Table 3.

Lessons learned and associated recommendations derived from the physician champion feedback

	Lesson learned	Recommendation
1	Physician champions needed more hands-on training, earlier on	Physician champions should have adequate training of the EHR prior to their customization work. At a minimum, providing the same training as the “super users” should provide the physician champions with additional background to help improve the customization process.
2	Ensure an appropriate training timeline; extensive customization done too early without sufficient training or context may be wasted effort	Limited customization should be done before the implementation but after physician champions have had sufficient training. Additional customization work should be expected to occur after clinicians have had a chance to work with the live system in real clinical environments.
3	The quality of trainers and the appropriate use of training time are very important	Effort should be made to use only highly skilled trainers with knowledge of local workflows. Time saving tips should come after basic usage has been mastered. A more realistic practice environment should be used to provide a more realistic context for training.
4	At-the-elbow support with peers is valuable	Ensure that at-the-elbow support has the right training and background to effectively meet the needs of clinicians during the implementation period. Peers can provide valuable support.
5	Two-way communication is vital to gain trust in the implementation process, and too many general communication emails may not be effective	Approaches for two-way communication and sharing information should be carefully considered. Involving physician champions in developing and modifying the communication plans as necessary may be more effective. It is important to provide timely and detailed feedback to physician champions so that the process can be trusted.
6	It is important to acknowledge the limitations of the new system to build trust in the implementation process	Leadership should provide their clinicians with a more realistic expectation of potential problems and roadblocks. While advocating for the benefits of the new system, it is also important to acknowledge the system’s limitations and display empathy with those struggling to become proficient.