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Challenges in Clinical Rotations: Implementing an EMR System

The Michigan Health Council’s ACE System was originally designed to increase clinical rotation capacity and save valuable clinical time by standardizing requirements of students and faculty.

The system has given ACE members in Michigan an opportunity to share information and a forum to share ideas, challenges, and opportunities.

One growing concern I have heard from many ACE System members is how EMR implementation will impact the availability of clinical placements. For those who have experienced it, an EMR implementation can be a disruption to every aspect of a health system or clinic.

I spoke with Sandy Schmitt, BSN, RN, Manager of Nursing Development from the Oakwood Healthcare System, about how she balanced managing clinical rotations with an EMR implementation process.Sandy identified that is was helpful to include a focus on the impact of the EMR for nursing students and faculty early on in a system’s EMR implementation process. It’s easy for the EMR vendor and hospital implementation team to initially be focused exclusively on hospital staff. However, the provision of training for nursing students and faculty was of utmost importance initially, as well.

Oakwood limited clinical rotations at each Oakwood site during the month of their individual EMR “go-live.” This limitation was communicated to the schools very early on in the process in order to limit the amount of disruption to the academic clinical placement process. According to

Sandy, in most cases, Oakwood was able to accommodate clinical placements at other Oakwood sites so that the schools did not experience problems.Sandy and the Oakwood system implementation training team developed EMR training courses taught by certified Oakwood trainers to give students and nursing faculty hands-on training with the system, saying, “It was great to give students time to barcode medication actually use the system in class and for faculty to watch them directly to see where opportunities were for improvement.” The student course was four hours and the faculty course was initially eight hours. These courses occurred at an Oakwood site on the student’s first clinical day.

However, replacing required clinical education hours with lengthy and costly classroom EMR training wasn’t ideal for schools or for Oakwood. Therefore, Oakwood developed online EMR training modules which were implemented one year after initial EMR implementation. Over 600 nursing students have successfully completed the online training modules (which students prefer over classroom training) throughout the first semester of their use.

Sandy recommended looking for userfeedback throughout the process, noting “when I asked them for feedback, I got it.” She responded to concerns about the faculty course length, by condensing it into only four hours, rather than eight and actually combined it with the student course based on faculty feedback. She included faculty and students in focus groups to review and comment on training and access processes. She surveyed students and faculty about the modules and discovered that multiple improvements could be made (which are being done now).

I asked Sandy what three things she would recommend to others going through this process, and her advice was simple, “Communicate, communicate, communicate.” By pro-actively working with clinical partners to provide adequate notification of the EMR changes and the resulting orientation and training, hundreds of students and faculty avoided the dual confusion of acclimating both to clinical rotations and an EMR. Numerous email updates were sent out to academic nursing administrators, coordinators and faculty as well as to hospital unit managers explaining the process each step of the way. EMR implementation was not without some individual problems, but overall, implementation and training went smoothly.

Obviously, communicating with the IT and HR staff is absolutely essential. Sandy was able to use ACEMAPP’s student records to provide human resources with a list of students and faculty demographic information, who were able to be assigned unique login information to access the learning modules and the actual EMR.

(To make this process easier, the ACEMAPP team is currently working on a feature to create customizable reports, directly from the ACEMAPP program. This should be available by Spring of 2014.)

Reflecting on the work before and after the 2012 August implementation of the EMR, Sandy had one other key piece of advice. She highly recommends that you learn from other healthcare system’s EMR implementation experience. The Beaumont Healthcare System was particularly helpful to Oakwood, especially since they had already implemented the same EMR system.

All of Sandy’s suggestions reflect one of ACEMAPP’s founding beliefs: proactive communication and organization help prevent changes from becoming problems.


This commentary was written by Stacy Gradowski, Program Manager of ACEMAPP, an online student clinical rotation matching, placement, and on-boarding system that manages clinical rotations for 7,000. Learn more here.

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