology for training. Develop­ ment of instructional content can include resources, such as manuals and handouts, the facili­ tator guide, sign-in sheets, learner exercises and scenarios, class evaluations, and notes pages. ILT provides a kinetic learner experience, which requires both computer hardware and a training database that mirrors the actual information-technology environment. ILT provides an opportunity for learners to interact and ask questions during the training process and can be a useful tool for change management (Celia & Rebelo, 201~)- ILT is often the most expensive training-delivery method; costs include, not only trainer and material costs, but also end user wages, technology, and facilities. Costs for ILT include: • Trainers. Trainers are responsible for the delivery of ILT, and spend time in learner assess­ ment, preparation for training, and formative and summati~e ~aining evaluati~n, and may also be accountable for training development, commurucation, and scheduling. 20 Chapter 12 rt staff may be used for printing, collating, and pre • Support staff Suppo cl ssion scheduling and tracking end “~-P ara.ti. on. t . als for each ass se , ~r s an. Of ti: ing ma en 1 . ti s and any refreshments for the class. ‘ d ¾ should be flext~ f gh in advance so that managers and sup ~ g Sc::h_ ed e l should be published ar enou er visors c:: li.~ £ training needs and replacement staff. . purposes, and costs w me · ” t ta.ff. Coverage is needed for patient care or other duties Whil e a • Replacemen s I. . ttending training. Salary costs for training will induct regu.1ar1 y scheduled emp oyee 1S a . e both t I ee Performing patient care, and the employee attending tr . the replacemen emp oy aJ.nin.g . . . 0 • ti ns may not have the available facilities to host ILT cl · • Facilities. rgaruza O asses tha uld rt a quality learning experience. Space may need to be acquired at ff . t wo suppo o -sit . h hotel training rooms or conference centers. Costs for these f ,-;i, e locations, sue as . . . . a … lllties which may require daily setup and cleanup, are mcluded m trammg costs. , • Materials. Learners attending ILT may be supported ~~th binder~, paper manuals, hand­ outs, assessments, job aids, and evaluation forms. Trammg-matenal needs must be identi­ fied, stock ordered, and the final product prepared for classroom use . • Instructional designers. The design and development of training ma y be performed b instructional designers, who are specialists in instructional and learning theory, and~ ing best practices. Instructional designers work with subject-matter experts to dev elo training content and materials so that trainers deliver the content. Costs for trainin:. materials development by professional instructional designers ma y be less than the costs associated with paying high-salary healthcare staff to per form this function. Because ILT is designed to be presented to a live audience , thi s me thod of trainin g is bes t suited for a larger-scale training effort. HIT undergoes frequent 11pc1a te s and changes , m akin g it difficult to repeat ILT training on a regular basis for newly hi r;’cj t: n ~:) loy ees. Large am oun ts of effort must be focused on ensuring that materials, and the tra it’~; ,; ~ e n v ironment , con tin u e to reflect the system and processes that are used in the live clin: .c ·1 : : . . d t ing. The key to the success of ILT is the training schedule. Sch erfo .~,s nee d to acc ommodate all staff work shifts and include make-up sessions for those not abl e to attend the re gular ly scheduled classes. Training schedules for ILT must be dev eloped and communic ated e arly in the planning process so that leaders can accommodate vacation s and staffin g levels dur ­ ing training. Class length is dependent on the amount of content to be delivered. Sessions can range from one to eight hours and, if scheduled during patient ca re shift s, r ep lac em e nt staff will be needed for adequate coverage. Classes scheduled before or after wor k shift s rna y contribute to decreased concentration and lack of attention to th e training due to fatigu e, resulting in decreased learning and retention of cont ent. . _ Tra~g should be delivered as close to the implementation date as pos sibl e; wh en train· mg IS delivered too early, the end users will not retain information. The ideal timefram e for training is to deliver content no more than a month before implementation (Peck, 20 13) . The most successful training strategies make use of dedic ated trainin g day s and tim es , wh en r e not schedul d f . . Workforce Development ·ci ants ar e or chrucal shift Partl p • ted and reinforced at th hi S, and expect ti 1Jl1.1Ca e ghest le 1 a ons about class attendance are coflll1l : … ;ng in a classroom requires suit bl ve s of leadership (Simon t 1 2013) fraJ.J…….. . a e accomm d . e a ., . technology, any mcluded peripheral de . 0 ations with enough space for the end sers, ll f th . vices, and a tl . w as we as space or e mstructor t screen and proiector for the class 0 Tle , • . • • o stand and in J · t _:1 ble within an orgaruzation, the training ove about. If suitable space is not vava d dd’ . 1 rooms may d a e is rente , a itiona resources will b nee to be rented as noted earlier. If 5pac e needed t d li ‘ . …,ent prior to class . Wireless connecti . 0 e ver, set up, and test the training n111J1Pµ• . ons Will need t b 0., _:11 need to include adequate parkin ° e present and reliable, and facili- ties ww . . g, restroom and b k f .. . . inent left overrught 1s safe. rea ac1lities, and security-so eqlllP 1· inf . As noted ear ier, ormation technology d . · ~ use m trainin h ul . keyboards, monitors, processes d . g s O d include the same com- uters, , an peripheral · P . 1 environment. The training env· eqUipment that will be used in the diJUCa rronment may b . . t the training environment and 1 e created using real patient data cop- ·ed J1l o c eansed of any ti “d tifi’ . . 1 f · 1· inf . . pa ent-i en able information . The rocess o copying ive ormation into the trainin . p freshed just prior to when tra· • b . g environment may need to be completed or re . . If h lini ming egins to reflect the latest functionality in the soft­ ware applications. t e c cal syst em changes, or is updated durin trainin , the trainin vironment should be updated as well t fl th g g g en . . 0 re ect e most accurate processes. The log-in P rocess should be srmilar to the real log-in process and e d h uld • d t t . , n users s o receive an es their personal log-in IDs and passwords at the end of the tr · · • •t tin. th . ammg session, necessi a g e need to connect with the live clinical system from the training classroom . Trainers can be employees of the organization who are either involved in education or func­ tion as super users. Trainers may also be contracted from vendors or training organizations, who are either involved only in delivering classroom instruction, or the entire training design-and­ development process. V end or trainers may train internal-organization trainers who will then con­ duct the end user classes. J! • ,,t as sta ff must be scheduled for training, a schedule must be created for trainers, so all shifts J’ · •_: ,.:)2, sse s a re accommodated. Depending on the knowledge level and experience of the end r:·,i,- ;:,,,,,ses may require multiple trainers-one to present the materials and one or more to ass i.-· · ,.e~r s ,v ho might have questions or get lost during the instruction. Most often, train er< :. .. • . · r::::’::,p onsible for developing the training data, consisting of realistic patient-care scenario s, y.. : i,,. : ~ ;5 loa ded into the training environment. The training data must meet the learning nee ds of dL of the disciplines and roles represented by employees attending training . Leaming need s o r is su es may emerge during each class, and trainers must have a plan to address or docum ent issues, and communicate these with other trainers and training designers to improve ongoing classes. It may be helpful to establish a method or location for trainer communication and updates, such as a wiki site, group email, or intranet folder. Training data must be comprehensive enough to address the needs of all learning sce­ narios presented during training, and enough examples must ~e present for multiple cl~s~es to use fresh examples each day. Data includes de-identified patient, employee, and physician databases ; student log-in IDs and passwords; orders for procedures, communication, and medications; system alerts; and admission documentation, test results, ~d other care docu­ mentation for the training patients. The training database should ~lso include alerts, error messages d d . . t t ols seen in the live clinical environment. Development , an ecision-suppor o . . . ~d maintenance of the training database will require collaboratio~ between the ~a1Illl1g and lllforn-. ti T . ust be included in information-system, pro1ect-change «La on-system teams. ramers m . Con,- • . 11 d tion application and environment changes, such as .. uiLlUUCahon to ensure that a pro uc , ‘ . . . Cod 1 · thin the trauung environment. e and software updates, are reflected accurate y wi . . . . . ‘T’L _ • th 1 room to practice is supported by activities designed ‘ue transfer of learning from e c ass · . ‘ • – · –•~ — M-…-1 nrnhlPm solving (Adams, 2000; Brady , 222 Chapter 12 aJjstiC patient scenarios are first Presen Furl 201 5. Gardner & Rich, 20l 4)·!’-,,.:ds-on replication of the activity. Seen:.~ llsi.. . 2011 · ong, , ed by 1uu• . -..10-b:i , b ‘-Ste demonstration, follow f atient care by presenting an end-~d ,_ ~ a~ Y ·’- p learning into the conteXt O P which is broken down into smane 1P’ trauung p:iaces h discharge, . f r e~b. · such as a client admission throug_ e ent to support completion o the entire Sc “- ~t segments, each building on the pno~ s ~o trigger the alerts, error ~essages, and d ~ o. Ideally; scenarios should be design . lini·cal production environment. The ecis:iOtt, , in~~c ~­ su rt notifications that are seen . 1 arrung-style preferences of the end USers th- “”-ll() m~ of training supports th e vanous ~ ns and kinesthetic replication of the p~ .. “llgli . al demonstratio , ed 1 . seri.~ auditory instructions, VlSU . • Middleton, 2012). Improv earning retention and> . Process (Anderson, 2007; Chai, 2006 , . cl ding exercises into each segment of train;_ iJi.­ Iished bym u -‘-ll1g. ‘this dation of skills can be accomp ario independently after proceeding through allows the end users to work throughtha sc~tation of specific problems, requiring th the f · · and through e P e etld. guided phase o trammg th t ls to resolve the presented issues . h 1 resources and o er oo users to access e P labo intensive means of end user training that is best Classroom training is a high~t, ~t reqwre· a large amount of knowledge disse rnina ~ for 1~~21o software implementations . . on, MUo-.;-~ . . rt fend users during learrung. One nsk of classroom…_’– as well as interaction With and suppo O • • hi «QJIJ- . . . the training delivered by different mstructors, w ch can resuit. mg. is there may be vanation m . c III inconsistent training results. Class.room training is also difficult to continue 1or new employees_ Ho . tructor-led training can allow for the flexibility needed when there are frequent wever, UlS . th tr · · changes to a new software application that cannot be taught usmg o er anung meth ods . ELEARNING A lower-cost training alternative that can be used alone, or in comb ination with other training-delivery methods, is provided by eLearning, which is the prese ntation of learning content through information technology, such as a comput~r or handheld device (Hainlen, 2015a, 2015b ). It is developed using applications that can provide content and inter­ activity; some applications are able to realistically simulate processes seen in the EHRS and other HIT. It also allows for asynchronous training: end users can access training when the y are ready and able to learn. The effectiveness of eLearning as a train ing delivery method equal to ILT is supported by research (Ahlers-Schmidt, Wetta-Hall, B ‘:·r,c · ::.~ ,) pas, Jost, & Jost, 2008; Buckley, 2003; Hall, 2015; McLoughlin & Lubna Alam, 201 4). -~’½is r..,c)dality can be used as an adjunct to other learning-delivery methods by providing a n opr ;:,rtt mity for pre-learning and preparation for validation of knowledge . Development of eLearning requires an instructional de sig nf:r vvi th a specialized skill­ set. Instructional designers work with SMEs to develop a curr icu lw n, identify key learning outcomes, and validate workflows and processes. Each hour of eLearning that is produced typically takes from 100 to 150 hours to develop (Kapp & Defelice, 2009). Costs for the dev el­ opment of eLearning include the time of the instructional designer, the time of SMEs, the cost ~f ~e eLearnin~ application, and any specialized software or hardware needed to produce the finished eLearrung product, such as video encoders or professional recording microphones and editing software. Applications for eLearning can range in price from a few hundred dollars for PowerPoint to several thousand dollars for applications such as Adobe Captivate Lectora® or Articul ate. For p~fessional e~arning development, a specialized computer widi enhanced memory and graphics, along with a large high-definition monitor may b . d D •te the higher t f · · Le . , e reqwre . esp1 cos s o acqumng e arrung-development techn 1 th . . il reus· bl ·th littl . 0 ogy, e learrung matenals are eas Y a ~ ~1 e to no mamtenance, providing an ideal tool for trainin new employee s. In addition, employees are often able to complete eLe . . g . • a regu· larly scheduled shift, eliminatin th anung dunng slower penods m . Pay Man 1 . g e need for replacement staff during class or for overtiJlle . y earrung-management systems can track th tim th d d in each e e at en users spen dule their completi Workforce Development jJl. g J1lO , on rates and th . rJ1 d lim” ‘ eu qu· /eJd Jlljzed to re uce ore mate issues of d” h iz or test scores . Test q ti. b 1 o . 1s onesh, hi ues ons can e r,ll . g evaluation. ..,, w ‘ch can occur w·th . d rJ1ifl . . 1 unmorutore /eil A well-designed eLearrung program w·ll . “” . . 1 . 1 contain el o11gh j_nteract1v~ srmu ations, activities, questio ements that engage the end user t/1ft1 ·011 (McLaughlin & Lubna Alam, 2014). It m bns that check knowledge sounds and 10 • bl · L . ay e tempf . ‘ ‘ n . t1es availa e m an e earning applicatio . mg to include all of the bells and 1v/11S • • n into the tra · · h uflJlecessary rmages, motion, colors and th ming; owever, research shows t/Jat • (Bl ‘ 0 er features d decrease learning ayney, Kalyuga, & Sweller 2 . can cause cognitive overload a Jl k Clark and Mayer (2008) noted that incl ct· b, OlS, Fraser et al., 2012). In a seminal vor, . u mg oth aud “bl · 1 …,,ng decreases learrung and increases c . . 1 e voice and written words in eLeav ….. – . ogrutive overlo d Cl k . _, -,ation obtamed through either the ea h a · ar and Mayer noted that uuOll” rs or t e eyes k essed in a single area of the memory syst hi as spo en words or pictures, are P roc em, w ch can att d t nl • . Applications for eLearning can typicall b . en ° o y one input at a time . Y e viewed on any t .th …… ,ng-management system (LMS) whe th L . compu er wi access to the Jea1, …. · re e e earning cont t . h d . tI·ons are scalable for viewing on a mobile d . E d en is ouse , and many appli- c a evice. n users ma h diffi uI · · 1,earning content on computers in patient-care if th y ave c ty viewing e . h areas e computers do not contain sound cards or plug-ms t at s~pport th e 0th er application. Prior to release, eLeaming modules should be tested on a variety of computers to ensure th t d h . . . . a en users ave an optimal trauung expenence. eLeaming is less flexible than classroom training and fr tl d • . • . , equen yup ating trauung mod- ules to reflec~ sy stem changes is not recommended. For this reason, development of eLeaming content requrre~ a broader approach to training than classroom training does. SMEs play an important role m the development of effective content. Rather than providing simulation of every detail for every step in a process, SMEs can identify key steps in a process, eliminat­ ing the smaller transition step s tha t are intuitive to the end user and are subject to frequent changes. eLearning can realisti ca lly simulate HIT, allowing the end user to see, hear, and perform actions based o:n re:-d isfic pati ent scenarios. Using this technology, end users can also repeat sections of train iJ~g Li J,.,:sfre d or proceed faster through areas where they are familiar. If eLearning is used as 2.n .-.. -i_iunct to class room training, modules can familiarize end users with system functionali ty ;:;; nd basic proce sses, paving the way for shorter classroom time that is focused on the applic ation o.f lea rni ng . Developing eLearning con t ent requires instructional designers with specia~ed skills, and the input of SMEs to design learning that focuses on the most important aspects of HIT processes. Due to the inflexibility of eLearning applications once developed, care should be taken to present key concepts, rather than all parts of a process. Evaluation, which will be discussed later, can be used to ensure that eLearning design is accurate, and that end users are demonstrating the desired learning objectives upon completion of the learning. _SELF-GUIDED LEARNING Although not frequently used, self-guid~d learning is a train­ ing-delivery method that utilizes text-based training manuals or materials that the end user can follow to learn a new system or process. Costs to produce a self-learning guide can range from stapl d . f d” •t 1 tr nun· · g manuals on the low end of cost, to profes- e copies o paper or 1g1 a a s ionaUy printed and bound manuals on the high end of cost. Learning ~des can be a useful re b t sed for limited changes rather t~ource as staff are initially learning to use HIT, but are es u n full-system implementations. Drawbacks to self-guided training include: • Littl e-to-n o ability to monitor compliance wi th training. . • ~ . I 1 ctroru ·c versions are a v ailable . • — J.~.-,-:t k un es s e e 223 224 Chapter 12 d resources may surface years lat . 1 . utdate e r t() 1 f nnted rnatena s. o gl.t.ict • Lack of contro O P ~ incorrect processes. . . th end users. 1 · t acbon wi · th d b • No instructiona in er . thiS training-delivery me o , est uses s h() . ture of the content Wl~ f r reJilinders on how to complete in.fr lllq b~ Due to the static na . new functionality or o eq1J.et limited to short job ruds for ) ks . the HIT system . performed tas in . . is a method often preferred by Ph . · tirne trauung Ys11.:” JUST IN TIME TRAINING Just-in- d tirne in a training classroom or vieWing l 1ilrs — 1 ctant to spen f . t • e ea ….. d other providers who are re u . . b £unction, pre ernng o mcorporate their le ~•1- ~ that is perceived as not relevant to ~e~ JO d livered this way enables the physicians t ‘~ mg 2012). Trauung e . . . d . th f () Pla.1: into daily practice (Catapano, . . ti t-care activities, an , w1 a ew repetitions ~ the process in the context of their daily pa ~n . ton their own. Just-in-time training res .. 1 of a I mf rtable performing 1 . . d th ‘-llts in. process, they often fee co O . tirne for busy phys1c1ans an o er providers d , greater efficiency and less non productive and supports greater adoption of info~ ~ scheduling resources, ation not require classroom or d t the unmediate needs of the learner. h · · that is targete 0 technology throug trammg f trainer or super user who can be physi all . • · · involves the use o a c y Just-m-tiine training th through the processes they feel they need to und t · th the providers to walk em . . . . h er- presen w1 I ting the processes. Just-m-time tram.mg, owever may tand at the time they are comp e f • h ‘ s , . . d tim for trainers with short periods o time w en many prov iders result m excessive own e ‘ . • db ·grun· g th tr • need assistance simultaneously. Resources can be maxlffilze . y ~ss1 ese amers to tha b f d in patient-care areas, such as morutonng user reports, or audit- tasks t can e per orme . . . . chart while waiting to assist providers with questions and trammg needs . Although the mg . s f. t . run· e trainers is strongest around physician work.flows and processes, these expertiSe o JUS -m- . . . trainers can also assist clinical staff with questions and work.flow while m patient-care areas . Additional drawbacks to this training method include gaps in training : the physician seldom sees the entire flow of a process and all of the step s in vc,lv ed from beginning to end . In addition, this type of training does not allow for probl e1n – -: -,vii. 7.g or addressing system alerts, or providing guidance as seen in a carefully plann ed ; ;=;.:..·, Blended Learning Blended learning combines elements of several different tra in .;ng- de livery methods in orde r to maximize learning and application, while minimizing expen siv e time spent in a classr oom . The blended-learning training model utilizes independent web- or print-based instru ction as preparation for an interactive instructor-led training that focuses on integration of co ncepts , learned by the end user during the independent study, into the context of practice. Th e class· room portion of this training model can be used to validate skills, present practice sce nari~s, provide discussions that stimulate critical thinking, and reinforce knowledge gaine d du nng the independent portion of training. Costs for blended learning are typically less than class· room_ tra~g, due t_o a dec~eased or eliminated requirement for replacement sta ff. Bl ended learrung 1s more easily replicated for training incoming staff on an ongoing bas is, du e to the reusable materials that support independent study . Adjunct Training Materials Training can be su po ortPrl i.. · – Workforce Development 225 aids provide an additional level of support (Martin, Silas, Covner, Hendrie, & Stewart, 2015) . care should be taken to keep job aids and reference materials to a minimum, because end users will have difficulty locating and accessing these documents in a newly paperless environment where there may be little space for storing paper documents. Critical job aids can be laminated and affixed to computers so that they are readily available when needed. specific types of job aids are correlated with the types of information and task needs . As an exam~le a task that must be completed in a particular sequence should have a job aid that depicts each step. When sequence does not matter a checklist is adequate. Other tyPes of job-aids include decision tables, flow charts, and reference sources. Job aids may also be deve~oped in response to practice gaps that are identified after EHRS training and i.Illplementation (Lear & Walters, 2015). Over time, the need for job aids, and the presence of the materials in patient-care areas, will decrease. Care should be taken to keep electronic copies of adjunct training materials easily accessible to staff hired after the initial system i.Illplementation, and to periodically review materials to ensure that they accurately reflect current system processes. Training is most effective when the hardware, software, and training environment closely match what will be used in the clinical setting. Development of training content, the technol­ ogy, and resource materials used to support training requires close collaboration between edu­ cators, informaticists, and those managing and updating the HIT system used in production. Training staff to use HIT is critical to its successful use. Training can be time-consuming and expensive, necessitating careful consideration of all training-delivery options in order to match training to the situation and need. In addition to matching the training-delivery method with the training need, there is some evidence to suggest that certain groups of learners learn best under certain training conditions. New research suggests that rather than a one-time process, training should be regularly offered, and repeated approximately every three years to address declining perceptions of benefits; this helps to improve quality Ouris Bennett, Walston, & Al-Harbi, 2015). Training Resources According to the HIMSS EMR adoption model, 93.6% of US hospitals have adopted an EMRS that includes nursing documentation (HIMSS Analytics, 2016). As the initial rush of system implementati on wind s down, some training resources are now available that offer the chance to reuse content Th ,:: fed•.~rnl goverr m1ent, HIT or EHRS vendors, training-development ven­ dors, and pro fc>s~.: ,: ·L ‘ •) rg ,. 1:1i.za tions all provide some form of educational content. Certain professiona l o ·. -~ / ‘ , ·,; :..cJ L -~lb t 1.:c h as HI MSS , AMIA, and ANIA promote instructional best prac­ tices for max i:r , • .·, · ‘. :i..·,~~”c’; 0t:.tco mes. Professi on Jt ; r;:”.Hzatio ns with a focus on training and development provide a rich variety of resou rces a.rid suppor t for trainers and instructional designers. These organizations include the Assocl3tion for Talent Development, the International Society for Performance Improvement, and the Association for Nursing Professional Development, most of which offer memberships at a reasonable cost. The Association for Talent Development (ATD) (2016) is a professional organization that provides networking, research, and resources for professional training and development practitioners around the world. Just as healthcare has best practices and evidence-based care, training and instruction is based on theories and research that provide training best prac­ tices. ATD is focused on research and education that supports trainers, instructional d.esign­ ers, and talent-development practitioners with the latest evidence and resources that guide and support best practices for instructional development and delivery. The organization 226 Chapter 12 ‘d . Learning training, and other t provi es courses and certifications in learning design, e ‘ _, Opir. I al ll s a yearly coruerence eLe -.. t so hosts regular webinars and training events, as we a ‘ arnii) resources, publications, and events held at local ATD chapters. ISPI) f g Th ement ( ocuses prirn . e International Society for Performance Improv ff . . ar1Jy 0 h , . th ost cost-e ective mterventi I uman performance improvement by exammmg e m 0ns th · ffered by ISPI look at all at influence human behavior, including training. Courses O • aspects h . th development and delivery of tr . of uman performance improvement rather than iust e atnii) Th Ass · • . . 1 D lopment (ANPD) focuses on the sp . g, e ocration for Nursmg Profess1ona eve ec1a1h. f . enhance healthcare outcomes. ANPD ·, o nursmg professional development in order to Pr ‘d ‘ch ddi · 1 resources, and the opportunity t ().. VI es n experiential resources, links to a bona O cot! . municate and collaborate with other clinical educators. . . l · titutions provide open-sourc tr . The federal government and some educationa 1IlS . . e atnin materials focused on HIT and the regulatory environment dnvmg chang~. These tnatenalg · l ‘ r specific EHRS and informati s are useful for providing background and rationa e 10 0n-tech nology functions within an organization. The Department of Health and Human Services. in collaboration with the Office of the National Coordinator, has developed a cornplete Se; of curricula designed to facilitate growth of the HIT workf~rce (Department ~f Health ald Human Services, 2016). The current curriculum is undergoing an upd~te, which shou ld be available in late 2016 or early 2017 . Additional workfo~e-~aining mate~, su~ as the Open Learning Initiative launched by Carnegie Mellon Uruversity, can provide publicly av ailable content that can be integrated into specific training programs. . . An HIT or EHRS vendor may offer training for a client org~tion ~ough the train. the-trainer method. Using this training method, the vendor trams sel~ mtei:nal train ers, who then provide training for all of the end users. The vendor may provide th e Instructi onal curriculum, the organization may customize content provided by the vendor , or the organiza. tion may develop all of the content internally. Vendor training typically reflects a generi c and standard use of information technology, not the customizations and workflow proces ses use d within a specific organization. Customization of c~culum an~ w?rkflow is often necessary to align the training with the work processes used in an organization. Many training-development organizations have emerged since the explosion of EHRS implementations. These organizations specialize in providing instructional design, training, and support services to organizations with trainir.ig needs. These vendors will wor k wi th SMEs within an organization to develop custom training that matches the w ork flow and functionality of the information technology. Training vendors can produce p rofe ssion al quality eLearning that can meet trajning needs for several years, while eliminatin g the ne ed to develop internal expertise in the development of eLearning . Although there are many resources available to produce lilT training, customiz ed work is necessary in order to accurately capture the workflow and functionality of an org aniz atio n’s EHRS . Professional organizations provide resources that support the development and delil’ery of training by using evidence and best practices . Publicly available lilT workforce-tr ainin g m a te­ rials are available on the Internet, and the detailed and customized training that is n eeded for learning to use an EHRS is available through vendors and training-development organiz atio ns. Evaluating Success ~IT trai~g should focus on producing end users who are competent in using sele(ted information t:~ology, with ~e assumption that proficiency will occur over tim e ,·ith use. Successful tralIUilg programs rncorporate formative and summative ev alu a tion to d eterm ine the effectiveness of the training program d d , · · I · ,,, , an stu ents success at accomp hshm g t’,11111 1 ~ workforce Development •eetives. A training program without eval · lib) fit. Evaluation should b 1 Uation can result in a large expense with little to 110 i,en e e P anned when training is designed and developed. po r:rnative Evaluation ativ e ev aluation assesses the eff ti fortn d th ec veness of the selected training-delivery method, the tent an e success of the tra · · d • con ‘ 015 H ld 1 nung esign to meet the needs of the learners (Flora & Nfarquez, 2 ed; bo _en et~ · , 20lS; McGowan, Cusack, & Poon, 2008). Formative evaluation 1,..,, conduct y mvolvmg SMEs and ·· d • • · can~ . . . naive en users ma systematic review of the trammg c o.11tent at certam pomts m th e development process. Tools used for formative evaluation can include focus groupS, pre- ~d post-tests after content review, and evaluation of the ability to use the EHRS after completion of the draft version of the training materials . Form ative evaluation can also be c d t d d · · · · . on uc e urmg the trammg process. Review of post- traifling eval~ations and tes~s _may highlight a pattern of learning that points to a gap in the training cumculum, th e tranung-delivery method, or even the instructor . When conducted early in the training process, formative evaluation of training will allow for rapid, on-the-fly changes that increase the effectiveness of ongoing training. summative Evaluation sununative evaluation assesses the success of the training program in enabling students to :meet the learning objectives. Summative evaluation can be used to demonstrate reactions to training, knowledge gained during training, application of training on the job, the value of the training program to stakeholders and the business, and ultimately, to determine the return on investment of the training program . REACTION EVALUATION Evaluation of response, or reaction to training, is the most com­ monly used method of summative evaluation. In this evaluation, the learners provide imme- diate feedback about how they liked the training program, how effective the training program was, and the perceived relevance to the work of the learners. Reaction evaluation can help to identify areas for improvement with instructors, class length, content delivery, and other logistics. However, Phillips and Stawarski, in their classic work, noted there is no evidence that a positive reaction to a learning program will result in successful application of learning on the job (2008). Learners can enjoy a training program and never apply the learning to their daily work. When learners are asked a question in an evaluation, there is the expectation that something may change as a result of the time and effort the learner puts into providing feedback. Be careful to only ask questions around items that you have the power to change. A question about the training room might elicit great feedback; however, the trainer may have little to no ability to change the size or other specifics of the training facilities. KNOWLEDGE EVALUATION Knowledge evaluation is the assessment of how the learner has gained new information and knowledge during the training session. This type of infor­ mation is typically collected during and immediately after training, using methods such as quizzes, post-tests, return demonstrations, or completion of presented scenarios. Although the learner will not be successful without the acquisition of knowledge during training, gain­ ing knowledge alone does not correlate to successful application of knowledge (Phillips & Stawarski, 2008). The ultimate goal of any HIT-training program is to produce an effective on -the-job application of learning. APPLICATION EVALUATION Collection of data used to evaluate the application of learn­ ing can occur both during the training session and a period of time after training, when the learner has had the opportunity to apply the knowledge gained in a real-life setting. App li ca tion-evaluation data requires more effort and time to collect, and may require chart 227 228 Chap(er 12 ed to capt.., •- d to the UJJtc …… ……… v, l ue <>r1 • i , d ·art . g ue ‘-.led t · ” _…,.rts esi,,– of JeatfUI1 __ -arfion measures O c ucfilS and system rcr”‘- pJicatioJl tion and CUJ.l~”- are the ~ Cl//, ;rgarozations evaJuate the :plication elalthu~orrnation teehnology. t iv, tio.n; however, . of heal 1 . this in{orma __ A _a;aent use . n or value eva uation , ex . (“(‘1,11″8le auu eJJI valuatIO ‘ . alllt to ensure a ‘fhe busiJleSS e ‘.fhis type of evaluation can 6 11es t’ LUATION h Jthcate · f HIT · · e dif f 1 susINESS EVA b . siJleSS of ea th 1,enefits O trauung are ct;, . le~ . . on the u t..,y,ause e ti’ t hn 1Jf1cu l jmnact of traiJtiI18 itOrunent ~ . f the informa on ec olog v . t, r- Jthcate env entatton ° • } 1tseu · to collect in a heel f the iJnpleJil . es.s measures. More informati , . rovide uuonna . . t e n – Training evaluation can P . hile summative evaluation IS used to evalu ate · methods through formative ev~luatio~, wthe learning objectives. Learning objecti ves sh o thl; of the · · rogram m meeting u ll success tnurung P d used to gw’de both the development of the h-.• · · t training development an ” sd ,e d f r storing and accessing backup data . , .1,,ods o rv1e 1.1• , re Directions -Ct,1.ttl- of :HIT is dependent on effective training for all members of the workforce . A_s J tuse · · · hnl · touti- , ficie tl advances m trammg tee o ogy keep pace. Just as healthcare strives o(O esses , . • . . . · t for 1 fl”f nrogr . es and evidence m the prov1s1on of care, best practices and evidence exis J1″ r ractlC . t d e !)es t P . and delivery. Sources, such as The Association for Talent Developmen an ni jJlitlS Jesignt of Health and Human Services, contain resources that can be easily accessed irJ arunen d . . pep ted to gui e trammg . 01e leJJ’.len . . . . 1 d d iJtlP …,,..,:, :HIT trammg may need to be considered as an ongoing process, that me u es JJ1 t}le fuL,..,_- , • • Ill technology and workflow changes. Training in the future may be less disruptive ,,&at es on e when supported by the latest training delivery methods. Sustaining a culture Lir . pt car . . to paue uires competent understandmg and use of health information technology. fet}’ req 0f sa s u rnrnary roficient use of HIT is imperative for the delivery of safe, efficient, quality patient car~ ­ • ~urse informaticists play a major role in the development, implementation, and opti­ • . ation of clinical applications, which include preparing the workforce to use HIT· • :elopment of a workforce development plan requires an understanding of the needs of the educators who will train the workforce, how change takes place, how the external environment impacts the internal environment, and organizational culture. , A workforce development plan requires identification of learning needs, subject­ matter experts, goals and objectives, and the scope of the effort . , A realistic training environment requires work to create and maintain, and facilitates learning. , Training is an ideal time to introduce policies relevant to maintairring patient privacy and security of personal health information (PHI), system-downtime procedures, appropriate use of email and computer resources, equipment-cleaning protocols, password management, camera use, removal of devices from secure areas, social ­ media use, information security, error correction, and use of personal devices . • Workforce development entails more than educating healthcare workers on how to use EHRs ; it entails the entire spectrum of HIT they will use to perform their duties. • The terms training and education are often used interchangeably, but differ in approach; education relies upon the development of a theoretical and knowledge­ based foundation to help the learner understand and apply concepts. Training pro­ vides skills needed to perform a task. • Training is not only critical to the successful use of HIT, but also consumes a large portion of a technology-implementation budget. • Training approaches vary but may include: instructor-led training, eLearning, self- loPfTl””” guided learning, just-in-time training, and blended learning. Costs for each method vary. • Matching training needs, end user characteristics, organizational resources, and training budgets to the best training-delivery method can help to manage and control training costs. • Adjunct training resources, such as job aids, email reminders, ongoing training tips, anrl easily access ible audio visual clips, as well as the ongoing presence of trainers ..:::: per users in work areas, can support training efforts. 230 Chapter 12 d ining-development vendors, and ftW are an tra . 1 Ptof , • The U S governn1ent , so • of educatlona resources that can b ess j,. ‘d ome 1orm et “~ organizations all pro v 1 es though training must be customized apPec1 ill • utco n1es, even . · tor n tn maximize learrun8 ° . . dt’vidual orgaruzations. :’i1ect ti abty at in eff workflo w and {unc on I 11·on to determine the ectiveness of t . tive e va ua rain· • Formati v e and summa tnp . ful HIT use. ci is important to ensure su~ce ss effecti veness of the selected training m th . h uld consider the e o ct • Evaluations o eeds of the learners . , co ~t and training design to m~t the.; gaps in training curriculum, delivery (~t. • Formati v e evaluation can identi a· ,e measures that ensure overall meth od 0 . rovide correc succe ‘ t with the instructor ~o P . 1 d user feedback, as well as knowledge ss. • Summative evaluation can inc u e ‘ apPlicar . ~ and business evaluat1on. nl d form of summative evaluati ‘ • User feedback is the most commo y use ful li ti on, alth ou . . ack does not guarantee success app ca on. gh positi v e user feedb ed during or immediately after trainin • Knowledge evaluation is often us d . g to dete . kn led gam· ed· quizzes, post-tests, return ernonstrahons, and co”‘pl r- nune ow ge , ‘” e ti tl USed measures. on of presented scenarios are frequen Y . . b d b th during and after trauung, but · • Application evaluation may e one O • • 15 lllore labor- and time-intensive to collect even though it may provide the best measure of training success. B • al . ti’ be diffi’cult to determine due to other variables such • usmess ev ua on can . . ‘ a s ben. efits associated with the new technology itself; return on mveStrnent (ROI) loo ks . ‘ti’ b . . at all costs associated with training measured ~gairu:t pos1 ve usmess unpact and intan. gible benefits, such as user- or patient-satiSfaction scores. • It is critical to include training on backup procedures so sta ff are able to continu e Providing safe patient care and other clinical operations without access to HIT rn . · – anv current healthcare workers have never used paper to manage patient care , n o r ha ve· they been without the safeguards provided with HIT. – – — —~– – — —— – Case Studies 1. Interprofes- A hospital implemented an interprofessional patient electronic health sional Team record. All clinicians now document on the same flowsheet in shared areas. Both respiratory and nursing document lung asses sment s and interventions in the same place on the patient record. Trad itionally, this documentation had been completed. independentl y in a sil o ed health record. Each discipline had their own section for resp irat ory assessments and interventions . At 8 pm, the nurse document s that the patient’s respiratory assessment is within defined limits (me anin g normal). At 8:30 pm, the respiratory therapist documents the patient is mildly short of breath with an intermittent inspiratory wh eeze. The respiratory therapist does not verbally communicate thi s to the nurse, thinking the nurse will see the respiratory therapi st’s assess­ ment and intervention in the EHR. The next nursing assessm ent fer this patient is not due until midnight. What may be the end result of relying solely on the EH R fo: communication within the interprofessional team? Is there J way for an informatics specialist to display critical asses sme nb differently to gain the attention of all clinicians? – pecision z, d support an Adoption 3, Medication Reconciliation 4. Emotional Intelligence 5. End User Needs Worl A heart-failure patient is readmitted to the hospital 30 days post ini­ tial admission for shortness of breath. The hospital system has dis­ parate EHRs. The outpatient , emergency room, and inpatient areas are all on different EHRs, which are not integrated. Upon the initial admission, the home-medication list is documented , but incorrect. The correction was made on the inpatient medication reconciliation page and transferred to the patient ‘s discharge instructions, which was faxed to the primary-care physicians, who then noted and made the change in their EHR. Upon readmission, the emergency-room record lists the home-medication list. What potential risks can you identify? Is there a way to resolve them? As a nurse informaticist, you are showing subject-matter experts portions of documentation involving a falls risk-assessment screen­ ing. The group is diverse and has many opinions on the tool that should be used to screen patients. Some of the staff are extremely passionate on what tool should be used as it was what has always been used . You feel yourself starting to get emotional as well. What would you do in this situation to keep it under control’? The IT department has completed an assessment on all units regard- ing placement of computers for the upcoming implementation of the EHR. Staff were not involved. However, the decision was made to place computers in every patient room to support the implementa- tion. When nursing informatics learned of this decision, they decided to complete an end user needs-assessment to ensure this was the right decision. The assessment focused specifically on computer accessibility to support real-time point of care documentation in a variety of settings. The assessment identified that different depart­ ments, such as med/ surg verses critical care, have different needs. How would you, as a nurse informaticist, approach a new solu­ tion and approach to the IT department? 231 (Con tinued) 232 Chapt.,,.12 6. Scope Creep A ·ect team is in the process of implementing b p~ . ~~ ed . ti” n administration. Someone on the te,.,_ an … , 7. Failure due to Lack of Integration m 1ca o -…… su -llt’lg f ,,, …… inO’ be expanded to include breast milk for n ggests (}t sc ….. ~–o . Th . . al ewbo,- thil ta1 : … tensive-care urut. e ongm scope wa ·••s i…. t neona .u, • • s to · .. , th b code scanning for medications only. By adding .-.. .. , l.rrtple”‘ e ar d b ‘-‘llS to n.. ··•et ect plan, many additional tasks nee to e completed toe ..,,e Pr(} · breast milk has a bar code placed on the bottle (workflow) l’s1.i.re th: ner can read the bar code (process), new tasks need t , the Sc;, … . bl d o he b “”I• the EHR (build), and the nurse IS a e to ocument the l.l.ilt . . edi . d . . . act.mi … , ll tion on the electroruc m cati~n-a nurustrati~i:1 record ( /· ‘Strc1 .. Although this may not seem like a lot of additional P 0cess) . . Work . addition distracts the pro1ect team from the original p . , eveh . roJect ·, and scope. Pl