Training on Bahmni?

Software Bahmni
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At PIH we are preparing to install and launch an instance of Bahmni at a clinic in Sierra Leone. I was wondering if anyone has any thoughts on what it would take to train 4 to 5 brand new users on the following features:

  • Patient Registration/Starting Visit
  • Patient Clinical Dashboard
  • Point of Care Clinical Data Entry (Vitals, Consultation etc…)
  • Lab Ordering and manual Results entry

These users would have only recently completed basic computer literacy training. If anyone has been through a similar process before, we’d like to know what kind of effort it was.

Also, is anyone aware of step-by-step end user training documentation for Bahmni?

The closest thing that I know if is the “User Guide” here: https://bahmni.atlassian.net/wiki/display/BAH/User+Guide I see this as more like an overview of Bahmni features for an application administrator and not for end users.

Thanks! Dave

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We have struggled a bit with creating a “valid-for-all” User Guide for Bahmni – the reason being that many screens of Bahmni, that would need user training - like registration, clinical dashboard, consultation, form entry, etc are all completely configurable by the particular implementation. Hence, saying: Click Here to do this, and then click there to do this, doesn’t stay valid across different implementations of Bahmni. In such scenarios, we rely on Implementers to perform end user training / documentation based on that particular configuration and screens of Bahmni.

Language of delivery (Bangla, French, etc), and local hospital processes are also usually an important criteria to consider with regards to a User Guide. For instance, its important to say: Capture Village Information on Registration screen, so we can ensure we get “Disease-by-Village” report. This is very context sensitive information, valid only for the local hospital, and such information helps improve the experience of users – so that they don’t just read “how” to do something, but “why its relevant” in their context.

Although it is also true that certain screens will remain static – like how to add concepts to Bahmni, or how to perform Administration tasks, or how to perform Exports. We have tried in most cases to give sufficient high level information, for users to read, and understand what the page achieves, and then rely on decent screen design to make it apparent to users what needs to be done. Here is an example of a page that doesn’t change much across implementations: https://bahmni.atlassian.net/wiki/display/BAH/In-Patient+Management.

But, please feel free to provide specific feedback about features you feel should have a detailed user guide, because people struggle in understanding how to use the feature. I would also suggest that we provide this feedback to Product team, so that maybe the screen itself is simplified, and we rely lesser on documenting “how”.

Also, in many cases we have seen that the end user of Bahmni still prefers to rely on human training (by implementers, etc), over wiki reading.

I have requested some folks to also reply to this question, with links to their sample User Guides which were handed over to hospitals as part of their implementation. My hope is that in keeping with the sprit of open source, Bahmni community members will make their User Guides publicly available to help other implementations reuse collateral wherever applicable. I also plan to put up a list of Implementation specific user guide links on Bahmni WIKI.

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#ddsimone That is so great, implementing Bahmni is awesome in solving medical record challenges more especially in low resource country like Sierra Leone. I took a lead to implement OpenMRS at Kerry Town Ebola treatment centre in Sierra Leone and currently working with Kings’ Sierra Leone Partnership to implement Bahmni at Connaught and 34 hospitals’ infectious diseases unit. For the past months, I have installed Bahmni – customising and interacting with it interface for deployment and implementation (thanks to Darius, Gurpreet and the whole of Bahmni team) Bahmni user interface is really marvellous, simple to use with little and continue training, depending on the curiosity of the end users. General and individual training using real app for demo will help greatly to understanding how to navigate within the app. For users to understand quickly, depending on your implementation, users responsible for registration should be trained with the registration module and clinicians should be trained with clinical module, etc. During the first two weeks if not month, expect omission of data, wrongly entry of information in the text field, hence individual continue training will be required. Policy that guides patient information management should be enforce even when dealing with electronic records. I am wondering how your implementation is plan, I will be happy to give hand on guide if needed.

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@sesayalieua - great to hear - thanks for letting us know! We would be interested in learning more about your configuration of Bahmni and the use cases that you are implementing. Do you have your bahmni_config available in a public github repository that we could check out?

Incidentally, we were talking this morning about our address hierarchy configuration. Is this something that you have done and would be willing to share your experience with?

Copying in @ddesimone and @cioan who are working closely on this project.

Thanks! Mike

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@gsluthra Thanks for the response. We absolutely understand the challenge of trying to maintain documentation for an app that is so highly customizable. We will likely be creating a guide ourselves, but it would be useful to see examples of other implementations’ documentation, if any exist.

My bigger question was just how much effort it has been for the initial training for users. We are currently working with site management trying to figure out how much time to set aside for this and how best to go about it.

Thanks @sesayalieua for sharing your experiences!

If anyone else has any thoughts, it would be great to hear…

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@ddesimone During the implementations, we train the end users by running a mix of training sessions, exercises and on the job support.

We invite each group of users at a specific time, and run through the workflows only relevant to them. For example: Lab staff for one hour slot in the morning, after that one hour session of IPD nurses , then one hour for registration clerks, then one hour for doctors and so on. You repeat this for five days, then it’s a decent training plan for a 50-100 bed hospital.

It’s absolutely important you invite staff only who have completed basic computer training. During the training if you discover that hospital staff cannot do double clicks using a mouse, your EMR training will not make much progress.

For each session, you have to plan for atleast 2 trainers. More trainers the better. One person to lead the session by showing workflows on the projector and others to walk around and help out the attendees. To run 5 days training session( 5 hours/day), including preparation and logistics effort you need to plan for at least 3 trainers.

Regarding teaching methodology, we follow a straightforward approach. For each groups of users, we decide before hand what all worfkflows we should cover for each session. we show them the workflows on the projector and ask them to repeat the steps themselves on their computer. At the end, we invite them to do the steps on the projector infront of everybody. The staff who wants more practice are encouraged to come again later in the evening and do practice on their own.

To train the doctors, you would need someone respectable and skilled in medical informatics. It’s best if you can find an EMR expert for a couple of days or a champion from the hospital staff themselves.

After the system go live, the trainers go around the hospital and observe how the users are using the system. In the first week, the staff would need support at their location to carry on with their work. We have observed that, for the first few days, staff at Lab, Registration and Pharmacy would need full time on the job support. Billing clerks would need help to close the cash counter end of the day.

Developing user materials is a lot of effort. You would have to wait till the configurations are ready so that you get the exact screens to put in the manual. We did this once for Bangladesh. The intention was to develop a manual for each user persona. It’s still in progress. You could view the documents shared in the google drive: https://drive.google.com/drive/folders/0B2dgg_RayglSMUhhd0o5OWdubWM

Till now we have been using manual efforts to run the end user training sessions. If you have many hospitals using the same set of configurations, you may want to explore how to automate the end user training sessions using videos or e-learning modules. We have not done that before, but that will be worth trying out if the rollout is on a large scale.

T

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+1 to what @apaule has mentioned regarding training end users.

There are 2 key reasons for having training material

  • Act as a reminder for one off scenarios vs regular activities
  • On-boarding a new employee or someone who is moving to another department

At one of the hospital sites in India, we provided class room training as well as on the job training in the manner explained by @apaule. However, we also created training material / aid as videos. These were created post implementation to ensure that the screens and workflows were in line with the final implementation outcome. Videos were kept short and focussed around specific tasks e.g. Searching for Patient, Create New Patient.

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@mseaton - am sorry I have not been able to respond to your queries as I have been away with limited internet service. I try to edit the address mapping template but it does not effect, however what I decided to do regarding address hierarchy, was just to edit the address labels via OpenMRS, manage address hierarchy and add fields where necessary. Base on my organisation needs and the interaction with Bahmni, little customization is just required. (Thanks to Bahmni Developers’ Team), notwithstanding the little customization, I will try to commit it into github repository. @apaule - that’s great breakdown, thank you so much.

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Adding a note here, since this Thread shows up on Google when someone searches for Bahmni Training.

On Bahmni WIKI, there is now a “Training Guide” available for Implementers of Bahmni to get familiar with Bahmni, its features and how to configure various modules of Bahmni. There is also a self-assessment test in the Training Guide to help you assess your comfort with Bahmni. We will continue to add more material to this training over the next few months. Contributions to these videos/material are MOST WELCOME! :slight_smile:

Link: