Loretta Gallagher on the Super Users VS. At the Elbow (ATE)

The widespread use of Electronic Medical Records (EMR) in healthcare settings has improved client care, lowered health care costs, and increased the productivity of providers.

Loretta Gallagher, owner of Gallagher Associates in Wayne, New Jersey, specializes in helping hospitals and corporations with their EMR and professional developmental systems. Here Gallagher shares her insight on super users and ATE.

Gallagher Associates

At Gallagher Associates, Loretta Gallagher and her team help others to implement successful EMR initiatives. With over 18 years of experience in the healthcare arena, Gallagher Associates has become well-known for their personalized and cost-effective training methods that consistently produce successful results. Implementing EMR initiatives can be a stressful experience when both the individual healthcare provider and the establishment has become familiar with doing things a certain way. However, it is incredibly important that EMR initiatives are welcomed with open arms to improve healthcare services and practices.


Gallagher Associates follow a two-step process. Firstly, they focus on training of staff and outsourced consultants. Once this is perfected, the next step is go-live support, which ensures the successful implementation of electronic medical records.

What is a Super User?

Super users are highly trained individuals from within your organization. Their training includes IT and healthcare, making them more knowledgeable about EMR methods than their coworkers. Super users are great to have during the implementation of new EMR methods as they are familiar with your staff, current state workflow and organizational culture. These individuals must attend additional training courses, work with staff prior to the go-live of the EMR method and be available for damage control once it’s live. There will be events and tasks leading to your go-live that this group of super uses will get pulled into. Therefore, instead of doing their normal job, super users will be focusing on supporting the team through this transition.

Loretta Gallagher — the staffing of super users needs to be thoroughly planned.

Super users are truly ideal; however, staff will be pulled slim with the weeks before and after the go-live due to training and support responsibilities. The staffing of super users needs to be well thought out and well planned. The biggest pro to having super users is the knowledge created through training stays within your organization, whereas ATE leave after a successful go-live, taking knowledge with them. When super users return to their normal responsibilities, their coworkers will continue to have an expert to ask for assistance.

What is ATE?

At the elbow support (ATE) are outsourced consultant services. These individuals are extremely valuable and knowledgeable, with the purpose of helping your organization stabilize faster before, during, and after the EMR go-live. However, Loretta Gallagher warns that since the ATE staff will not know your workflows or the culture of your organization, they require training in the areas that they will be supporting. This is essential as you do not want the ATE staff changing your workflow practices to those of other hospitals they have worked with. Additionally, ATE’s can be expensive and less cost-effective than super users, as they are only present for a few weeks.

Go-Live Support

When staffing your go-live support, your organization will need to decide on a support ratio. Some vendors recommend 4:1. For every four end-users there is one support person. This means 20% of all staff would be supporting others instead of working in their normal roles. Gallagher has seen hospitals do a 7:1 support model. Although this may seem overwhelming for the one support person, Gallagher Associates says that success is possible if the support person has received proper training.

The first decision an organization needs to make will be, what is the support ratio that will work for them. Loretta Gallagher gives an example: if it is 6:1 and there are 2400 employees that will be touched by the new system, that means 400 support people will be needed. Gallagher Associates recommends taking the time to gather your super users first and create an agreement between the super users and department managers, so everyone understands the additional responsibilities they are taking on.

If an organization can provide 70% of super users from in house, they can use ATE’s for the remaining 30%. If an organization can only provide 20% of super users from in house, Gallagher Associates recommends they go back to the drawing board. 80% of outsourcing is not necessarily money well spent and 80% walking out the door with their knowledge and expertise going with them after two or three weeks, can be destabilizing and your staff will likely struggle.


Loretta Gallagher and her team at Gallagher Associates stress the long-term importance of super users. Not only can they build on and improve the current workflow practices, they are also a knowledgeable resource for other staff members before, during, and after the go-live of new Electronic Medical Record implementations.