Facility Training Guide for County ToTs

FACILITY TRAINING GUIDE FOR COUNTY HIS TOTs

Goal	To provide Trainer of Trainers (ToTs) with a structured approach to effectively adopt, implement and sustain KenyaEMR 3.x implementations at healthcare facilities
Target Group	County, Partner ToTs and Facility level trainers
Objective	To provide the Trainers of Trainers (ToTs) with a clear guide on Key EMR training areas within a facility and equip them with necessary knowledge and resources to deliver effective training.

 

Introduction 

Palladium Kenya through the Kenya’s ministry of health identified and trained county HIS Trainers of Trainers (ToTs) alongside trainers from service delivery partners. This training aims to foster sustainable and efficient HIS implementations at facility level while strengthening the last-mile capacity building for end users. The ToTs play a crucial role in ensuring successful adoption and implementation of KenyaEMR system at facility-level.

Training Objectives

The training is expected to achieve the following objectives:

• Equip end user with the knowledge and skills to effectively use the HIS for clinical documentation, patient clinical management, and reporting.
• Provide a step-by step guide for KenyaEMR implementation and troubleshooting.
• Improved data accuracy, completeness, and timeliness in the facility.
• Enhance the use of HIS data for decision-making and patient care.
• To ensure compliance with the data protection requirements and privacy standards and policies.

Expected learning outcomes

At the end of facility level training, users are expected to develop competencies in the following areas:

1. Technical proficiency in HIS EMR system
   • Demonstrate use of HIS to access patient records, update orders, and generate reports.
   • Ability to trouble shoot common technical issues related to HIS implementation.
2. Foster Training, facilitation and capacity building skills
   • Gain skills to mentor end users to adopt and sustain HIS EMR system practices
   • Explain how HIS can help improve patient care in their specific role.
   • Ability to adapt training methods to diverse audiences and end users with diverse technical expertise.
   • Ability to identify and address knowledge gaps among the end-user trained through on job and preceptorship trainings and mentorship.
3. Knowledge of HIS standards and policies
   • Understand National and County level HIS policies and data standards
   • Describe the types of data and reports available in HIS.
   • Identify the security and privacy risks associated with using HIS and explain how to mitigate these risks.
   • Ability to communicate the importance of compliance with set standards to end users.
4. Demonstrate maintenance and administration skills of an HIS.
   • Advocate for the adoption of the HIS EMR System and address resistance to system adoption among users.
   • Develop skills to promote the culture of data use and continuous improvement of the HIS system in the facilities.

Mode of training delivery

• • Classroom session for sensitization and planning
  • Introductory presentations by county and KeHMIS
  • On job training (OJT) to all users at the service delivery points

Roles and responsibilities of ToTs

• • Conduct navigational training sessions for facility end-users on KenyaEMR system use.
  • Provide first level of technical support during KenyaEMR implementation.
  • Monitor and evaluate best methods to apply for full adoption of KenyaEMR at the facility.
  • Act as a liaison between the facility end -users needs and the MoH and HIS partners for KenyaEMR related issues.
  • Source for training materials and schedule training sessions with different end -users.
  • Ensure all facility staff are trained and competent in using KenyaEMR within their scope
  • Document challenges and escalate to the next level of support
  • Promote a culture of system use and data accuracy among the facility end users of KenyaEMR.

Eligibility /Target Group for the facility-level trainings

The target group is end-users involved in patient management continuum in the facility including commodity managers and revenue officers.  Specific users include the following:

• Data managers/Health records information officers
• Receptionists/ Registration officers
• Doctors/Nurses/Clinicians
• Special clinics
• Laboratory technical / officers
• Pharmacy staff
• Store managers/ point persons
• Facility administrators
• Cashiers and bill processing officers

 

Pre-Training Activities

The following are key pre-training activities which forms part of the preparation process.

Identification of the ToTs

• County ToTs are sourced from the various cadres/departments from facilities already implementing and effectively using KenyEMR3.x
• Logistics preparation which includes transport plans to the facility and per diem (if applicable)
• Avail training resources: ToTs must have all the training materials ready. These include power point presentation from the county digital health team and the facility wide KenyaEMR introductory slides. Other useful resources include links to online user manuals, training curriculum among other.

Facility Assessment

Conduct a baseline assessment for KenyaEMR implementation at the facility:

• Identify Infrastructure gaps- service delivery point devices, facility connectivity (LAN, WIFI), Internet availability and available staff per department.
• Access staff knowledge and capacity needs for KenyaEMR use

System Implementation Planning and preparation

• Develop a detailed facility specific implementation plan and road map, that includes specific timelines.
• Ensure KenyaEMR system and dependencies are installed and functional
• Conduct a pilot end-to end test of the system functionality as applicable for each department and user within the facility, if issues arise, resolve or seek next -level support for resolution.
• Engage the facility management and departmental heads to secure buy-in and gain support for KenyaEMR.
• Communicate the value add of the KenyaEMR system to the facility staff through a system overview and sensitization
• Schedule training sessions with departmental facility staff
• Align with the facility in charge on which facility staff will be responsible for system administration activities.
• Configure required system settings with responsible facility staff such as the facility system administrator, ICT Officer or the HRIO.

 

Implementation Activities

Training day preparations

At the facility, the deployment and training team is expected to conduct a courtesy call to the administration. During the courtesy call, the team should hold a brief Introductory meeting with the facility staff and the trainees

• Introductions and climate setting
• Introductory Presentations.
  • • County digital health team slides
    • KenyaEMR introduction slides to sensitize the users on key features/benefits
• OJT / Preceptorship Sessions-ToT/Users pairing
  • • Facility staff will be paired with respective ToTs to ensure all the service points are covered as shown in the table below on Training Schedule
    • Conduct hands-on capacity building sessions on KenyaEMR with the different departmental staff as proposed below in the training schedule table.
    • Use relevant and applicable cases and scenarios to enhance user understanding of each module and functionality in KenyaEMR.
    • Provide user guide- flow charts, SOPs, Videos and KenyaEMR practice test instances as quick reference guides to each user after the training sessions.

Training Schedule

The following is a tabulation of key topics that TOT should focus on as he carries out the OJT session at the facility. Depending on the availability of ToTs, all the service points should be covered concurently for each session.

No	Service Point	HIS Module(s)	Specific areas of focus	Duration
1	Registration	Registration Module	–          Registration of clients –          Checking in of Clients	3 days
2	Cashier / Revenue	Billing Module	–          Configurations of Billable Services –          Processing of Bills –          Processing of	3 days
3	Triage	Triage Module	–          Completion of Triage Form –          Queuing of Clients to the next service area	3 days
4	Clinical	Clinical encounter forms	–          Completion of Clinical Encounter Form –          Completion of Lab Order form –          Completion of Pharmacy Order form –          Give necessary role scopes to the Clinicians	3 days
5	Laboratory	Laboratory Module	–          Entering of Lab results	3 days
6	Pharmacy	Dispensing App Manage Stocks	–          Perform stock operations –          Give necessary role scopes to the Pharmacists	3 days
7	Special clinics	Special Clinics Module	–          Enrolment of clients to the Special clinics –          Completion of Special Clinics Form –          Discharge of clients from Special Clinics	3 days
8	MCH	MNCH Module	–          Enrolment of clients to the MCH Module –          Completion of ANC Forms –          Completion of Labour & Delivery Forms –          Completion of PNC Forms –          Discharge of MCH Clients from MCH services	3 days
9	Administration	Admin Module	–          Creation of users and their necessary user roles	3 days
10	Inpatient Department	IPD Module	–          Admission of clients to the ward –          Bed management –          Completion of IPD Forms	3 days
11	Data/ Reporting	Reporting Module	–          Generation and validation of EHR Reports –          Generation and validation of Stock Reports	3 days
12	Morgue	Mortuary Module	–          Admission of Clients to the Morgue –          Completion of Morgue forms –          Discharge of Morgue clients from Morgue services	3 days

NB: All the sessions are to be conducted concurrently in the facility for the indicated duration.

Training Resources and Materials

The following resources are available to support ToT training at the facility. ToT should access the relevant materials. Where possible the resources should be shared with the end users for reference.

• Training Manuals: Step-by-step guides for using the HIS. The manuals can be obtained from KenyaEMR 3.x Content – Kenya HMIS Documentation
• Online Resources: Access to e-Learning modules and YouTube video tutorials and online training materials.
• Helpdesk Support: Contact information for technical assistance. Call 0800722440

 

Post-Training Activities

Training Outcome Monitoring

Thorough follow-ups should be carried out to the facility to ensure system use and uptake is maintained. Follow up should be conducted on a weekly basis.

The ToT responsible for a particular facility shall track the facility’s progress in adoption of the EMR system on a weekly basis and develop an evaluation criterion using structured KPIs such as system usage rates per module, per department and data accuracy metrics and report to county leadership.

• Mentorship Program: Assign experienced users to mentor new staff and identify areas of intense mentorship among each user.
• Refresher Training: Routine mentorship sessions to reinforce skills and introduce updates based on identified gap
• Ongoing Support: Regular check-ins and troubleshooting assistance and support.
• Collect feedback from facility users that will support in identification of system related challenges and areas of system improvement.
• Organise for supported facilities cross learning sessions to share on best practices and lessons.

Training impact assessment

Post training evaluation on KenyaEMR system for each user is important to measure knowledge and skills. It Can be used to:

• Improve mentoring and participant learning.
• Assess achievement of learning objectives

Develop a training assessment, to include:

• Pre – Test
• Post Test
• Training evaluation /Feedback

Sustainability Plan

• • Develop a facility centric sustainability plan with the facility leadership to ensure long -term use of KenyaEMR.
  • Identify and intensively train facility- level departmental champions to support other users and to ensure continuity of KenyaEMR use.

Trouble shooting and challenges resolution

How to identify common issues and provide solutions

Categorise each issue into three areas:

• User Attitude
• Knowledge gap
• Technical system issue

Example of common challenges encountered while implementing KenyaEMR and recommended resolution strategies:

No	Identified Challenge	Issue Category	Recommended solution
1	Staff Resistance to implementation change	User attitude	Conduct system awareness sessions through CME’s and departmental meetings and highlight the system value add to each system user cadre.
2	Incomplete and inaccurate data capture	System Knowledge Gap	Provide additional modular level training to the specific user. Analyse data output and engage the users highlighting the gaps in their system use practices to promote keenness and system adoption.
3	System Down times, System bugs and errors	Technical system issue	Follow the established issue escalation protocol

 

Documentation requirements

Each ToT is required to maintain the below documents for each facility they support to implement KenyaEMR.

• Training schedules
• Training attendance
• Facility readiness assessment reports
• Capacity building reports
• Implementation progress report
• Feedback and user evaluation reports
• log of the reported issues, resolution strategies applied and the resolution status for each.

NB: Submit monthly progress reports to the MoH and County teams as required.

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Resources

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