Edward Bulwer-Lytton, a 19^th century author, coined the famous adage, "the pen is mightier than the sword." If this is true, the electronic pen is strongest of them all!

This month, we planned, tested and implemented electronic signature and online deficiency analysis. Chart analysts in HIM adapted fairly quickly to the new process. And our scanning technicians no longer have to re-scan a signed document for permanent filing. So, they were thrilled.

The medical staff, on the other hand, required a lot more coaching, handholding and patience! Let's take a look at how the process unfolded.

Electronic Signature with EDMS
With HealthPort EDMS, SDS's electronic document management system (EDMS), physicians can view transcribed documents and sign electronically. They can also affix an electronic signature to hand-written documents scanned into the system. They can sign from any location-even home or office. With all of this convenience and flexibility, we thought physician acceptance of electronic signature would be easy . not so. We identified five steps necessary to fully implement electronic signature, and along the way, we stumbled on a few more. With the September quarterly medical staff meeting in mind, we planned our steps and our timing.

Step One: Solicit Input Early
Early in the process, we sent a memo to the entire medical staff, informing them of the change and soliciting their input. We kept the communication brief and asked them to share their experiences and advice. Of course, nobody responded to our request for input, but this early communication confirmed our eagerness to include them in the process and get them involved.

Step Two: Find an Electronic Guinea Pig
The HIM Department at North Valley has a good working relationship with our Chief of Staff. We asked him if he would be our "beta site" for electronic signature and he agreed. We trained him on the application and explained all the various workflows involved. Once he was familiar with the system, we had him sign and complete his own charts in the live environment.

We used the "live" vs. "test" system for several reasons. First and foremost, the live system is more realistic. Secondly, if there are any problems, they are limited to only one physician. With physicians, you have only one chance for success. Using the live system ensured there would be no surprises when the entire medical staff started signing charts electronically. Over the next several weeks, we worked with the Chief of Staff to raise his productivity and efficiency.  

Step Three: Get Other Guinea Pigs on Your Side
Once the system was working well for our first electronic guinea pig, we looked for others. As physicians came into HIM to complete their charts, we asked them if they would like to give it a try. We trained them on the system and let them test drive. They tried it and gave the system great reviews! 

By engaging a few other physicians prior to the quarterly meeting, I knew I'd have more than one supporter in the audience. I've been to meetings in the past where all I received was negativity. I wanted to have a few positive testimonies in my back pocket. Now it was time to make our case to the entire medical staff!

Step Four: Make Your Case
When it came time to make my formal presentation to the medical staff, our Chief of Staff led the discussion. Physicians will listen to their peers over HIM professionals. And this was no exception! He started the presentation, and I explained the details. According to Margaret Amatayakul, RHIA, CHPS, CPHIT, CPEHR, FHIMSS, physicians only have two assets: their knowledge and their time. So my emphasis was on how electronic signature would save them time. I had protocols and step-by-step guides already designed and ready for their use. In addition, we promised to save them time by conducting one-on-one training at their convenience and even in their offices if they preferred. In addition to the Chief of Staff, our other guinea pigs shared their support of HealthPort EDMS's electronic signature module, but we also had some opponents.

Three physicians were not very happy with our timing. They were very vocal, negative and complaining. HealthPort EDMS had not yet incorporated electronic annotation, so in order for physicians to edit or change something that had been transcribed, they would need to print and hand-write the edit or dictate an amendment. General Patton once said, "A good plan today is better than a perfect plan tomorrow." This was our mindset, and knowing that physicians had several work-around options for annotations, I was confident we should proceed. Secondly, our medical staff has always reported high levels of satisfaction with the quality and accuracy of our medical transcription. History has shown that few, if any, ever request edits or changes to a transcribed report. Despite three disgruntled physicians, we forged ahead.

By the end of the meeting, everyone agreed that we were going live with electronic signature, physicians would need to get on board and the new process was approved.  Now the training could begin!

Tips for presenting to the medical staff:
-          They believe what comes from their peers
-          Make an effort to inform and gather their input at the beginning of project, even if they never respond
-          Have protocols and step-by-step guides ready
-          Make them look competent (private training sessions)
-          Respect their time

Step Five: Personal Training With Carrots
Physicians don't want to be embarrassed in front of their peers. So we agreed to support one-on-one training. We offered to visit offices or train them in the HIM department. One physician even began training his partners once we conducted the initial training for his office staff. In addition to personal training sessions, we offered another important carrot-a clean slate.

On day one, the entire medical staff was given a clean slate for chart deficiencies. We stopped counting delinquent records on paper and started only counting days in the system. As physicians underwent training, they began immediately signing and completing records in HealthPort EDMS. For those stragglers who still have not been trained, the clock continues to tick. There are only a few.

Lessons Learned
One thing we learned along the way was that our CEO should have also been informed and trained on electronic signature prior to the medical staff meeting. This way, he would have been well-prepared when our three unhappy physicians knocked on his door to complain. After all, in the health care world, physicians do carry a mighty strong pen!

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