Posted on Nov. 17, 2008

A butterfly's movement can alter the path of a tornado on the other side of the world. Part of the Chaos Theory, this assertion is appropriately named the Butterfly Effect. Its premise: the tiny flap of butterfly wings can have large-scale effects down the line, altering the course of nature. Whether you buy into this theory wholeheartedly or just think it has limited applications, nearly everyone can look back on their lives and think, "if only I had." Small things matter and a simple tweak here and there can have a huge downstream effect. This is especially true in complex environments, or when people are adapting to major change. The health care provider environment is undoubtedly complex - and going paperless is definitely a major change.

Over the past year, our roundtable has discussed the challenges and surprises inherent in a hybrid medical records environment. According to the study, "Health Information Technology in the United States: The Information Base for Progress," approximately 25 percent of all U.S. physician use EHRs. Only 10 percent, however, would consider their EHR "fully operational," which means nearly all health care organizations implementing EHRs are exactly like our panelists. They're in a hybrid environment, with one foot still in the paper-filled past and the other in the e-enabled future.

As we wrap up our roundtable discussions, each panelist will look back over their past year in the hybrid environment and discuss what they would've done differently. Not only that, they'll tell us why - what downstream effects would've resulted from these changes. With that in mind, I'll turn it over to Glennda Gore, RHIA, vice president of corporate compliance and risk management (formerly the HIM director) of McAlester (OK) Regional Health Center.

 McAlester Regional's journey to e-enablement is far from over; although we've made great progress, we know there's more to come. Looking back at 2008, I'm very pleased with the way our HIM department has handled the hybrid environment, not just adjusting to but embracing change, making adjustments on the fly and helping users get on board. I am thrilled that cross-departmentally, we've had such a strong relationship with IT, clinicians, legal and others. If I could go back and do things differently, I wouldn't make drastic changes, but I would exercise the following guiding principles as liberally as possible:

1)     Anticipate Resistance - The old adage, "Hope for the best but prepare for the worst" is entirely applicable to EHR implementation and the hybrid environment. Expect resistance from nurses and physicians. Change is often hard to accept, and many clinicians will immediately say, "I don't have time to learn this!" If you can prepare your staff to expect it and cope with it, you'll not only help them overcome resistance but also keep their own attitudes positive. Anticipate what resisters will say, and coach your staff on how to respond. Make sure your team knows all the benefits to every user group - not just themselves. Most of all, make sure any resistance doesn't "beat up" your team and have an impact on morale.

2)     Over-communicate - Keep staff informed every step of the way. If you feel like you're over-communicating to your team as well as your users, you've probably got it just right. Remember, nearly everyone is apprehensive about something: keeping a job, getting used to the system, remembering new processes. Even if you feel like you're going overboard, they'll appreciate it. Here are just a few areas that require frequent communication:

a.      Jobs, Staffing and Changes in Responsibilities
b.      Training Opportunities
c.      Quick Tips
d.      New Workflows
e.      New Policies (e.g., related to downtime or the legal medical record)
f.        New or Changing KPIs
g.      Feedback and Compliments

3)     Listen Officially and Unofficially - On the flip side of communicating is listening - and it's just as important. From the very beginning, gather input from your team, clinicians and anyone who will be affected by the system. This has two benefits: First, your planning will be more thorough and accurate. For example, we worked with our vendor consultant and management team to determine what size scanner to buy. After we got it, we realized it was too small. In the grand scheme of things, this isn't a big deal; however, it's an issue that could've been avoided if we had gained input from the front line staff. Make sure all user groups are represented at meetings or create some type of forum or medium to enable clinicians and staff to provide input.

Second, people are much more willing to make changes if they feel like they're being heard. Sometimes, you can get buy-in just by letting clinicians and hospital staff vent or express their concerns. That's where the "unofficial" listening comes in. Just letting people express their thoughts and concerns - whether it's in the hallway, after training, or in the break room - can go a long way in helping them adapt.

As you evolve from a paper world to an electronic one, there's inevitably going to be some trial and error. Hospital staff and clinicians are known for being strong and dedicated, though, so have faith that it will turn out for the best!


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Glennda's insights over the past year have been invaluable, and we thank her for her participation. Stay tuned for our final column next month, when we'll hear from Beth Kost-Woodrow, RHIA, assistant vice president and chief privacy officer of WellStar Health System in Atlanta.

Kelly Quigg is HealthPort product manager.