the path to paperless
Preparing the Staff for EMR
Major changes require employee "buy-in."

Perhaps one of the most challenging aspects of implementing an electronic medical records (EMR) system is managing its effect on the staff.

According to a study by executive search firm Korn/Ferry International, one of the most common mistakes that executives make when joining a company or making changes is failing to properly read the existing corporate or office culture. An example would be a control-oriented manager coming into a company with a collaborative culture, leading to tension and resistance.

In this column, I'll explain how to adapt the existing office culture to facilitate your staff members' acceptance of a switch from paper records to EMR.

ILLUSTRATOR: MARK HEINE/ DEBORAH WOLFE, LTD

Planning is the Key

Taking time to properly plan a project and making minor tweaks along the way can help to avoid having to pull the plug completely on an EMR system, often with significant financial consequences for a practice. This is also important in the planning of the computer network that will be used in the office, regardless of which software you decide to use.

A useful tool to employ in making any significant transition is the concept of change management, which is essentially making changes in a planned and systematic fashion. The following 10 principles of change management can be adapted to the implementation of an EMR system.

Address the human side. Jobs will change and there will be anxiety. If employees don't "buy in" to a new system it will probably fail. For example, you can't "sell" a new computer system on the premise that it will enable the practice to cut jobs.

Start at the top. It's important for key staff, including the physicians and administration, to be on board. A physician "champion" is needed -- one of the doctors with a strong commitment to see the project through to the end, preferably someone facile with technology but realistic and not overly optimistic.

Involve every layer. Everyone needs to feel that his or her contribution is important. Form a committee of employees to evaluate different systems and let them make proposals to the physicians. These should be people who will be using the system: administration, business office, and medical assistants.

Make the formal case. People will always question the need for change. Have a written vision statement. You need to be able to explain to the organization the what, how, and why this process is taking place. Prove that an EMR system is better than the existing paper process or else it won't be used.

Create ownership. Appoint leaders who will have ownership of the project: They have more credibility with their subordinates than the doctor. Train these core people and then use them to train the rest of the practice.

Communicate the message. Keep channels open. Encourage constant feedback. Lay out a plan and sequence of action. Keep staff informed and involved in the process.

Assess the cultural landscape. Identify core values, beliefs, perceptions, and sources of resistance. People get set in their ways: the employee who doesn't know how to use a mouse or the doctor who can't check e-mail.

Address culture explicitly. Take baby steps if necessary -- people should gradually learn to use a computer, a mouse, e-mail, and more sophisticated programs like practice management software, then finally EMR. Keep less enthusiastic physicians involved, otherwise they'll be resistant.

Prepare for the unexpected. There will be problems. Hurricanes Charley, Frances and Jeanne resulted in a changing target for our "go live" date of conversion to the new system, with significant ripple effects, which were manageable because of proper planning and flexibility by our EMR committee.

Speak to the individual. Be clear in what is expected of each person. Be confident, but not unrealistic -- allay employees' fears, particularly when there are problems.

Many "failures" of EMR systems have as much to do with poor planning and implementation as with deficiencies in the software itself. This is especially true when it comes to the changes that occur on the human side. Planning how a new EMR system will integrate within a specific practice before actually installing the software will be time well spent and, ultimately, will benefit the bottom line. OM

Next: Hiring the Right People Sources:

Anupama Chandrasekaran, "Office Culture Gaffes Top Errors of New Executives," Reuters.com, Aug. 20, 2004.

John Jones, DeAnne Aguirre, and Matthew Calderone, "The 10 Principles of Change Management," Strategy & Business Magazine, Summer 2004.

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.

In this multipart series, Dr. Polack will describe how a seven-partner practice, Ocala Eye in Ocala, Fla., with five locations and 120 employees, makes the major transition from paper medical records to EMR. During the course of the series, Dr. Polack will provide readers with a "real-time" look at how the implementation is progressing. This is part 2 of the series.