the path to paperless
The Staff Must Embrace Change
Our EMR implementation motto is "Yagottawanna."
By Peter J. Polack, M.D., F.A.C.S.

A critical factor in the successful implementation of an electronic medical records (EMR) system is staff involvement. This can't be overemphasized. No one person can accomplish this task alone. When problems develop, and they will, you'll need to remain confident in the abilities of your staff, and express your trust continuously throughout the process. Here, I'll describe the type of persons you'll want on your staff and how to best involve them in the EMR implementation process.

Meeting the Challenge

	ILLUSTRATOR: MARK HEINE/ DEBORAH WOLFE, LTD14D

The concern the staff has over introducing a new practicewide system is real, and therefore must be fully understood and appreciated by the owners and administrator. The staff knows that, by converting to a new electronic practice management (EPM) system, patient scheduling and billing is going to be affected. The staff intuitively understands that the stakes are high, and therefore risky, and they feel the pressure. The kind of employee that will thrive in this environment has the type of personality that we try to hire into our practice -- the individual who wants to succeed and accept responsibility for his or her own actions. We have a phrase we use in our practice that summarizes this attitude: "Yagottawanna."

One of the most interesting observations we made during the process of design and implementation was the difference in how staff of different generations adapted to the new program. Younger staff tended to learn the software program more quickly, probably because they grew up on computers and learn differently than the older staff members. Conversely, the older staff had experience with all the tasks associated with any given job function. So be prepared for frustration on both sides of the generational divide.

Taking the Lead

As we initially transitioned from our old EPM system to our new one, and prior to going to the full EMR system, we often faced resistance from staff. Even with a new system that's more intuitive and user-friendly, some people are comfortable with old methods.

The members of the EMR committee who, as "super-users," are the first to be trained on the new system, must be able to take the lead for the rest of the staff. These individuals make up a representative slice of the practice, including administration, the business office, coding/compliance, front desk and information technology (which can be outsourced in a smaller practice).

For the transition to be truly successful, the committee has to "own" the project. Those aren't just words. Our committee had the authority to hold meetings whenever they felt the need. Individual members worked evenings and weekends because they truly owned this project from its inception, and had the authority to make their own decisions. They also accepted responsibility for those decisions. One of the side benefits from this type of management style is that the committee members' confidence grew, not only in themselves individually, but in each other.

Identify the Key Players

Staff members in the following positions will be key players in an EMR implementation:

IT specialist. This person should be involved from the beginning, prior to choosing the EMR software. If a practice can't initially justify the expense of a full-time IT specialist, an IT consultant should be retained.

Coding/billing specialists. These employees should also have a voice in the initial software selection process. They helped to minimize the hiccups we experienced when we switched from our old 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. Their expertise will also be invaluable when the EMR module of our system goes live, to prevent under- or over-coding and ensure HIPAA compliance.

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 now is manually posting the charges at the time the patient checks out. This will be even more significant when the EMR module posts the charges automatically in real-time. Having the time to get the bugs out of this process helped to support our initial decision to postpone the implementation of the EMR until the staff was well-acclimated to the new EPM system.

Clinical staff. Although not as vital during this phase of EPM conversion, their participation will be key to the success of the integration of EMR into the practice in a few months. It's important for them to be involved in the early stages of planning. It's helpful for them to appreciate what the nonclinical staff does and how the EMR will fit into the overall scheme of things.

The physicians in our practice felt it was essential to empower the EMR committee with the authority to plan and manage the EPM/EMR integration from the beginning. The managing partners meet on a regular basis with our administrator for status reports, but we don't get too involved with the details of the process. The success of this project will depend in large part on the involvement of all members of the organization.

Next: Building the Infrastructure.

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 120 employees. He can be reached by e-mail at ppolack@ocalaeye.com.