Dear Diary,
I've always thought one of the greatest books for learning how to get along with others and get what you want is How to Win Friends and Influence People by Dale Carnegie. Some of his fundamentals include, "Don't criticize or condemn." "Elicit an 'eager want' in them that correlates with your goal."

His methods are great, and while I'll never achieve Carnegie's status, I now feel like I could write a book, or at least a column, called "How to Win Friends and Influence Physicians."

As we wrapped up same-day surgery records and began planning the inpatient portion of our EDMS implementation, we realized once again what a huge task we'd undertaken. The good news is that we had already collected our forms, defined indexing schemes and determined user rights. Now it was time to take a hard look at processes within our own department-HIM.

Process Improvement for Incomplete Records

Streamlining processes and reducing paper is obviously a key benefit of our HealthPort EDMS from SDS (formerly Smart Document Solutions). This goal requires more than just hard work; it requires major change. It requires buy-in and the willingness to do things differently, not just from the HIM team but also from a myriad of physicians, nurses and others. That's where the "winning friends and influencing physicians" comes in.

We planned for changes that would have a huge impact on many, especially physicians, and had to be smart about how we implemented these new processes.

One process change that caused major ripples dealt with scanning inpatient records immediately following discharge, whether they were complete or not. For instance, discharge summaries or signatures may be missing, but we proceeded with scanning the chart anyway. Why do it this way? There were several reasons:

1.      We reduced the amount of paper in the incomplete record room because only single pages, not complete records, would be stored there for physician completion.
2.      Multiple users have access to the discharged chart as soon as possible-one of the key benefits for our organization.
3.      Most requests for the record occur within 10 days of discharge. Having the record online, albeit slightly incomplete, reduced record pulls and phone calls in HIM.

Here's the new process: Once we scan the record, it is immediately sent for deficiency analysis. If something is missing or incomplete, the scanned record is flagged in the appropriate place and the incomplete document is pulled from the paper chart. The rest of the chart is boxed in preparation to be shredded.

From there, the specific document requiring a signature, not the entire chart, is kept in a physician-specific paper folder within the incomplete record room. Once complete, the final document is scanned into HealthPort and the record is updated. Version control and audit logs are used behind-the-scenes so the end user sees only the most recent version.

Winning Physicians

Those of you who work in HIM probably know what happens next. If the physician who needs to dictate a summary doesn't know how to use the new system and the paper record is gone, what do they do? Two things:

A)    They are forced to use the system. This is the immersion theory at work.
B)     They call us and ask for help. We give it to them.

So ultimately, even though some physicians feel inconvenienced and may prefer the "old" world of paper records, the system becomes adopted very quickly.

"But wait," you optimistic readers might say, "What about training? Didn't you offer a varied schedule of training times to meet everyone's needs?" Sure we did. And sometimes, one or two showed up. Then we realized we needed to try another tactic. Enter our "How to influence physicians" piece. We used influence by helping them learn to use the system on their time, when they needed it.

This may seem backward to some people, because we're making the change first and then asking the behavior to follow. It works, though, especially because we added in another factor-we were open to changing the system to meet distinct user needs.

For instance, anesthesiologists struggled with accessing HealthPort EDMS due to the many forms they'd have to wade through upon login. We heard their feedback and made a change. Now, they log in and only see the anesthesia section. Hearing them and meeting their needs has made them more willing to adapt to the new technology.

A major lesson learned-user champions are great, but sometimes you have to go the extra mile to get them on board. Be open to trying new methods, not just training sessions, to affect change and move your department (and the entire hospital) to the next level.

Next month, we'll look at another HIM process that changed dramatically and let you know how it went!

Traci Waugh is director of health information and compliance at North Valley Hospital, Whitefish, MT, and a client of SDS.