Originally published in High-Profile Monthly. By Jason Costello and Nathan Turner
May 20, 2016 – The requirement for hospitals to convert to electronic health records (EHR) is a significant endeavor that contains many challenges for the successful implementation of the technology. Adoption of EHR systems, as illustrated in recent media articles, can pose a steep learning curve for some medical staff. Technology change is particularly difficult in the ever shifting healthcare environment where staff commonly complain about high stress levels, being overworked, and not having enough time with patients. The EHR training requires a significant time commitment from both the employee and the institution. At the very least, EHR training sites should not contribute to these employee frustrations.
Training locations should be chosen to minimize the impact on employees’ daily commute and routine.
Locating EHR training within proximity of a clinical facility also reduces travel time for doctors and other employees on call, a hidden expense often overlooked when evaluating sites.
A variety of real estate options should be considered, from repurposing existing space on campus for training rooms to leasing commercial space and fitting out a training center. The most viable from a cost and convenience standpoint is to identify space on campus that can be temporarily utilized for the short but intensive training. Smaller community hospitals can utilize their existing multipurpose room or large conference room as the training setting. These spaces can put limitations on class size and functionality but often have the basic AV requirements for computer instruction and can be readily converted to accommodate the classroom function.
Larger institutions may choose a commercial lease and fit out a custom training center programmed to meet their specific training needs. This provides them with a highly customized classroom setting that aligns with their short-term training plan while addressing other long-term facility needs for meeting rooms, clinical simulation labs, and ongoing EHR training for new staff. When placing a training facility in a commercial multitenant building, issues of access and schedule must be addressed with property management. If large groups are accessing secure entrances and elevators simultaneously, it will inevitably impact building security staff, other tenants, and visitors. Some landlords may require a design that supports additional entry/check-in areas dedicated to trainees.
Other alternatives to building dedicated training space may be advantageous for organizations trying to manage the initial capital costs of both a new facility and the procurement of new EHR technology. Short-term rental contracts can be made at training centers, convention sites, and, for smaller hospitals, hotels. Choosing a temporary offsite training location also eliminates the challenge of repurposing a new fit-out space for future uses.
The design of the classroom and adjacent amenities can impact how the training process is perceived by staff. Two important design factors include: 1) right-sizing the classroom to avoid overcrowding and improve visibility to the instructor’s projection screen and 2) designing the HVAC systems to ensure the training rooms are kept at a comfortable temperature for everyone. The latter is especially important if the classroom function is a change in occupancy from the standard business and hospital occupancy to assembly occupancy, impacting the HVAC systems to provide appropriate cooling and ventilation for the occupants and the computer heat loads.
For example, Margulies Perruzzi Architects recently designed a training center for a major academic medical center, establishing the optimal classroom size at 850sf to 900sf. This was determined by evaluating coursework hours, students, classes per day, space available, total employees trained, and ideal class size. Classrooms were designed for 16 to 20 work stations to achieve a good balance of efficiency and personalized attention. The combination of these factors determines the overall schedule of the training period; a recent client required 12 months to train more than 18,000 employees. MPA also replaced the majority of the HVAC system and provided a new variable air volume (VAV) system for the training center. This upgrade to the existing space provided increased cooling capacity for the change in use, as well as individual temperature controls for adjustment in each classroom.
There are many variables in the design of EHR training centers. The goal should be to create a positive training experience that promotes learning and helps hospitals make this technology transition smoothly, without inflicting more stress and frustration on their employees.
Jason Costello, AIA, EDAC, is an associate principal and partner, and Nathan Turner, AIA, LEED AP, is an associate partner and senior project manager at Margulies Perruzzi Architects.