Open Access Research article

Training providers: beyond the basics of electronic health records

Christine E Bredfeldt1*, Elias Bruce Awad2, Kenneth Joseph3 and Mark H Snyder4

Author Affiliations

1 Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St., Rockville, MD 20852, USA

2 Mid-Atlantic Permanente Medical Group, Rockville, MD, USA

3 KP HealthConnect - End User Support Services, Kaiser Permanente, Silver Spring, MD, USA

4 Strategy and Operations, Clinical Information Systems, Deloitte Consulting, McLean, VA, USA

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BMC Health Services Research 2013, 13:503  doi:10.1186/1472-6963-13-503

Published: 2 December 2013



Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities.


Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers’ effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case–control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test.


36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States.


Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria.

Electronic medical records; Physician education; Physician behavior; Provider satisfaction; Health IT; Meaningful use