Getting Doctors and Staff On Board With EHR

Wendy Lipton-Dibner, MA

Disclosures

September 02, 2009

In This Article

Introduction

Physicians often give logical-sounding reasons for not adopting an electronic health record (EHR), but sometimes there are additional reasons they don't express that aren't financial or practical. This is particularly a problem when your practice involves several physicians and staff members, where it's common for some to stonewall or to subvert the efforts to move ahead with EHRs.

It's important to align your team before launching any major change initiative, but especially one that demands as much widespread change and precision as the installation of an EHR system. You'll need to address 3 areas to gain buy-in: financial resources, practical applications, and emotional responses.

If you find that physicians and administrators are spending what you consider to be excessive hours churning over the financial and practice areas, it's possibly due to unidentified emotional responses to the change initiative.

If you're frustrated by your colleagues' refusal -- overt or covert -- to move ahead, it's vital that you find and address the unstated reasons that are causing them to resist.

The most common reason I've seen for practice members to avoid the move to an EHR is that they are fearful and/or angry. However, practice members don't necessarily reveal these emotions, but rather mask them with objections about financial or practical concerns. Unless the factors leading to their discomfort are addressed, they will not move forward on the initiative.

For example, the managing partner of a 5-partner gastroenterology practice put EHR on the agenda as something that needed to be adopted. The partners discussed the financial and practical considerations every month for 2 years, always demanding more research and postponing decisions.

In the 24th month, consultants talked with the practice members to identify their specific concerns. They made these comments:

  1. I don't know whether I can learn this.

  2. Am I setting myself up for malpractice?

  3. What if I hit the wrong buttons or delete something important?

  4. If I'm going to spend time learning, I'd rather spend it learning something that's going to make me a better physician.

  5. I've been in practice for many years, and no one is going to make me change now.

  6. No one has the right to tell me how to practice.

  7. I don't have time for this.

The managing partner had been unaware of those concerns. Once the issues were on the table, he addressed his partners' fears and anger with concrete data. The partners were able to look at the facts, reach consensus, and move ahead.

In another practice of 10 cardiologists, the practice had purchased and installed an EHR system, but they were unable to launch because many staff members had failed to meet their objectives for start-up. In the 6 months since installation, the practice had experienced a 21% increase in sick days and early departures; morale had dipped dramatically; and a significant percentage of staff members were falling behind on completing their training modules. Every day, staff members were appearing in the practice administrator's office with complaints about lack of teamwork and their inability to "keep up" with regular duties. Through confidential surveys, we discovered that many staff members resented the physicians for unrelated issues, leading to a resistance to support the practice goals.

Consultants called a full-practice meeting, and learned that staff members perceived that they were unappreciated by their physicians and felt angry and unwilling to do more than what they considered should be done. Problems also existed between clinical and administrative departments, which led to miscommunication, mistrust, and resistance to working together on the EHR initiative.

In the meeting, they were able to talk through the difficult issues and improve communication.

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