In order to implement important changes at your practice, you must gain buy-in from the staff. The executive search firm Korn/Ferry International cites a lack of employee buy-in as one of the most common management mistakes a new executive makes when trying to implement any new strategies or changes. If this executive fails to take the existing culture into consideration, the initiatives often fail.

For example, consider the controlling manager who arrives at a business only to discover that the employees work collaboratively. This combination can lead to significant struggles. Alternately, let’s consider the savvy executive who approaches the situation with an ability to acclimate, and who discovers ways to work in harmony with the existing culture and style at the firm. The latter approach can significantly assist your efforts to gain cooperation from staff when implementing the transition from paper records to electronic medical records (EMR).

Proper planning and the ability to adjust during the process are two tools that can help you avoid the need to pull the plug on your EMR project, with a potentially disastrous economic effect on your practice. The ‘Change Management’ process, which touts navigating change in a careful and systematic way, is a great tool to employ during this time.

Change Management: 10 Key Factors

1. Be clear and concise in speaking to each individual. Everyone should understand what is happening and what is expected from each. As long as having confidence doesn’t mean being unrealistic, it can be good for morale when problems arise. Be prepared to calm the fears of some staff.
2. The need for change will not go unquestioned. Present your case in a formal, referenced way which proves the benefits of changing over to a paperless system. Users need an incentive to change their habits, and will actually resist using the new tool otherwise.
3. Maintain good communications by keeping a dialogue channel open, encouraging participation at each step. The plan should also include a time line of actions for completion. Make sure to give the staff all the required information in the implementation process.
4. Address the aspects of the culture with explicit intent and detail. People can be expected to learn new skills on a gradual basis, taking baby steps toward learning more about more basic technology (using a computer, using a mouse. etc.), then advancing to more complex systems such as EMR.
5. Problems are a given; expect the unexpected. These may push back the system go-live date, and the effects will reverberate throughout the organization. Use the correct degree of flexibility to manage these effects.
6. When gaining acceptance, start at the top. The top tier of staff members, especially physicians and administrators, should be on board with the program, including any champions for the cause. If you have strong allies with the right technological skill and without a naive level of optimism, that is especially helpful.Resistant doctors in particular can be detrimental to the project, so stay on top of the nay-sayers.
7. Always acknowledge the human aspects. Without acceptance from the staff, a change to a new system could ultimately fail. The prospect of change often adds anxiety to the mix of human emotions, and this should be acknowledged during the process.
8. People should get involved at every level, so that everyone feels they contributed to the outcome. A committee of staff members, formed to create a proposal for delivery to the physicians, is another excellent tool. This committee should be representative of those who will ultimately use the EMR: administrators, business staff, and medical assistants.
9. Always make identifications and assessments of core values and beliefs in a cultural assessment, including possible sources of conflict or resistance. People often become set in their ways, resisting change as a general rule.
10. The leaders of the group should take ownership over project elements. As these staff members have better credibility with their subordinates compared to the physicians, these people are crucial and should be the first trained in the new system (‘super-users’), then passing the info on through training.

Ultimately, every employee needs to buy-in to the change, and for this to occur successfully, a helpful framework is known as the ADKAR model (Prosci):

• A = Awareness of why the change is needed
• D = Desire to support and participate in the change
• K = Knowledge of how to change
• A = Ability to implement new skills and behaviors
• R = Reinforcement to sustain the change

Have you already implemented EMR in your practice? Did you have issues related to the Change Management? Post a comment below and let us know.

Tweet This Post

Do you plan on implementing electronic medical records (EMR) at your medical practice? If so, you’re taking on a sizable project. Something this large must stay on a time-line or it may never reach completion. At our practice we experienced some setbacks including back-to-back hurricanes, construction of two new buildings, and hiring of a couple of partners - all of these events pushed the date of launch back over a year. Even so, having a firm date to ‘go live’ helps get everyone on board, allowing them to team together to engage in what could be one of the more challenging changes in their career.

Choose someone to be the project manager in charge of implementing the project. It could either be someone from staff such as an IT person or supervisor, or you could hire an outside consultant. Next, you want a comprehensive plan which covers the how, who, what, where, when, and why of the project from start to finish. Before going forward on your EMR plans, be sure your assets are ready. It just takes one poorly-prepared component to send well-laid plans down the path to failure.

Regardless of the practice, physicians’ attitudes towards EMR will range from gung-ho optimistic to downright resistant. Whoever is in charge of leading the project must decide when all of the physicians will roll-out on EMR, whether in unison or staggered on various launch dates or locations.

Some doctors may be quite comfortable allowing colleagues to test the waters first; but this may lead to more work and stress for the staff. If one doctor sees a patient using EMR, and the patient returns on a follow-up visit with another doctor using a paper chart, how will the patient’s chart be reconciled?

If there are multiple locations at your practice, you may want to implement EMR at one office before going on to the others. However, if your employees rotate between locations, your training plan must take this into account; if too much time passes between the launches at different locations, training may suffer.

Again, a project this large requires a firm commitment from the top authority at your practice, typically a physician ‘champion’, along with buy-in at all levels. One single voice of negativity from someone in a power position can drag down the entire campaign. A managing partner may have to intervene if the practice discovers that a doctor is actively working against the project – your administrator should not be put in this no-win situation. It’s also important that patients are well-informed of  the practice’s goals, so that they are more likely to tolerate the expected delays and hiccups while your team is working out the kinks in the system.

If you’d rather not make the big switch to digital all in one day, you may prefer to see only some patients using EMR. At our practice, we began with new patients requiring complete exams only, to prevent our clinics from grinding to a halt. As these patients gradually return for follow-ups, they continue to be seen using the EMR system. In this way, we were able to launch all locations simultaneously so clinics would not suffer from disparities in employee training and skills. This has also allowed us to gradually ramp up EMR with little effect on productivity.

Other items which shouldn’t be left to the last minute:

• Are your desktop machines or wireless tablets configured correctly?
• Has the software been installed and tested?
• Is there a proper disaster recovery plan in use?
• Is your infrastructure (wiring and wireless networks) ready to go? Adequate bandwidth?

Your schedule should include at least a month of intensive training for staff, which concludes well before the launch date. You may have to rotate staff during the day, or train people after hours at the usual overtime rate. Supervisors must have the ultimate word to ensure that the employees are trained to work with the EMR system in a live clinical setting. Naturally, they will need to practice to keep their skills sharp.

Tweet This Post

Although written two years ago, a post by Vince Kuraitis on the e-CareManagement blog seems timely:

“Google Health promises to simutaneously create and dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.”

What follows is an extensive analysis on the impact that Google could have on not only the individual patient but also on health system reform itself.

So, has anything changed since then? Well, there is still no central repository for PHRs. But with the heated debate about health system reform, Google, Microsoft, and their ilk are trying to stay in the fray. In fact, they aren’t too happy with what they are hearing from the Obama administration regarding health information technology (Health IT).

They would like to see Health IT information rolled out on web-based platforms (theirs, of course) instead of the network of “outdated database systems” that they feel the government is proposing.

What do you think? Do Google and Microsoft have our best interests in mind?

Is your personal health information fair game for free market capitalism?

Tweet This Post

In order to implement an electronic medical records (EMR) system, you must have ‘buy-in” from your staff. This means you’ll need firm commitments from the influencers at your medical practice, along with cooperation at all organizational levels.

One Bad Apple

Since one single naysayer can drag down everyone else down, it is important to intervene early. A managing partner may have to interject if it turns our that another physician is working to prevent project implementation. It’s also a good idea to tell your patients about the practice’s upcoming move to electronic records; they’ll be more patient when the practice hits the expected little bumps along the road.

The majority of project managers would cite the ‘people factor’ as the primary cause of project failures, particularly those of the scope and magnitude of electronic medical records implementation. Usually the causes are traceable to ineffective planning and training.

A transition over to EMR can be a stressful situation for some people – this is particularly true if they’re having to learn the system while caring for patients in a live work setting. It’s usually a good idea to specify some key personnel as the go-to people, and these should always be available at the different locations and within the various departments.

Audit Your Training Process

One way to determine if your staff is ready for EMR is to conduct training audits. For example, one practice asked the office coordinator to conduct a course which taught employees to use the upcoming EMR system. These training sessions were held each week. Everything seemed to be flowing well. However, when the launch day arrived it became obvious that some employees didn’t have much skill using the new system.

Unfortunately, their training process didn’t include an audit or a way to evaluate effectiveness on the individual employees. Sending employees to EMR ‘class’ is a good idea in general, but this doesn’t guarantee they’ll understand how to use the new EMR system afterward. Tests should be conducted, and grades issued based on performance. Also bear in mind that skills fade after long periods of inactivity.

Ideally there are ample opportunities for staff to develop and practice new skills during the workday. It’s a good idea to offer after-work tutorial classes as well. Remind your staff that successful implementation is a team effort, and you understand how hard everyone is working to reach this aim. Bottom line: trust, but verify, that everyone is prepared to make the big switch to EMR, with an effective training audit process.

Tweet This Post

Well, several of my colleagues said it was never going to happen, but not only are there federal mandates for the adoption of EMR but now the states are starting to push for it as well. If you still don’t think that EMR is going to happen….I just can’t understand where you have been living these past few months.

Anyways, according to an article in Kaiser Health News, state governments and agencies are both facilitating and enhancing the implementation of health IT through a variety of means, from incentives to loans to the creation of health information exchanges.

Of course, like a lot of things benefiting from stimulus money, on-going funding for many of these projects may be a challenge going forward. Backers of these initiatives hope that savings from enhanced efficiencies and decreasing costs will more than make up for any short-falls.

Tweet This Post

According to an article by Lou Agosta in B-Eye-Network.com, 80% of healthcare is delivered by medical practices consisting of only 1 to 5 doctors. And most big players in the EMR software system arena are marketing to larger clinics and multi-specialty institutions.

Even existing and proposed open-source systems such as OpenVistA still require significant investments in infrastructure on the part of the clients. And the government seems to be pushing for more open-source solutions, catching the attention of proprietary vendors like GE Healthcare, who may be offering some less-expensive options.

Still, there is a a lot of potential for EMR vendors who can target small medical practices, possibly with the SaaS (software as a service) or ASP (application-service provider) models.

Click here to read the entire article.

Tweet This Post

There is a very interesting blog post by Steve Brown that gives us a novel way of approaching the massive challenge that is healthcare reform. While politicians and pundits are arguing about how to spend stimulus bill money, nobody is thinking about how to improve the dissemination of information. This, after all, is the holy grail of EMRs (electronic medical records). Not just the reduction of medical errors but also the great benefits of EHR (electronic health records) which promise greater efficiencies in the delivery of medicine.

Tweet This Post

According to a recent report from McKinsey, the US Congressional Budget Office (or CBO, always described by the media as “non-partisan”) predicts that the stimulus incentives for EMR adoption will have a significant effect on medical practices in this regard, as compared to projections without the incentives.

Part of this is due to the fact that the incentives, which may amount to as much as $44,000 per physician, would more than cover installation costs of an EMR system, particularly for web-based type systems. These systems, known as ASP (application service provider) or SaaS (software as a service), generally incur less up-front costs since they do not require on-site hosting servers and their associated infrastructure but rather reside on the vendor’s servers.

The CBO also predicts that adoption rates under the stimulus incentives will climb to 90 percent by the year 2019. The slice of the stimulus pie earmarked for healthcare IT is $40 billion. And while physicians will realize many benefits from the use of EMR, the main beneficiaries are expected to be medical payers, since the expected decrease in both healthcare costs and medical errors will improve profitability.

McKinsey expects hospitals and physicians to spend about $170 billion on EMR over the next ten years. This is good news for information technology vendors and medical equipment manufacturers. So, rest well, knowing that the money you spend on your EMR system will not only help insurance companies keep a better eye on you but will also be good for their bottom line.

Tweet This Post

In order for your electronic medical records (EMR) implementation to be successful, you need to get buy-in from your employees. And for that to happen you need some key personnel involved from the get-go. It’s not possible for just one person to handle this task alone, no matter how talented he or she is.

The employees will well understand that a new EMR system will have a profound effect on the practice. They’ll also realize the pressures they are facing at work, and some anxiety is to be expected. Administrators and doctors should understand the top concerns which staff will raise when discussing EMR implementation. And sometimes staff will present with some resistance to the plan.

In our practice we use an integrated EPM/EMR platform but we didn’t switch on the EMR module until we were humming along with the EPM system. Only after the staff were well trained and we had converted all of our useful data from our old EPM system did we attempt to go live with EMR.

We created a group of ‘super-users’; these people were the first trained on elements of the new system, and had the responsibility to bring  the rest of the staff up to speed. Peer-to-peer learning is the most effective, even among physicians. Your super-users should be representative of the various departments, including IT, office staff, compliance, front desk, administration, and clinical.

At our practice we also created an EMR committee that was authorized to hold meetings when necessary – these individuals had run with the project since its inception, and some had put in long days and weekends. They ended up with some decision-making power, as well as the added responsibility that comes along with it. Confidence in the project began to grow from that point on.

Some of the most important staff players include:

Coding/Billing Specialist

This person should have a voice in the initial software selection process. Having their expertise helped to minimize the hiccups we experienced when we switched from our old practice management (EPM) system to the new one. On their recommendation, we performed a trial run on the new system prior to completely abandoning our old system. This allowed our IT specialist to verify that the posting and billing were being performed correctly. Someone technically proficient with coding and compliance issues will be invaluable when your EMR  system goes live – to prevent under- or over-coding and ensure HIPAA compliance.

Clinical Staff

Although not as vital during conversion of your EPM system (unless you are using an integrated system), their participation will be key to the success of the integration of the EMR into the practice. Therefore, it is important to for them to be involved in the early stages of planning; it is helpful for them to have an appreciation for what the non-clinical staff does on the EPM side and how the EMR will fit into the scheme of things.

IT Specialist

This person should be involved from the beginning, even prior to choosing the EMR software. If a practice cannot initially justify the expense of a full-time IT specialist, at the very least an IT consultant should be retained. Because we knew that conversion to EMR was just part of our overall strategic technology plan, we felt we could easily justify hiring a full-time IT specialist. In fact, due to this person’s expertise in such areas as software licensing, internet communications, and hardware networking, the changes that were incorporated into the practice saved enough to cover part of his salary.

Front Desk Staff

They provide valuable input from the perspective of the end-users of the EPM. Their tasks include check-in, check-out, posting of charges, and scheduling. Their critical job prior to the EMR rollout was to help test the design of the posting process at the time of patient check-out. Once we went live with EMR, they had to learn to post the charges electronically in real-time. Having time to get the bugs out of this process helped support our decision to postpone implementation of EMR until the staff was well acclimated to our EPM system.

At our practice the doctors empowered the EMR committee with authority to manage and plan the EPM/EMR integration. Managing partners continue to meet regularly with the administrator for status reports. They also meet with IT to continually tweak the system to improve efficiency. Bottom line: the overall success of the project will depend on the cooperation and involvement of everyone at the organization.

Tweet This Post