Latest / Becker’s Healthcare Podcast / Leading Change: How CMIOs Are Redefining Health IT Education

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Leading Change: How CMIOs Are Redefining Health IT Education · Becker’s Healthcare Podcast

0:00
Hello, everyone, and welcome to this episode of
0:03
Becker's HealthCare podcast.
0:04
I'm Stephanie Lahr, chief medical officer at UPerform,
0:07
and I'm thrilled to be joined today by
0:09
doctor Brian Jarabic, CMIO
0:11
at mHealth Fairview.
0:13
Doctor. Jerabick is a practicing hospitalist and CMIO
0:16
who has led major EHR optimization and digital
0:19
transformation efforts with a strong focus on clinician
0:22
readiness,
0:23
scalable education, and making change stick.
0:26
At Fairview, his work has helped reshape how
0:29
teams approach health IT training, moving beyond go
0:32
lives to continuous learning that truly supports adoption.
0:36
I'm excited to explore what's worked, how education
0:39
and change management come together, and what leaders
0:41
should be thinking about next. Brian, thanks so
0:44
much for being here today. Thanks, Stephanie.
0:47
Alright. Well, let's dive right into the conversation.
0:51
MHealth Fairview's approach to health IT education and
0:55
clinician readiness
0:56
have been really successful, and I think also
0:58
a bit of a journey of transformation
1:00
to get there. I would love for you
1:03
to share a bit more about your key
1:04
wins,
1:06
key changes, strategies that kind of contributed to
1:09
getting to this successful place that you are
1:11
today.
1:12
Yeah. Thanks, Stephanie. Just excited to be able
1:14
to share about this and all the improvements
1:16
that we've done with our training teams for
1:18
our caregivers.
1:20
Everything's done as part of a community. So
1:22
Derek Harley and Jen Steinhaus
1:25
are two of our leaders and wanted to
1:27
just say thank you for all that they've
1:29
done in the last few years, that we'll
1:31
be talking about here.
1:32
We've really transformed the way we deliver training
1:35
at mHealth Fairview.
1:37
We're a large
1:38
academic health system. We have 10 hospitals and
1:41
around 60 clinics,
1:43
and we're based out of Minneapolis,
1:45
Minnesota.
1:46
And over the last couple years, we've really
1:48
transitioned the way we do all of our
1:51
training. So it's
1:52
been, a big change for the entire organization.
1:55
It was driven by wanting to adjust to
1:58
the way that our health care staff really
2:00
wants to engage technology and how they wanna
2:03
be trained, which is really different than the
2:05
old school model of, you know, line me
2:07
up with a teacher, let me learn something
2:09
from somebody in a classroom.
2:11
They really wanted more asynchronous
2:14
technology,
2:15
to be used where, you know, teach me
2:18
as I want to learn something, when I
2:20
want to learn something,
2:21
keep it short, keep it video based,
2:24
put it directly in my workflow, like, we
2:26
heard all those things.
2:28
And so now we
2:30
went away from in person
2:32
training.
2:33
We started doing everything asynchronously.
2:36
We developed all the material differently. So we
2:38
took all that classroom material,
2:40
divided it up into really small little segments
2:43
that are more bite sized,
2:45
that you can really learn from.
2:47
And then we've really
2:49
developed these learning pathways
2:51
that are all the way from beginner up
2:53
to mastery.
2:54
And I'll say it's really transformed
2:57
the way we deliver training in a really
3:00
successful
3:01
way. The feedback that we got from people
3:04
is
3:05
it's not like drinking through a fire hose
3:07
anymore. Sometimes those classroom trainings are just intense
3:11
four or eight hours, try to learn everything.
3:14
Now it's more bite sized, and you can
3:16
feed it back to them as they're kind
3:18
of learning and developing.
3:20
So those have been some of the the
3:21
big transitions
3:23
that we've made.
3:24
It's been really helpful.
3:26
I'd also say, continuing to emphasize
3:29
change management and kind of high touch ongoing
3:32
support
3:33
has been key.
3:35
So we've been doing a lot in that
3:36
where we actually go out and do rounds
3:38
now.
3:39
So it's not as much about training them
3:42
in that classroom or figuring it out right
3:45
away,
3:45
but having touch points all along the way
3:48
with people. So if you can combine that
3:50
asynchronous learning with some high touch personalized support
3:53
and ongoing learning,
3:55
that's been the trick that's really led us
3:57
to over the last seven years now, we've
3:59
had
4:00
EHR satisfaction
4:01
improvements every year for seven years in a
4:04
row. And so something our training teams are
4:06
really proud of here at mHealth Fairview.
4:09
Yeah. That's that's amazing. I mean, seven years
4:12
year over year of improvement.
4:14
I don't know that I've heard really any
4:16
organization. One, the fact that you're measuring that
4:18
and evaluating it is commendable in and of
4:21
itself, but the fact that you're able to
4:23
every year continue to improve on that is
4:25
is really fantastic.
4:27
Knowing that, obviously, you have and you mentioned
4:29
some of them already, a really stellar
4:32
team that is supporting this,
4:35
and that many organizations that are listening right
4:38
now might be thinking,
4:40
wow. That's the kind of transition that we'd
4:43
like to take on as well.
4:47
They can't take your team, but they can
4:49
take some of your ideas.
4:50
So maybe dig in just a little bit.
4:53
If an organization is
4:55
thinking that this resonates and is trying to
4:57
figure out where to start, maybe talk just
5:00
a little bit more about
5:02
in the beginning of this transition, did you
5:04
start, for example,
5:06
with your
5:07
onboarding
5:08
and then created that you know, did that
5:10
happen first, or did you actually start with,
5:13
you know, new elements that were coming out
5:15
and then back into
5:17
the onboarding? Because there's a lot of elements
5:20
and there's a huge amount of work that
5:21
went into this transformation.
5:23
So knowing that some of the listeners are
5:25
gonna be saying, where do I get started
5:26
and how do I do this? Maybe just
5:28
dig into that a little bit.
5:31
Yeah. Great point. As you're thinking through it,
5:33
you'll have two big decisions kinda where
5:36
you do the most classroom training.
5:39
You could start big and go with, say,
5:42
you know, all your nurses,
5:43
and then say, okay. I'm gonna develop training
5:47
that way first.
5:49
The advantage of doing it that way is
5:51
you end up with a lot of materials
5:53
that then you can use for all the
5:55
other training that you're gonna do later.
5:58
We we didn't do that right away. Right
6:00
away, we were like, well, let's try this
6:02
out on a smaller population. So we did
6:04
some stuff with, like, resident training, which is
6:07
a smaller group.
6:08
And we said, well, let's make that material
6:10
and see how we could convert a classroom
6:12
to asynchronous.
6:13
And it might be best to kinda do
6:15
what we did. I'll start with a couple
6:17
small groups, but then pretty soon you're gonna
6:19
wanna hit that bigger group
6:21
because that's where you get so much content
6:23
done that now it makes everything else easier
6:26
later as you're wanting to convert eventually all
6:28
of your classroom training
6:30
over to this asynchronous model.
6:32
The other thing we learned afterwards
6:34
is
6:35
once you have all this material,
6:37
now you can start to think about, well,
6:39
maybe we don't do in classroom training for
6:42
this group of people. But now, wait, we
6:45
have a bunch of content that actually applies
6:47
to them. So you might be able to
6:49
do training of smaller groups more effectively
6:52
by just adding a couple extra,
6:54
you know, asynchronous kind of videos and modules
6:56
and build out training materials to groups that
6:58
you maybe haven't done
7:00
training with.
7:01
So, yeah, that's how we kinda tackled it,
7:03
but, yeah, it's a good thing to think
7:04
through as people are starting to think through
7:06
how they could do this kinda asynchronous transition.
7:09
Yeah. And the other thing I love that
7:11
you mentioned earlier was talking about
7:14
freeing up your
7:16
training team
7:17
to be able to do this sort of
7:19
higher quality, high touch interaction and and similar,
7:23
you know, when I was at Monument Health
7:26
as CIO and CMIO, we went through this
7:28
transition as well. And I know that was
7:30
super satisfying both for our trainers
7:32
and for the clinicians was
7:35
that rounding and having them, you know, at
7:37
the elbow
7:39
when it really could be meaningful and impactful,
7:42
and they were able to do that. I'm
7:44
guessing, you know, for your organization similar to
7:47
ours
7:47
was because they weren't tied to the classroom.
7:50
So it could sound overwhelming to an organization
7:53
to say, well, wait. How are we gonna
7:55
get them out there rounding? But the reality
7:57
is once the content was built and the
7:59
asynchronous part was happening,
8:01
they had more time. Is that a fair
8:03
reflection?
8:04
Yeah. Definitely. And I think you'll wanna think
8:07
through
8:07
bringing in the right people.
8:10
Because a lot of our people that did
8:11
classroom training, they just naturally synced over to
8:14
this. But we brought in a couple special
8:17
people that were more specialized in this
8:20
asynchronous
8:21
platform,
8:22
and people that kinda knew UPerform tools, whatever
8:25
your delivery system is, as well as the
8:28
materials and how to efficiently
8:30
make those materials and record them. I think
8:33
you need a different skill set there. So
8:35
you'll need to bring in a couple people,
8:37
do some up training. You know, maybe you'll
8:39
hear some people really like the classroom stuff,
8:41
and so they don't wanna be part of
8:42
the new model,
8:43
and they might need to transition.
8:45
Pretty much all of our teams knew this
8:47
was kind of the way training was going
8:49
everywhere,
8:50
and so they were excited about this. But
8:53
bringing in a couple people that have that
8:55
new skill set of, you know, making the
8:57
videos, editing the videos, making the walk throughs,
9:01
that that's a really good point, I think,
9:03
Stephanie.
9:04
And and I think encouraging the team that
9:06
this is what
9:07
people want. On the end of receiving it,
9:10
they don't wanna sit through the classroom and
9:12
only have the four, eight hours to learn
9:14
all of it at once.
9:15
They want ongoing materials and touch points where
9:18
they can learn over time, and kinda that
9:20
beginning
9:22
phase of learning needs to go on to
9:24
more, what do I do to become an
9:25
advanced user? What do I do to become
9:27
a master
9:28
user? How do you set that up? And
9:31
I think, yeah, it it's a great way
9:33
to set that structure up. And so, we've
9:36
really been
9:37
it's a new adventure to go into all
9:39
this stuff, but it's been really exciting, I
9:40
think, for our teams and for our caregivers.
9:44
And given the success that you've had,
9:47
with this transformation in the EHR side of
9:50
the world, which is obviously where you have
9:52
the highest volume and complexity of of learners
9:55
and topics to be educating on. But knowing
9:58
that there are many other technology systems, software
10:01
programs, etcetera, that the organization leverages both clinically
10:05
and beyond,
10:07
is Fairview considering taking,
10:09
the same sort of asynchronous
10:11
training strategy and approach,
10:13
in other applications and other areas beyond the
10:16
way you are leveraging today with with Epic
10:18
and the EHR?
10:20
Yeah. The short answer to that is definitely
10:22
yes.
10:23
The question is just how to do it.
10:26
So you could start with big things. So,
10:28
like, we have a new ERP that we're
10:30
deploying. So we could do a large project
10:32
and say, well, maybe we can help with
10:33
that.
10:34
At least doing some consulting around what would
10:37
it mean to have asynchronous
10:39
training set up, what would it mean to
10:40
use UPerform and that kind of structure to
10:42
be able to do that project.
10:45
We also have a huge
10:47
Fairview pharmacy solutions
10:49
where we actually are teaching
10:51
other pharmacy systems and large health systems all
10:53
around the country about how to use their
10:55
pharmacy systems better because we have one of
10:57
the most successful one in all of Midwest.
11:00
Could we maybe
11:02
talk about at least asynchronous in that training
11:04
model be part of that
11:06
rollout in consulting.
11:09
We've also talked about a lot of the
11:10
smaller groups. So coding
11:12
review,
11:13
you know, imaging workflows.
11:15
There's a lot of small areas where we
11:17
do training.
11:19
Maybe we can take some of these benefits
11:20
that Jen and Derek and the team have
11:22
developed,
11:23
and these strategies can be actually applied to
11:25
lots of the training things that we do
11:27
across mHealth Fairview. So, yeah, we're looking for
11:30
more and more ways to kinda use this
11:32
since it has been successful, and I think
11:34
it is the future of how training is
11:36
gonna be delivered.
11:38
I think we're excited about where that could
11:40
go and other places we could use those
11:42
tools.
11:44
And, philosophically, you know, some of what I
11:46
hear you talking about is
11:48
the there's there's the training specifically. Right? There's
11:51
the here's where to move the cursor. Here's
11:54
the button to click. Here's the content that
11:57
you might need. But I also am hearing
11:59
elements in this that are related to big
12:02
picture. Right? Like,
12:03
we're making changes. We're setting the tone for
12:06
the organization
12:07
or maybe even beyond your organization with the
12:09
pharmacy,
12:11
work that you mentioned. So as you think
12:12
about the blend
12:14
of how
12:15
education
12:16
comes together with really communication and change management
12:20
to prepare clinicians
12:22
and end users
12:24
for ongoing transformation, which
12:26
given the era of where we are today
12:28
feels like an hourly
12:30
situation if, you know,
12:32
when we used to think on days and
12:34
months.
12:35
What how were you thinking about how those
12:37
things come together and
12:40
bringing, you know, the opportunity of both the
12:43
tactical elements of
12:45
what people need to learn, but also bringing
12:47
in the elements of of change management, communication,
12:51
the why, all of those things so that
12:53
you get to the level of adoption that
12:55
you're really trying to achieve.
12:58
Yeah. There's lots of good questions in there.
13:00
So I I would say,
13:02
first, kinda thinking of what do you need
13:04
to make it successful
13:06
in the new world that's coming. I would
13:08
say a well designed training platform.
13:11
You also need that asynchronous content. However, you're
13:15
gonna generate it or get it from other
13:17
organizations,
13:18
and then you need the appropriate
13:21
pathways for learning to really be developed from
13:24
beginner to advanced
13:26
to,
13:27
mastery.
13:28
And then I think you overlay
13:30
with those things,
13:34
the putting it into the workflows and the
13:36
high touch
13:37
part of that.
13:38
That's what I think will really bring the
13:40
success.
13:42
Physicians and nurses
13:44
will do almost anything for their patients.
13:47
But when it comes to taking time to
13:49
invest in themselves
13:50
so that they can really learn the new
13:52
technology,
13:54
I know you guys have come out and
13:55
done rounding with us. It's just everything is
13:58
so busy in the hospitals and clinics. Like,
14:00
to even talk to them about, hey. Can
14:02
you take a little time to just
14:04
learn this thing that'll save you ten minutes
14:06
every day?
14:08
It's like, well, but I'm busy. There's a
14:09
patient right over here that I need to
14:11
go see.
14:12
And so I think change management is really
14:15
the other big area that often gets
14:18
missed.
14:20
So, yeah, I think figuring out a way
14:22
to engage them and do that change management
14:25
is the key. Once you have the structure
14:26
in place,
14:28
we have a small but amazing change management
14:30
team here in informatics,
14:32
Our informatics department as well.
14:35
They teach a lot about our ADKAR
14:38
model, which is from Prosci. It's awareness, desire,
14:41
knowledge,
14:42
ability, and reinforcement.
14:45
I think a lot of people have heard
14:46
about that. But I I think we overlook
14:49
the desire and the reinforcement
14:52
part in health care are the two things
14:54
we really struggle with.
14:56
How do you generate desire
14:59
from the care team when they're so busy?
15:03
One thing that we've done that's been
15:05
somewhat successful is we have a change agent
15:08
and smart user program that we deployed
15:11
where we really engage
15:14
we try to engage all the managers throughout
15:16
our organization saying, you really are a change
15:18
agent. That's what your job is as a
15:20
manager.
15:21
And one of your most important things as
15:23
a change agent is to find some smart
15:25
users
15:26
that are really trying to help everybody else
15:29
around them level up and be better.
15:32
And so
15:33
I think desire comes much more
15:36
readily
15:37
if
15:38
a doctor or nurse sees another doctor or
15:40
nurse saying, wow. I use this tool, and
15:43
it saved me ten minutes and got me
15:44
home
15:45
quicker. Or I used ambient
15:48
dictation for when I was seeing this patient,
15:51
and now I've had lunch for the first
15:53
time I've ever had lunch, which is something
15:54
I actually heard a couple weeks ago.
15:57
So I think that desire change agent and
16:00
the smart user program could really go that
16:02
way. And then reinforcement is the other thing
16:05
I think we struggle with. Again, this is
16:07
where that classroom to asynchronous training, I think,
16:10
could really help because you have to circle
16:12
back. And we've learned
16:14
you can't mandate training. What happens if you
16:17
mandate training is people just click the boxes
16:20
and get it done, but they don't really
16:22
learn.
16:23
But how do you really motivate people and
16:25
create that desire that they should be wanting
16:26
to reinforce their learning, take time for their
16:26
themselves? I think
16:28
for
16:30
their themselves.
16:32
I think the materials are getting it there,
16:34
but then also having the change management principles
16:36
where there's, you know, somebody at least in
16:38
their group that is a smart
16:40
smart user and trying to
16:42
incentivize and promote everybody else. Hey. Do take
16:45
some time for yourself. Learn a little bit,
16:48
about, you know, your workflows to make them
16:50
a little faster, get you home a little
16:52
quicker, maybe do a little bit better,
16:54
care for the patient. So those have been
16:56
a lot of the principles that we've we've
16:58
learned and used here at M Health Fairview.
17:01
Yeah. I really appreciate you sharing the specifics,
17:03
you know, whether that a listener right now
17:06
can be truly taking notes and thinking about
17:09
real takeaways that they could deploy,
17:13
organizationally
17:14
within their, you know, within their own constructs
17:16
to have some similar success. So really great,
17:20
recommendations.
17:21
As we sort of close out and and
17:24
finish up our conversation today, knowing that we
17:26
are at the beginning of a new year
17:28
and that there are lots of thought processes
17:31
that we all have right now around what
17:33
the future can bring, how we wanna do
17:35
things differently, etcetera,
17:38
I'd love for you to maybe, you know,
17:40
to spend our last couple of minutes talking
17:42
about
17:43
key recommendations
17:44
that you would share with informatics or education
17:47
leaders,
17:49
as they consider their approach to health IT
17:51
education
17:52
and change management.
17:54
Yeah. Thanks again for the opportunity to kinda
17:56
be here and talk through some of our
17:58
successes.
17:59
I I have two big recommendations I usually
18:01
give to health care leaders.
18:04
The first recommendation
18:06
is to take some time
18:08
to build and invest in a community network
18:11
where you can teach and learn from others.
18:14
You know, we're we're in the world of
18:16
training others with informatics
18:18
and training,
18:19
but often you need your own network.
18:21
And sometimes you can create that at work.
18:23
You know, some of the managers are really
18:25
good at creating that network and that team
18:27
building. You can do it through huddles. You
18:29
can do it through meetings. You can do
18:30
it for one on ones.
18:31
But I think another thing to really do
18:33
is broaden that out through organizations like UPerform
18:36
or the American Medical Informatics Association or find
18:40
ways to build your network that are people
18:42
outside of your own institution
18:46
where you can really learn from others, whatever
18:48
way that is.
18:50
But it's really important to have a network
18:51
so those ideas are constantly
18:53
flowing.
18:54
And then my second recommendation
18:56
to everybody is to set aside some time
19:00
for yourself
19:01
to learn about artificial intelligence
19:04
and not just learn about it, but use
19:06
it.
19:07
You'll learn really quickly. You have to ask
19:09
AI about the resources
19:11
that it's getting things from. You know, are
19:13
you hallucinating is a great question.
19:16
And it it it's weird how honest it
19:18
is that it's like, yeah. I didn't know.
19:19
I kinda don't know exactly.
19:22
But, yeah, I think
19:23
taking the time and learning about AI, we
19:26
are all gonna be asked to teach everybody
19:29
about those use cases, find the value in
19:31
it.
19:32
I think,
19:33
would strongly recommend that people take that time
19:36
as leaders
19:37
because I think it's gonna benefit all of
19:39
our health care team. Those doctors and nurses
19:42
that aren't taking the time to do it
19:43
themselves,
19:44
if we spend the time for them and
19:46
then we take that to them with those
19:48
high touch asynchronous learnings,
19:51
I think AI is gonna change a lot
19:53
of workflows.
19:54
And like I said, one of
19:57
one of my providers said, it's probably the
20:00
best time right now to be a CMIO.
20:02
The computers are finally helping us do something.
20:06
And so I think us leaning into that
20:08
and figuring out how to teach others how
20:10
to do that well,
20:12
that would be that would be my recommendations
20:14
there. Yeah. Absolutely. I what comes to mind
20:17
for me is as much as AI might
20:19
be a buzzword, I feel like we have
20:21
a whole another podcast in the making here
20:23
where we can talk about AI and its
20:25
opportunity
20:26
to impact training and education because it's gonna
20:29
have an impact there. We didn't even have
20:31
any time to to get into today, but
20:33
I know you guys are thinking about that.
20:35
We're thinking about that. So there we go.
20:37
Podcast,
20:38
number two. We'll have to get scheduled for
20:41
a future time to be able to have
20:43
that conversation.
20:44
That wraps up today's episode of Becker's Healthcare
20:47
podcast. Doctor Jarabeck, again, thank you so much
20:50
for your insights, your experiences, and all of
20:52
the incredible work. Congratulations on that. That is
20:54
happening at mHealth Fairview. Thank you to all
20:56
of our listeners.
20:58
This podcast is sponsored by UPerform.
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by accelerating onboarding, reducing screen time, and boosting
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You can tune in to more podcasts from
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Becker's Healthcare by visiting the Becker's podcast page
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at beckershospitalreview.com.