Last month, our hybrid medical records roundtable talked about the staffing-related surprises and challenges they faced while transitioning to a paperless environment. Not surprisingly, our panelists were well-prepared by setting and managing expectations, keeping morale high and helping staff overcome the obstacles inherent in adopting new processes and technology.

But aside from all of these things, there's an even bigger element--the human factor--that requires even more attention. And it's perhaps even trickier, because it's not scientific or predictable. It can't really be planned to a "T;" you can rewrite job descriptions and pave the way for smooth transitions, but people aren't computers and you can't predict what will happen!

This month, we'll talk more about that human factor, which is certainly at play when positions are eliminated or drastically changed. We'll look at what staffing challenges our panelists faced, how they dealt with them and what they'd do differently if they were starting over.

Also, for the first time, Glennda Gore, RHIA, joins our roundtable with insights and experiences gained during her tenure as vice president of corporate compliance and risk management at McAlester Regional Health Center in Oklahoma.

Brandwein: After being in the EMR market for some time, we can almost predict some common fears associated with going paperless. The most common is an overwhelming concern that staff will be instantly reduced and people will lose jobs. How have you circumvented the pervasive concern that this will happen?

Gore:  My best advice is to keep staff informed every step of the way. With this, as with so many challenges in life, people can imagine the situation to be much scarier than it actually is! Right now, we're just changing duties from filing to scanning, but even with this small change, you can't communicate too much!

As our end users become more comfortable with the software and as we run out of paper records to scan, I do think we'll eliminate at least two full-time equivalents (FTEs), but that's about 3 years away. When we installed Meditech in 1999, I had to let one worker go because she just couldn't grasp using the computer. She was 68, so she'd never had to rely on computers in the workplace. Fortunately, we reassigned her to another hospital department that didn't require computer usage. I think Beth Kost mentioned a similar situation on a larger scale in last month's column. She had people re-apply for new positions and if they didn't fit the skill sets required, they tried to find places elsewhere in the hospital. Communicate with your staff and let them know you'll work with them to learn the software or alternatively find another position, if at all possible. That's the key to keeping the peace!

Kost: Another thing we did to ease the transition and make sure we handled everything correctly was involve the human resources (HR) department. I know if you're trying to ease fears that could be counter-intuitive; sometimes when HR is involved, people jump to conclusions and think jobs are being eliminated. But, HR helped us with  individuals who may be at risk with the new system. We looked at others in the organization that might be a fit in the "at risk" jobs, while also seeking a better fit for the individuals in jeopardy.

Everyone also received a salary increase. HR helped us determine what salaries would make the new jobs competitive, and this made everyone happy!

Brandwein: HealthPort conducted a live roundtable titled "HIM Issues with Hybrid Medical Records" at the 2007 California Health Information Association's (CHIA) annual conference. The 26 participants all agreed on three basic ways to set your staff up for success while combating the fear of job elimination.

1.      Honesty - Don't keep secrets; immediately set aside misconceptions by discussing the variety of positions that will be created and the steps necessary to transition into these positions. Sometimes, staff reduction comes strictly from attrition rather than lay-offs.

2.      Test existing staff - This must be combined with the liberal communication Glennda already mentioned, but if you test staff, you know their qualifications and strengths and so do they. They won't ultimately be happy where they don't fit, so testing is critical.

3.      Set Goals - Communicating goals and position requirements can be a great motivational tool. It eases your staff's concerns if they know they have every opportunity to move from a file clerk position to a scan, prep or quality control position.

Kost: Another important factor is letting everyone practice in a test environment. Even if they're unsure, they can build confidence and go from feeling negative to being empowered about a new challenge. The test environment is less stressful, so it can really help your staff make the transition and get excited about their new roles.

Agyei: I mentioned this in our last discussion, but I'd like to reiterate the value of celebrating every success, big and small. Many HIM staffers stay with a hospital for most of their careers, and going paperless represents monumental change. Breaking up this monumental change into small steps--and small victories, which you can celebrate--can be a real morale booster.

Brandwein: Another fact we uncovered in a similar roundtable HealthPort conducted at the 2007 Ohio Health Information Management Association (OHIMA) annual conference was that most staff reduction didn't happen because jobs were eliminated, it happened because some staff quite simply didn't want to learn a new system. You can encourage them to make the transition; our panelists have given some great tips to ease peace of mind while getting everyone up to speed. You can't force change on anyone, though, and some people would just prefer to leave.

Kost: I agree; we had a few people retire early or leave. Overall, though, people jumped in and learned the system, and we found a place for everyone.

In conclusion, when it comes to planning for your new HIM staff in a hybrid environment, maybe it's safest to just say "aloha" to staff--that way you're covered whether they're staying or going. You can certainly be proactive in not only helping your team become competent with your EMR, but also excited about using it ... but the "human factor" is always there, so you can't predict everything that will happen!  

Aaron Brandwein is divisionalvice 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.