Ep. 46: Coping with Super User Turnover

by | Oct 11, 2023

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Super users integrate into so many aspects of day-to-day operations. You may not realize the extent of their impact until you need to replace one. They are the ultimate problem-solvers, managing EHR operations from user access to training, system setup, workflow coordination, RCM quality, customized reporting, and seamless interfaces for billing and pharmacy. But with the looming reality of turnover in healthcare, you need a contingency plan. 
In this episode hosted by Rebekah Duke, seasoned EHR consultant Jim Muska provides a deep understanding of the super user role, and how to avoid some of the setbacks when a super user leaves an organization. Jim provides several scenarios to better illustrate how the loss of super users typically plays out. Download this episode to learn: 

  • Why super users leave 
  • Why compensation packages are oftentimes not enough to retain talent 
  • The residual impact of super user turnover, even when the handoff is smooth 
  • What coverage a healthcare organization should have to ensure they have adequate super user support 
  • How external support services such as healthcare consultants are a key resource for coping with super user turnover 

Healthcare organizations of all kinds and sizes may face the loss of a super user at some point. When you have a super user your organization greatly depends on, it is wise to prepare for their departure which could happen at any given time. Jim’s insights will help you map out a plan for super user turnover so that your operations can continue as usual. 

Thank you for listening to the Medical Advantage Podcast, where each we take time each episode to discuss the ideas and technologies changing healthcare, and the best practices your organization can take to stay productive and profitable. Subscribe wherever you get your podcasts to ensure you never miss an episode. 

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Full Episode Transcript

Medical Advantage Podcast: Welcome to the Medical Advantage podcast, where you can hear healthcare professionals, expert consultants, and industry thought leaders discuss the exciting new ideas and technologies that are changing the business of healthcare. Tune in to each episode as we hear from some of the most innovative minds in medicine about the future of healthcare. And how your organization can stay profitable, efficient, and on top of industry best practices.

Rebekah Duke: Welcome everyone back to the Medical Advantage podcast. Once again, I am Rebekah Duke, your host for this episode. Today we are joined by Jim Muska. A seasoned EHR consultant with a great depth of experience in EHR solutions. For those checking out our podcast for the first time, welcome, we are Medical Advantage, a healthcare services company providing a broad portfolio of services for medical practices, specialists, groups, and private equity.

So much of our content, including this podcast, centers around EHRs, but today we will touch on the super user. In our blogs and eBook, we talk about super users a little bit, but one thing we haven’t covered yet is what to do when your super user leaves your organization. While you would hope that the superuser would stay long enough to train their replacement, this isn’t always the case and departures could be abrupt.

So let’s have our in-practice technology expert weigh in on what organizations should do and have in place for mitigation, should the super user leave the organization for any given reason.

Welcome to the podcast, Jim.

Jim Muska: Thank you. I’m glad to be here, Rebekah.

So to provide a full context, Jim, could you please start out by explaining what a super user does?

Jim Muska: Sure. Well, the short answer would be everything from A to Z. They handle everything from user sign-ons and access all the way through end user training builds, and set up, as well as working and coordinating with the other sections or other departments within the practice. So RCM quality and any other reporting measures that are needed, depending on the practice setup.

So it would be making sure that the interfaces work in terms of billing, in terms of pharmacy, so basically they’re a super user. A super user has the ability to help assess and remedy any break fix type issues as well as when you want to take your EMR or EHR to the next level.

Rebekah Duke: Thank you, Jim, for this discussion. I think it’s important that we really fully lay out what a super user does as a starting point. So what is an organization looking for when they choose their super user?

Jim Muska: You want the technical competencies, right? You want that almost IT level technical competencies. You want somebody who has demonstrated a knowledge of how your system works.

So some systems are based off of forms or templates. Some systems are based off a little bit more of specific user preference. So you want somebody who knows the difference between system A and system B, and why you would want to do all of your setup, all of your fixes in a certain method, and that’s familiarity with the system so that you can get the easiest results if they have to do a build or do some unfamiliar task, but you want to start interfacing with quality components. Well, you have to be able to recognize that there is a way that you’re going to have to do that in order to be successful.

So you want someone who has a specific competency, but you want somebody with a high level of computer competency, understand the logic of the system, and then you want someone who can utilize your specific system to achieve the goals of the organization.

It’s a very difficult process.The easier way is to have a person internally who has been identified as having a few of the key factors so they have, you know, the technical ability, they have an interest in being a super user, they want to learn more about the system and how it interacts, and they have the ability to take a view from a 30,000 foot level and see that the EHR, the clinical application is going to interface with several other applications.

So the reason why it’s easier to get somebody internally is because they are familiar with your specific EHR. as opposed to getting somebody, And say, okay, we’re going to bring in a super user and we’re going to go through IT pools and what not to get those same qualities. But the problem is then you have to begin teaching from square one, the specific system that your company utilizes.

Rebekah Duke: So let’s talk about the real world consequences of not being prepared for the departure of a super user. What happens when an organization finds themselves without a super user?

Jim Muska: Well, basically, the practice comes to a standstill in terms of who did those ongoing processes as well as any type of upgrade that you need recently with the 21st Century Cures Act, most EMRs changed. They had to change in order to meet the quality goals to comply with the Cures Act. Well, if you have a departure of your super user at that time, and you have one super user and because that’s backburner, that was going to happen in December and, we’re going day to day here in September or October, we’re not focused on that and then all of a sudden, that second super user is now dealing with something they have no frame of reference on.

So that can be a real problem. Those types of patches, scheduled maintenance, those things will end, and it depends on whether the practice is on premise or whether they’re hosted, those type of things all factor into the usability of the EMR. And when the knowledge, to say that the person who has that knowledge departs in the middle of that process, there can be, basically it can get lost in the shuffle, in the transition. You maybe are not upgrading in a timely fashion and then you maybe have one patch that triggers off a previous patch and those are not getting done. So the fixes become larger.

Rebekah Duke: Thank you, Jim. With that said, we can move into why they are leaving. I’ve heard that one of the main reasons that super users end up leaving an organization is that they get tempting offers. They’ve developed this really valuable skill set and now they are prime targets for recruiters. Is that still the case?

Jim Muska: You cannot control the outside forces. So ideally a super user could leave tomorrow and understanding that as the reality of the situation, you want to do all the things to retain that person in their primary role. So yes, benefits, time off. You want to meet that person where, whatever their needs are or their desires are, you want to keep talented people, however. Sometimes there is a better offer, or sometimes it could be, a medical issue. It could be a different stage of life, like somebody retires midlife as opposed to a little bit later where they normally traditionally enter retirement. So, because of the nature of the forces.

While you can’t, you can’t control those outside things where somebody may make them an offer, you can make your, your job that you’re paying for as attractive as possible. It’s better to be prepared for their departure than it is to spend all your effort trying to keep them, if that makes sense.

Rebekah Duke: Yes, thank you for confirming that. I think it’s important for our audience to know that continues to be an issue surrounding super users. So I just want to make sure we haven’t left anything out. Is there any other reasons for turnover that you’ve noticed with super users?

Jim Muska: Well, it’s one as we just identified, you know, talented people are sought after. Two there’s also whatever the reasons of turnover in any organization they are still in play with super users.

So if somebody is at a different stage in life and wants to move into having weekends off, for instance, is more important to them than let’s say financial compensation, they make all those same decisions. So you have the same reasons that happen in any organization, as well as the added level of they may be pursued by other players in other geographical locations for remote work, you know, that can happen where you’re going to be a remote user.

I know several super users who are not in the same area codes or even on the same half of the country as the practices they work for.

Rebekah Duke: Thank you for all that, Jim. I think that creates a complete picture of common reasons for super user attrition and with these retention strategies having a dubious success rate, what is the most proactive way to deal with super users leaving an organization?

Jim Muska: I think one that is always important is, do not have a single super user. Never is it a good idea to have all the repository of any information being one person. There are several factors that can change that person’s desire to stay with the organization and while you are keeping them happy, a lot of times what I have found is that you hire, let’s say a practice manager for a very specific set of skills.

So you’re hiring a practice manager and you get a very competent and dynamic leader as your practice manager. However, they have never used the system before, and now you’re sort of forcing them into learning a new system. So I would think one of the best strategies or first strategy is try not to have a single super user.

Then, and that of course depends on the size of practice, but also have multiple super users so that your practice manager can be a practice manager first and a super user second. And then you have multiple people who can fulfill the super user role in different parts of the application.

And it depends on the type of departure, right? So in a let’s call it a perfect world, the person says, I’m having a change of life goals and I’m going to be leaving in a month and I will not be working in the industry anymore. Now you have one month to prepare for that eventuality.

If you’ve created the capacity within the organization where you have someone who can step into that role, then you can begin the training process and that is probably I’m going to call it position B. Position A would be to have several super users and then you can rearrange assignments where they have all had similar training so you can rearrange work responsibilities so that the three can now cover the fourth and then you bring in a fourth person where you can coach them up and get them to that level of familiarity with the system. Then you can get back to full strength.

If it is a sudden departure and you haven’t done those things, well, that’s a completely different story. Then you’re kind of left with, you need to, on an interim basis, insert a subject matter expert or several subject matter experts to meet all the goals and all the processes that are ongoing in any practice.

You on board people, maybe monthly, maybe weekly, depending on the size of the practice. You off board people, you have new providers that come on that need to be trained on the system from everything, how to prescribe to how to, you know, fill out their notes.

So if that is the case where you don’t have any other super users and you still have these requirements that are, I don’t want to call them daily requirements, but they’re regular requirements where you have to have training, where you have to have, you know, creation of templates or favorite list, or these things need to be filled by somebody. Your best bet in that case is to call somebody like Medical Advantage.

Rebekah Duke: All solid advice. Thank you, Jim, for explaining all of that. I just heard you mention that it might be time to call Medical Advantage. Could you explain the role that a consulting firm would play in a successful super user transition?

Jim Muska: We work with several EMRs and we have several consultants who are subject matter experts on name your EMR here and we can then partner with you to replace that. So I have several clients. Some of them tell me whenever we hire a new provider, you are our trainer. Okay, that’s the relationship and we’ll take a holistic look at whatever the needs are.

Once you hire a new super user, we can train them on the specific and we’ve done this in the past on that specific EMR. So they’re a great practice manager. They have a history and a resume that indicates that. However, they’ve never used this system. You have us come in, we train them, and then they are now a super user for your system, as well as a great practice manager.

It all depends on the nature of it and I call them a warm departure versus a hostile departure. What I mean by hostile departure is somebody is leaving and in one of the two parties is not exactly thrilled about the departure. That is a tough situation to be in because while you want your current super users to be able to train future super users.

There’s something that’s referred to as training drift, where if they remember 95 percent of their job, or they have an opportunity to demonstrate 95 percent of their job, the 5 percent that they did not demonstrate, that knowledge is now institutionally gone. So your next super user knows 95 percent of the job. And the same thing happens with them, now you’re down to 92% and if after enough generations of that, you have super users who don’t know the entire system, and have not been keeping up with changes of the system’s patches, updates, upgrades when your EMR takes a huge upgrade, and it doesn’t appear any different, but there’s some functionality that has changed. You need to hire somebody like Medical Advantage to come in and partner with you during that.

Rebekah Duke: Thank you, Jim. I think the more we have these conversations, the better we can help people connect with the right resources for the right challenges. It sounds like external resources are absolutely necessary to deal with the major challenge of the need for superusers and keeping that superuser function going, even in the absence of one.

So on an administrative level, what can be done to be proactive with the anticipation that there may be some time between regaining that capacity for the super users that your organization will need?

Jim Muska: You want to have consistent practices and workflows. It’s just general good medicine that everybody is utilizing the same type of procedures and workflows across the practice. Whether it be a single provider, all the way up to, you know, 30, 40 providers. You want the same workflows across the board so that when you lose that super user. You have the ball 90 percent of the way down the field. Now, anything new coming in, any new changes, any governmental changes that need to be addressed, there’s going to be a little bit of time that’s going to pass in between.

We recognize that something new is on the horizon and we don’t have the person specifically. So then you’re going to need to identify, knowledgeable users within the organization so that they can step up in an interim basis or that you have a pool of individuals that you can promote from within.

Rebekah Duke: So without question, you need super users and you need enough of them. So, Jim, could you go into an explanation of how many super users an organization should have and which roles they need to cover?

Jim Muska: The size of the practice has to be a consideration as, you know, revenue dictates how many people you can have. Let’s say if we’re talking about the utopia setup and let’s say you have a larger practice and I have a couple of large practices that have done it this way.

I would say you have one super user who is in your IT Space. They’re used to working with sign on, they’re used to working with interfaces, H. L. Seven interfaces, etcetera. I would then have another super user in your clinical section, so to work with your M. A., nurses, providers. This person would be the person who is using the clinical part of the EMR daily is super familiar with it, is super familiar when you have a wish list of how you would improve it for usability purposes.

I would then have also somebody from your front desk and front desk and billing tend to dovetail more than might be apparent for folks. So there’s a lot of functionality and a lot of EMRs where. What you do on the front desk determines how the billing works, for instance, for auto eligibility verification. I would have somebody in that space, and then finally, I would have somebody in the RCM space. The RCM/quality space. Sometimes they’re hand in hand in terms of how the reporting goes, and it’s all dependent upon your specific EMR.

So, if you had four/five people who all were working daily in their space and working together, they could cover anything that’s happening. I have set up a client this way, and so I know that when we’re working on quality, we definitely want to have included the quality super user. Then sometimes though that quality super user might involve the clinical person as well, because then we’re going to have to build a form that meets the quality measures in the clinical application. You bring in people as needed. The nice thing about that is if somebody leaves, or if somebody goes on, let’s say, unfortunately, extended medical leave, short term disability, for instance, you still have everybody with enough cross knowledge to continue the practice going forward and meeting the goals.

Rebekah Duke: At this point, we have pretty much covered it all, but to further illustrate what it means to cope with the loss of a super user. I wanted to know if you had any real-world examples of how a health care organization successfully navigated through the departure of a super user. Do you have any in mind?

Jim Muska: Sure. We’ve had a good relationship with a large orthopedic practice. Their practice manager, as we discussed earlier, was their super user. Upon first meeting with the client, you know, we take a holistic look with everybody that we work with. So upon our first meeting with the client, we said, it’s great, you are incredibly knowledgeable to the practice manager, but we said you probably should have some other people and they had their geographic setup was such that they had a couple of offices and a office manager at each one.

Ideally, they should be super users as well. They can handle the day-to-day task. We have a new MA starting here, so we want them to know how to do that. We did set that up. We thought we’d be working with that particular practice manager for a long time. They had been with the company for a long time, they had started as an MA and had worked their way all the way up. Unfortunately, that particular practice manager left kind of unexpectedly, but they did have enough time to take one of their office managers who we recommended that they get trained and make the next practice manager.

So we did that and with the client, we brought in the quality person, we made them a super user, we brought in a clinician to make them a super user, and we brought in a person from their PT department to make them a super user. And things were moving along smoothly until the second practice manager had to leave as well.

As companies traditionally do, when you’re looking for a practice manager, you’re looking for that leadership experience and not necessarily a super user for the practice manager. They brought in somebody who had never been in the system before. As a matter of fact, there was an uptick on that person’s specific learning, but they have done great with it and while we were doing that, their quality person also left to begin a new career in a different field.

Effectively we’re on a new batch, let’s say we’ve replaced all four super users and one position we’ve replaced twice. However, we’ve created that capacity for leadership among the people that we designated as super users with the practice and now they’re currently have moved. It was almost a seamless integration. They have called us and said hey, we need your help in this process. So we’ve been able to work on every area of the practice and we’ve been able to help them meet their goals in terms of quality.

They were looking at a MIPS penalty. Now they’re looking at MIPS incentives. So we’ve been able to make that a seamless process. Once again, we partnered with them to make sure they were thinking about things, it’s very helpful to have an outsider’s perspective when you’re dealing with turnover, especially at the leadership level.

So we’ve been able to partner with them. The practice has kept moving forward, has kept moving towards the goals that they’ve had. Their five-year plan, their 10-year plan and the fact that they’ve had some turnover in key positions has not hurt them.

Rebekah Duke: Thank you, Jim. I think examples like that really lock in these concepts, taking it from theory into real practice. Thank you for powering through all of this with me. I have one final question. Can you again briefly summarize the role of healthcare consultants to support organizations in regard to super user transitions?

Jim Muska: Sure. So the short answer is we are the pros. In most, almost all, in the case of Medical Advantage, pretty much any EMR that you have, we are the pros and if you find yourself where you need full knowledge, operational knowledge, of your EMR and your systems. We have that at the end of a phone call, whereas you may have to train, you may have to train somebody and then experience training drift, and they don’t know how to do everything that a super user would do.

You call us, we can help you. If you have a situation where somebody left unexpectedly, somebody hit the lotto for a billion dollars and they decide that works not necessarily in my future anymore as nine o’clock last night. Well. You can call us, we can help on an interim basis to help get you through that critical phase.

Also, we partner with you. We take a holistic look at your entire EMR. We can help with everything from end user training, to builds, to quality work, to RCM work and so effectively, I like to refer to it as we are at the end of a phone call. If you were to call me today and get me access to your system, I could be helping you today. So when you’re really up against it, is a great time. A better time is before, because you don’t know what your super users have learned, you don’t know what type of institutional knowledge has escaped the institution because of turnover.

We pride ourselves on keeping up with anything that is new to your EMR and so we can give you updates on your EMR that maybe you miss because a practice manager was busy being a practice manager and not following the EMR updates that come as an email in your other box.

So, you get all the knowledge you would need, immediately, and then… You can make that determination, what should that relationship look like going forward? I have some clients who called me one time for something very specific and now we work with them on all aspects of their EMR. I have some that say, you’re my trainer when I hire somebody, you train them. I have some that we have worked to train their super users to the point that after many, many months, we get a call saying hey, I’m not sure how to show you this. Can you get online and demonstrate it to me? We’ll do that.

In this moment in time or this snapshot in time. We are working with a lot of folks on quality. There are some changes coming to quality as the COVID exemption ends for a lot of practices and people have not looked at their quality in the better part of three years because they’ve been able to take the exemption for the last three years. 2024, there’s going to be some significant changes that we can help navigate. So I would say that we are a phone call away and the help is a phone call away. You can have that immediately. That’s probably the best reason to partner with somebody like Medical Advantage.

Rebekah Duke: Yes, with the absolute imperative to have that super user or have enough super users coupled with everything being in flux in health care, you certainly need support services to keep operations running smoothly. I absolutely agree and this perfectly wraps up our podcast.

Should you have any questions regarding the topic covered today, please contact us at info@medicaladvantage.com. We are prepared to help. Visit our blog for an abundance of EHR resources and for healthcare industry insights you won’t hear anywhere else.

Please help yourself to older episodes in our podcast library. Plus, join us back here for our next episode coming soon.

Medical Advantage Podcast: Thanks for joining us this week on the Medical Advantage podcast, where we discuss the ideas and technologies changing healthcare and what they mean to your organization. For more information, visit us at medicaladvantage.com and make sure to subscribe to the podcast on iTunes, Spotify, or wherever you get your podcasts so you never miss a show.

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