Tense Moments When Implementing an EMR

Posted on January 10, 2006 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I found this article which described some of the feelings we’ve had in implementing an EMR. This article in the beginning highlights how a simple phone call has a great effect on the morale of the clinic and the need to relearn this process after implementing an EMR. I agree whole heartedly and even extend this same response and lack of morale throughout almost every single piece and process in the clinic. Every step that is taken before a patient arrives, how a patient gets checked in and processed through the clinic(not that patients are “processed” like computers) and even after the patient leaves has to be evaluated and decisions must be made on how everyone is going to function with a new EMR.

Here’s the start of the article:

From the January-February ACP Observer, copyright © 2006 by the American College of Physicians.

By Janet Colwell

At Greenhouse Internists in Philadelphia, getting patients’ phone messages to physicians used to be a fairly simple process. The receptionist would write the message down, pull the patient’s chart, clip the message to the chart and place them both on the doctor’s desk. The physician would record the conversation in the chart and then send it back to be filed.

Converting to an electronic health record (EHR), where all the physicians and staff would have simultaneous desktop access to everyone’s files, promised to make that process even easier. But after the office went live with an EHR in mid-2004, taking a phone message—along with every other office routine—became a source of missteps, errors and tension among the once-compatible staff.

At Greenhouse Internists in Philadelphia, Melissa G. Schiffman, ACP Member (left), and Richard J. Baron, FACP, discuss the best use of patient data recorded in their tablet laptops. The group implemented an electronic health records system in 2004.

“Just responding to a patient’s question or phone call became difficult,” said Richard J. Baron, FACP, one of the group’s four general internists. “Everyone had to do things differently, and no one knew exactly how to communicate with everyone else. How did the people taking the message communicate with the people in the file room if there wasn’t a piece of paper moving around? Where would the doctors look for information to support telephone decision-making?”

While physicians anticipate rough spots in adapting their clinical workflow, many groups underestimate the level of disruption—and just plain stress—that staff can experience during an EHR implementation. At Greenhouse, the 15 staff members, all of whom had been there for at least five years, suddenly felt incompetent, Dr. Baron said. Well-established work patterns had to be re-tooled and collegiality temporarily evaporated as staff members wrestled with new roles and modes of communication.

‘We didn’t anticipate the group tensions and that was one of our biggest surprises.’
—Richard J. Baron, FACP

“We went from an environment of productive, happy employees who covered for one another to one where everyone was more resentful and had a shorter fuse,” said Dr. Baron. “We didn’t anticipate the group tensions and that was one of our biggest surprises.”

There is, however, light at the end of the tunnel: According to Dr. Baron, morale will recover and office routines will be even more efficient than before in about three to six months. But he and others who have weathered the implementation process warned physicians to expect morale to get worse before it gets better—and they offered some tips to make the transition a little easier.