When HR manager Toby from the TV sitcom The Office speculates about his attitude toward work, he says something like this: "Sometimes when I come into work, I ask myself if this were my last day on earth, what I'd do differently. Well, I'd wear a T-shirt, and I'd order a French dip sandwich and eat the whole thing. And I'd blow this building up. And I'd go swimming. And I'd drink wine."

We all feel that way sometimes (well, hopefully not the part about blowing up our building). And the reason isn't hard to decipher. According to a recent opinion editorial in the New York Times, the typical American now works more each year than he or she did 30 years ago. And Americans put in 350 more hours each year than the average European--and even more than the industrious Japanese!

Continuous hard work can often lead to burnout and frustration--especially when big changes are taking place. And for HIM, as well as many departments in a hospital, what's a bigger change than moving from paper to electronic records? Building on last month's discussion about the changes in workflow brought about by EMR, this month we're addressing how staffing changes--and what you can do to prepare your team and help them find their place in the midst of a hybrid record environment.

Brandwein: First of all, what is your vision for future staffing requirements and skill sets, and how are you preparing for the future state?

Kost:  First, to get an idea of what we'd need, we conducted an analysis. Our vendor had a staffing analysis worksheet as part of the return on investment analysis they provided. We developed a completely new set of positions for our HIM department and created six key questions--the same for every position--to help guide the interview process. The questions were aimed at skill sets we knew people would need in the new, completely electronic environment.

Then we asked staff to re-apply for the new positions. People didn't need to fear the process; we found an initial place for everyone. That being said, we did have a few people retire because they didn't want to have to learn so many new skills and the system. Otherwise, people were positive and have adapted extremely well.

We can't be sure how our full-time equivalents (FTEs) will evolve over time. We acknowledge that we have a long way to go, and we'll have to make adjustments--but we know that the transition will be gradual because we are making adjustments as we learn what is most valuable about the technology.

Agyei: I believe there is an underlying fear of EMR implementations--one that's not necessarily confined to the HIM department--but we've worked hard to alleviate that fear. I don't see any jobs being eliminated and I've conveyed that fact to our team. We're still in the early stages, but we plan to transition staff to new positions, much like Beth mentioned.

Brandwein: What's the biggest change you envision for your HIM department as a result of the EMR?

Kost: Our philosophy is that as we as an organization become more automated, our HIM staff should move toward a more analytical role--especially that of a documentation improvement specialist. It's a definite skill set; rather than just keying in data, it's about using clinical knowledge to maintain and improve quality.

Agyei: Our chart analysts will move into scanning and imaging roles. The primary skill they'll need is ease using computers rather than paper, but we'll work with them to make the transition as comfortable as possible.

Brandwein: Do you have any advice for setting expectations and managing milestones while maintaining productivity, morale and energy levels during the hybrid phase?

Agyei: We try to identify and celebrate every time we discover a time-saver. Even in the early stages, we've noticed not having to decipher handwriting, find paper charts or wait for a physician signature are all big time-savers. Focusing on these "wins" keeps us motivated for the next step.

Kost: I have to admit, we did initially face some morale problems simply because of the volume of records to be scanned. Our HIM managers did a great job of being there every day, providing small gestures such as buying lunch for the team and giving special recognition to them..

We've set performance indicators related to quality and productivity in each job description. Everyone has a document with indicators for almost every aspect of our operations, but it's specific to each job. As a result, staff is getting more consistent feedback than ever before, which keeps them very informed--there are no secrets and no unknowns, and that can also help morale.

Brandwein: It seems that you both have two key pieces of advice for HIM managers transitioning staff to EMR: First, use tools, your vendor, HR and your own "emotional intelligence" to analyze staffing requirements and determine how your current staff fits with this plan. Second, keep morale high through clear communication about what's happening and what will happen--and reward your team for adjusting to the big changes brought about by EMR!

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.