We're taught from a very young age that the word "report" often carries foreboding, negative connotations. During youth, report cards tell your parents everything, good and bad, about your performance at school. When you first learn to read, it seems you're asked to write an endless succession of book reports. As an adult, we dread the month of April because it's time to report our earnings and assets to the IRS.

Often, we bring this same dread about reporting to our professional lives. Everyone reports to someone--HIM directors report to CIOs, CIOs report to CEOs and CEOs answer to the board of directors. We don't necessarily look forward to it, though. It can be time consuming, tedious and, well, unglamorous. And all too often, reporting exposes flaws and creates friction, which seems to ultimately generate more work for everyone involved.

In a hybrid medical record environment, however, reporting can mean the difference between success and failure, or adoption and resistance. Last month, we discussed how key performance indicators, or KPIs, can provide a focused snapshot of the hospital's operations during the tenuous hybrid phase. While these KPIs will inevitably expose problem areas, is that necessarily bad? Granted, showing executives how and where your organization is missing the mark doesn't make for a happy, pleasant morning meeting. On the other hand, KPI reporting can be an invaluable tool to engage your executives, show them where their influence is needed, and help set reasonable expectations.

Brandwein: Last month, you talked about the many indicators you track and measure for KPI reporting--DNFB, delinquent billing, staffing by HIM position, how many pages are printed out of each system and who is printing them. This sounds very comprehensive. What's your process for creating these reports?                         

Beth Kost-Woodrow, RHIA, chief privacy officer and executive director, WellStar Health System, Atlanta: We have a monthly report card for each of our five facilities. We include such a large variety of data that we can't pull everything from the same system, so I have to do some compiling. It is well worth it, though, and I'd recommend that any HIM director in a hybrid environment go through this monthly exercise.

When you're in a hybrid environment, staff will complain. Initially, physicians may be vocal about disliking the system and the new processes it requires. Your executives will hear these sentiments, and it opens the door for them to question your EMR's value (or any other system you've implemented.) With the report card, you can show them improvements in black and white.

Brandwein: How do you communicate with your boss and other executives in your organization regarding KPIs and your progress in becoming paperless?

Glennda Gore, RHIA, vice president, corporate compliance and risk management; former HIM director, McAlester (OK) Regional Health Center, McAlester: Our EMR vendor holds weekly conference calls with all parties. While our executives can't make every week's call, they join in and get status updates as much as possible. Because I'm the VP over HIS, I'm in the same boat as they are; I can't attend every call. Having this frequent weekly communication, however, benefits everyone. The information is readily available whenever any manager or executive has a question about a KPI, process change or project status.  

Kost: As I mentioned earlier, each of our five facilities has their own report card. Assembling this information does take some work, but it's very helpful. Each facility's leadership has come to rely on this data. It has also helped me get buy-in and support; our leadership has a much clearer picture of how much work truly is involved in going paperless, and they are much more involved since they're "in the know."

Brandwein: What kind of KPI variances did you experience during implementation and how did you plan for them and explain them to leadership?

Kost: During implementation, our DNFB and delinquent records both increased while staffing stayed the same. This was a lesson learned for me. I didn't communicate as well as I should have before we went live, and its increase actually shocked people. This is a great example of managing expectations. It is common practice for certain benchmarks to fluctuate while a hospital team is learning a new system; however, most people forget this fact. We now circumvent these problems by including best practice objectives on monthly report cards; e.g. "We expect to be best practices in 6 weeks."

You can also expect some variance due to the awkwardness of living in both paper and electronic worlds. We realized when delinquent records increased by 50 percent that certain physicians just didn't know how to use the system. We ran reports to see who wasn't using it and then made sure they received training. I'd recommend being very patient and flexible--train physicians when and where they can manage training. Also, determine which physicians have the highest case load and train them first.

Brandwein: It's an excellent point: every organization, no matter how well-prepared, can expect some surprises, or "awkwardness," in a hybrid environment. These variances make reporting and transparency about your implementation process essential. The more we discuss our experiences in a hybrid environment, the more apparent it becomes that frequent, regular communication is key. It helps keep staff motivated and on track, and it helps executives support your team throughout your day-to-day challenges.

Next month, we'll discuss outsourcing and the hybrid environment -- when is it a good idea, and how can you ensure that it will help, rather than hinder, your quest to become paperless? We look forward to exploring this topic next month.

Aaron Brandwein is divisional vice president for HealthPort, formerly SDS. He is responsible for HealthPort's EDMS technology division and currently serves on the AHIMA Exhibit Advisory Committee and has spoken at numerous AHIMA national and state conferences on the topic of electronic and hybrid records.