Friday, 12 April 2019

Helping Staff Accept an EHR/Practice Management System

ehr staff acceptance

NOTE: This article is adapted from a Facebook Live presentation by Dr. Michael Gordon. The co-founder of ClinicTracker, Gordon is a Ph.D. clinical psychologist, veteran clinic administrator and clinical researcher, and a longtime advocate for effective, data-driven clinic management.

Regardless of the EHR system you purchase, you’re going to have to go through an implementation process that involves setting the system up so it “knows” your agency’s staff, procedures, and revenue management. But it also involves working out how to get all of your staff on board with the new system. If you don’t think through how to make sure all are willing and able to learn the system, the road to going live can be rocky and perhaps even blocked.

As you know, many of your people – mainly, but not entirely, the older ones – will find the entire process annoying and may resist the change. Here’s why:

  1. Most of us hate change, even if it’s for the better. It probably took your staff a while to get comfortable with what they’re currently using and they have little interest in learning something new. They didn’t go to graduate school or medical school to spend lots of time inputting information. If they’ve always used paper and pencil forms, many will want to continue using paper and pencil forms. If they’ve used a system they criticized because it’s clunky and time-sucking, some still won’t want to move to a better system. Even younger staff can be unhappy that they have to learn something new.
  2. Lots of staff have had bad experiences with systems that complicated their lives more than helped them. They automatically assume they’re in for more misery and a system that will make paperwork and other workflows more difficult.
  3. Some people simply react poorly to a higher level of accountability.

Here’s a story that illustrates my last point: When we were first implementing ClinicTracker, I wanted to test whether we were indeed tracking all appointments accurately. I printed sheets to put in everyone’s mailbox to verify that we had an accurate tally.

You would have thought I had thrown a grenade in the middle of the clinic. Within the hour, one of my social workers responded with fury. She thought I was treating her unprofessionally by having a real-time accounting of her activities. She pointed to my desktop computer and said, “It knows everything I’m doing.”

Watch the recorded Facebook Live session with Dr. Michael Gordon.

Listen to Dr. Michael Gordon here or on your favorite podcast player.

I told her that, yes, it knew her caseload, but that it was good for me to have access to that kind of information. I explained that I needed to verify our efforts for contracts and such. But she didn’t care. She felt that even having that information changed the climate of the clinic. Instead of being an autonomous professional responsible for her own accounting, she found the process upsetting (so much so that she quit about a month later).

To be fair, this was about 18 years ago and people weren’t used to practice management systems, but I have good reason to believe that type of underlying concern persists. Many staff, both professional and administrative, feel very threatened when their supervisors can know exactly where they stand with their caseloads, paperwork, billing, and other tasks.

One reason some staff didn’t like the new order was that, frankly, they could no longer complain that they were working harder than everyone else or that their cases were more challenging. Now I could say, “Well, let’s look at the data.” You know the rest of the story: The frequency of those interactions dropped to zero. What increased was the number of times I went to other staff with concerns that they were working too hard or had too many challenging cases.

The bottom line is that lots of people have issues with a high level of accountability. Your most responsible staff will love it because it shows that they’re productive. Less productive staff will identify the practice management system as a threat.

So how do you maximize the chances that staff will accept the new system?

First, get at least some of your staff involved in the software selection process. They’ll probably have good opinions. But more importantly, they’re more likely to have an investment in things going well with a system they helped choose. You’ll want people you can use as “super users” when you get the system – people who are invested in learning and promoting its use.

One way to ensure staff will be agreeable is to select a system that’s designed to work everyone through their daily routines. Most systems will offer forms and templates to complete, but they won’t tie them into a system of alerts and notifications based on when those forms are due and who should be completing and signing them. The more your people have checklists to guide them, the more comfortable they’ll feel. They’re also likely to do a better job getting their work done.

The system should eliminate the need to remember what forms are required for the phone admission process as opposed to the walk-in system. Or which clients are due for treatment summaries. Staff absolutely love not having to wonder what they owe or what to include in a particular form. They also appreciate not having to type more than what’s required. The more the system acts as a guide and not just a repository of information, the happier and more productive the staff will be.

Next, choose a system that you can modify, preferably on your own, so it looks familiar. You’ll want your staff to look at a new form and say, “Wow, that’s just what it looked like in the old system. It even uses our terminology for clients versus consumers or patients.” If you used Clinic ID# for the client identifier in the old system, make sure you can use that same identifier in the new system (if that’s what you want, of course). Learning a new software system can involve learning a whole new language. You want to minimize new language learning to the extent possible and advisable. People won’t resist change as much if there’s not that much of a change.

Think through who to use as your implementation project manager; beyond which system you use, this might be the most important decision you make. As with any project, you need someone good at seeing it through – someone who’s smart enough to pick up the system and to work out what needs to happen to go live. They need to be assertive in working with the software company and working with the rest of the staff.

Our implementation staff will tell you that there’s a direct correlation between the wherewithal of the clinic’s project manager and the ultimate success of the implementation. They’ll also tell you that that best project managers are the ones who know their limits, who know when to stop trying to do something on their own and call support. Some users will spend hours trying to figure something out that one of our support team could help them solve in a minute or two. There’s no need for people to get frustrated because they’re determined to figure everything out on their own.

Make it clear to the staff that you want their ongoing input. You want to position this implementation as an ongoing group effort to optimize the system for everyone’s benefit. You explain that you bought the EHR software because you could customize it and you want their ideas about what would work best. It’s extremely difficult to get staff to think what might be than what is or what had been. It’s worth pursuing initiative and “what if” thinking as you implement an EHR.

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