There's no question that an electronic medical record system can improve your practice's efficiency and productivity. However, without full buy-in from everyone on your staff, you'll never achieve the performance results you anticipate.

It's one thing to know that you need staff buy-in, it's another thing entirely to know how to get it. Here are the steps to take to get participation, cooperation and collaboration from staff members at all levels, and increase your chances for a more rapidly successful electronic medical record implementation.

Convey The Urgent Need For Change

Making a major change in your medical practice is hard enough. Trying to make that change when people don't recognize the need for it is a recipe for failure.

Everyone in your practice needs to understand the factors that make the new electronic medical record system desirable or even essential - for example: the ability to streamline work and enhance patient care, the opportunity to reduce costs and increase productivity, and the ability to adapt to changes in patient needs, 3rd party demands and new government requirements.

However, while you may make a great logical case for change, people don't make decisions based on logic alone. Emotions are a powerful factor. You need to make sure that your staff not only understands the logical reasons for implementing the electronic medical records system, but also understands what the consequences will be to them personally if the implementation isn't successful.

When you present the new electronic medical records system as a way for the practice to continue to operate profitably - despite challenges, to continue to provide quality care to your patients, and to continue to provide your valued staff with employment, you're likely to capture their attention.

Keep People Informed

People don't really fear change. What triggers fear is uncertainty.

The worst thing you can do is to keep people in the dark about your plans. This encourages rumors and leads people to start grumbling about their jobs and worrying about their futures.

When it comes to implementing an electronic medical record system in the practice, one of the biggest concerns people have is whether the new technology will take away their jobs.

In light of today's economic realities, no one really expects guarantees of job security. However, what they can and should expect are honest answers to tough questions.

People will want to know:

* How the electronic medical record system will impact their work and their futures
* What new expectations you and the practice have of them
* What new skills they will need to meet these expectations
* How they will be trained and supported for these new challenges
* How their performance will be assessed

The fact is, the new electronic medical record system will make some tasks unnecessary, and some skills irrelevant. However it's important for you to recognize, and to communicate to everyone, that when work gets reorganized, and when certain tasks are no longer necessary, people can be moved to more profitable activities. For example, if implementing the new electronic medical record system will allow you to increase your patient load, you may need staff to shift to more patient-centered activities in order to take advantage of these new opportunities.

Harness the Power of Collaboration

Regardless how large your practice is, a new IT system will impact the work of staff members at all levels. To get the maximum value from that system, and to increase the speed of getting to that value, you need discretionary effort and enthusiastic collaboration from everyone in your practice.

First, when it comes to designing the system and reengineeringing the workflow, you must get your staff's perspective. They are closest to much of the work of the practice and can offer suggestions and ideas that can facilitate implementation and reduce the expenses and the temporary productivity slow-downs that inevitably accompany any new electronic medical record system implementation.

Second, if you want to mobilize people to not only cooperate, but to give their best effort, you need to allow them to participate in developing plans. You may have heard the expression,"People who plan the battle, rarely battle the plan." If staff members at all levels are involved with the development of the implementation strategy, they will have a vested interest in its success.

The way to do that is through a series of interactive workshop-style staff meetings that elicit staff ideas and engage staff members in creating their own future.

Show People What's In It For Them

The real secret of successful change management is to show people what's in it for them. You can accomplish this in two ways.

First, by showing how the electronic medical record system will positively impact people's work and enhance their job satisfaction. For example, once implemented, will the system eliminate the frustration of lost charts and information? Reduce tedious tasks? Improve documentation and coding accuracy? Allow staff to get home earlier?

The second way to show people what's in it for them is to attach rewards and recognition to specific goals and milestones. Offering team bonuses for increased practice productivity, increased referrals and increased patient satisfaction can be very effective in building a cooperative environment. However, it can take a while to get to significant performance increases.

Establishing intermediate milestones, "small wins" - like getting a specific system module successfully up and running, or achieving a certain reduction in transcription usage - can go a long way to building momentum and can help to convert any lingering skeptics.

These kind of rewards and recognition are tangible pay-offs that fuel the fire of motivation.

Jane S. Adler, MD is founder and president of NeoVista Health Strategies, a provider of resources and information for higher performance in healthcare. She is a co-creator of The Road to Excellence System™ for maximizing staff performance and productivity in clinical practices, and author of How to Position Your Clinical Practice for Outstanding Success and A Profitable Practice is Everyone's Business.



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How would you feel if I tell you that nine million children in the United States of America do not have access to quality affordable health care, for which their parents wouldn't have to shell out a fortune? It sounds terrible, I agree. This number and more like this are probably what prompted the government to gun for a health care bill.

It is a worldwide phenomenon. The wages and salaries of people across the world may be increasing or decreasing, but it is quite certain that medical bills are not what they used to be some time ago. And more and more people are falling ill, thanks to fast lives and sedentary lifestyles. Affordable health care seems to belong to the past.

Paying monthly bills is a task, probably for which you set dates and timers. On top of that, there may be the car insurance, home insurance, home loan, taxes and so on. But, you cannot afford to ignore the most important thing of all - your body. Is it insured? What about your family? If an unforeseen illness affects you or some member of the family, will you be capable of paying the bills without a problem? This is one of the reasons why in the modern world, you cannot live without a medical insurance.

However, it is an area where you have to tread with caution. There are enough policies from so many companies to confuse you. You have to choose which one to take after checking out the various conditions they have or require. Apart from the monthly or annual premium, you should also decide based on the deductibles, co-payments and other such conditions.

In some cases, if you join for a medical plan alone and later you want to add members of your family to it, the company may not allow you to. Make sure you go for a policy where your family members can be added later too, so that the cover extends to them too.

The importance of an affordable health care plan surfaces when you may have to run from pillar to post to find money to pay your bills. The worry of paying your bills should not make you choose a center which is poorly-staffed or has quality problems in treatment. While paying a premium every month may seem tough, it is better that you go for an insurance policy which will pay your bills when you least expect illness to strike.

Many companies have a list of hospitals where you can seek treatment. If you go to these hospitals, you may have to make only part payment of the bill and the rest will be taken care of by the insurance company. And, if you decide to go to a center that is outside the purview of the insurance company, you may have to request for a reimbursement for the bills you paid. When you are facing a cash crunch, it is better you rush to a hospital where you may have to shell out less.

Affordable health care is not available anymore. But what is available are means to make health care affordable to you.




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The HIECH Stimulus Act is part of President Obama's plan for full, nation-wide use of EMRs by 2014. The act promotes Electronic Medical Record (EMR) adoption by allocating funds to reimburse physicians for purchasing and using a qualified EMR system. In addition, physicians who fail to adopt an EMR will eventually face Medicare reimbursement penalties. Although the goal is lofty, Obama hopes the act's carrot and stick approach will encourage physicians to adopt EMRs.

However, a recent report by HealthLeaders-InterStudy indicates that Phoenix, Arizona is experiencing a high rate of Electronic Health Records (EHR) uninstalls. According to the report, the trend is due to training, functionality, or affordability issues. Both top-level hospitals and smaller providers struggle with the financial constraints of purchasing and implementing EHR systems. Arizona rapidly adopted EMR systems due to a 2005 executive order by Governor Janet Napolitano, which required that all healthcare providers install an EHR by 2010.

Does this uninstallation trend provide us a glimpse into the future? Will the U.S. share Arizona's experience at the national level? Arizona's executive order is similar to the HITECH stimulus act because both seek to rapidly drive EMR adoption to meet an arbitrary deadline. In both cases, physicians feel pressured to make a very important and potentially very expensive decision. Although EMRs provide many benefits, selecting the wrong system, or rushing the implementation process could lead to many problems. It seems that Arizona physicians are scrambling to remove unusable systems due to poor selection or botched implementations.

This does not necessarily mean the HITECH Act will fail. Rather, it means that physicians need to be careful and not rush into a decision they may regret. EMR system prices can reach $100,000 or more. In contrast, the stimulus act will only pay about $44,000 in reimbursements. Physicians should focus on their needs, not wants or superfluous features, and select the simplest system that fulfills their requirements. Simple systems are easy to install, easy to learn, and easy to use. Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded.

The uninstallation trend in Arizona is a clear warning. Although well-intentioned, the HITECH Stimulus Act may encourage physicians to rashly purchase a system that will not work well in the long run. Physicians must resist the temptation throw in a system just to qualify for reimbursement payments. Instead, they should take their time to find a simple, user-friendly system that meets their needs. After all, $44,000 sounds like a lot of money, but it will probably not cover the more expensive EMR systems with monthly maintenance fees.




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