The Path to Paperless

Avoiding a Mutiny Against EMR

Signs of discontent must be nipped in the bud.

By Peter J. Polack, M.D., F.A.C.S.

You will rarely face an issue as big as implementing EMR in your practice — unless you are unlucky enough to have to deal with a malpractice lawsuit or dismissing a doctor from the group.

The cost in terms of financial investment and time are significant. And the failure rate, according to numerous sources, can be upwards of 30% to 50%. Studies have shown that, in a broad range of industries, IT implementations have a similarly high failure rate — so why should the health care industry be any different?

We Can't Afford to Fail

Well, because it's your practice or mine we're talking about now. And it's your wallet and mine, too. We can't write off a failed project as easily as a larger corporation can. We know the most common causes of EMR failure are people-related factors. It also happens to be the most neglected part of the EMR equation.

So, I can't say it was a shock to hear that there were rumors that some of our physicians wanted to hold a vote on whether or not to "pull the plug" on our entire EMR project. Before I tell you what happened, here are some suggestions for preventing a possible mutiny in the first place:

■ Keep the lines of communication open. If there was one thing that the "champions" or proponents of our EMR project could be faulted with, it was that we assumed that silence from some of the other key players meant total deference to our plan. That, coupled with a decrease in our normal board meeting schedule because of the holidays, meant that some gripes and major issues were not being heard or addressed.

■ Don't let passive-aggressiveness morph into active-aggressiveness. Any change, whether for good or bad, is going to create stress — and an EMR implementation definitely means change. Different people handle stress differently: one common response is shutting down psychologically. If you notice someone checking out and not participating in project meetings, workgroup discussions or scheduled trainings, you have early signs of trouble. This is the time to nip things in the bud, before it blossoms into more obstructive behavior: planting seeds of doubt in other staff members, regressing back to paper charts, or out-and-out violation of office network policies or procedures.

■ Make sure the leadership is singing from the same page. It is important for any differences of opinion to be kept within the confines of the board room, or whatever is analogous in your situation. Physicians should not voice their dissent at employees as this undermines the process and can be very detrimental. There should be an oral agreement that all problems and complaints are to be addressed at the board or partner level. The implementation is stressful enough to the staff members without feeling that the owners of the practice are in conflict about whether or not the correct decisions were made.

In the end, the "vote" never happened. There were some legitimate issues which were aired and addressed, and, not surprisingly, most were due to miscommunication. Not every problem will always be resolved completely, but all involved parties can at least agree to disagree and then show a united front when it comes to the rest of the organization. OM

Next: Keeping Your EMR Project Nimble.