Training challenges in national ehealth initiatives: Insights from a case study on the implementation of an electronic hospital separation record system in Sri Lanka

Objective: To present insights on training challenges arising during the development and implementation of one of Sri Lanka’s first national ehealth initiatives: the national electronic hospital separation record system.

Methods and procedures: This system aims to improve the reporting of separation diagnosis in public hospitals and was developed through an Agile software methodology. Initially users at 7 hospitals were engaged in the system design and iteratively trained in system use. Subsequently the national roll-out began with a further 8 hospitals trained in the system by October 2012. More than 150 hospitals are expected to have the system in place by January 1st 2014 and nation-wide implementation is expected to complete by 2017. Analysis of training challenges is based on data from both the first 7 hospitals and the second 8 hospitals. It is anticipated insights presented will support an improved national roll-out of the system.

Results: Training approaches and user training requirements varied considerably between users involved in the initial development and the users to whom the developed system was subsequently introduced. Significantly, the system changed medical workflow such that the project had to extend training beyond system usage and into the medical processes of diagnostic records management. Engagement of system users through the Agile methodology imparts system knowledge and training not readily available to subsequent users exposed during roll-out. This posed a number of training challenges that had not been foreseen during project planning. The paper highlights the need for comprehensive consideration of all aspects of workflow including non-technical dimensions to support a smooth national roll-out.

Conclusions: eHealth system training should not be limited to system use without a detailed consideration of how clinical practice and clinical workflow will be transformed. Recognising differences between training needs of initial users involved in system design and those subsequently expected to use a system needs attention. On-going iterative evaluation of system use and system outputs is required to iteratively refining training programs.