Challenges and Solutions to Implementing Electronic Health Records (EHRs) with Non-Clinical Staff Members
The following question was presented to us by a manager in the behavioral health field.
My employer has implemented electronic health records (EHRs) in several departments but not in my department which includes direct care, day hospital, and residential services. Senior management says it will be too disruptive to operations now, and that my staff members are not ready for EHR. But I really think it will be best for our operations. How can I move this forward?
This question is really two questions: how to advocate with senior management and how to implement EHR with different types of employees and programs.
Regarding advocating with senior management, your challenge is an example of the importance of managing up – understanding the situation of your superiors and learning the best means by which to communicate with them. Here are some suggestions:
Recognize competing priorities: I am sure your employer is aware that EHR will be a requirement for all programs. Likely they are juggling different priorities and financial matters. The pandemic could have reduced program revenue or there are other financial priorities. In your meetings with your superiors, acknowledge these factors. You may not have authorization to know the details but stating that you are aware of competing priorities shows sensitivity to your manager’s situation, making them more receptive to your comments.
Gather input from peers: Speak to peers in other departments or peers who run similar programs at other agencies. They will give you information that you can share with your superiors. What others in the industry are doing, particularly locally, will be important to your superiors. Your data collection helps your superiors do their job better, an important piece of managing up.
Suggest a pilot implementation: Maybe you have an employee who is particularly adept at data entry and documentation and eager to learn. Suggest that this person be a pilot to demonstrate how EHR would work in your department. A pilot has the advantage of identifying any problems in implementation and correcting them before rolling it out to the others in the department.
Be respectfully persistent: Ideally you have regular meetings with your manager and therefore can keep this item on the agenda for follow-ups. In doing so, you can continue to advocate. But you must also be sensitive to feedback from your manager. If you are continuing to bring the issue up and not getting any new feedback, it may be best to take a break. Repeated reminders about an issue can seem more like nagging or complaining than being solution focused.
Regarding the implementation of EHR with non-clinical or non-professional employees here are some suggestions.
Consider data entry format: Because many of these employees may not have college degrees, they do not have much experience with writing and typing. Many of them do not use a computer keyboard to type, but they do use a keyboard to send text on their phone. Therefore, electronic health record data entry may be easier to use and used more readily if an interface can be created to allow them to enter data in a format similar to the way that they text.
Consider typing classes: Years ago, keyboard typing was a standard class but now it is presumed that people will learn how to do it on their own. Nonetheless, some employees may benefit from self-study or short-term classes as further support. They do not have to learn speed typing. But, giving them exercises can help them to become more familiar and comfortable with a standard keyboard data entry.
Work with the bargaining unit: Employees in the programs that you supervise may be members of bargaining units (unions). The bargaining unit can be a partner in implementing the change. Here you would be communicating as you do with senior management – explaining the problem, emphasizing the need and urgency, and gaining their support to implement the change. Suggest a recognition plan for employees who are quick adopters of the EHR. Doing so will please those employees and create an incentive for others. The union will also appreciate the recognition given to their members.
Work with the EHR vendor: The EHR documentation for your programs is different from that for more clinical behavioral health programs such as case management, drug treatment or mental health outpatient. Forcing your employees to use a documentation model that is unnecessarily detailed will discourage their willingness to use it and their effectiveness at using it. To be sure, EHR vendors charge more for customization of documents. Vendors and providers should strive to enhance the user experience of all staff but particularly those who are less familiar with such data entry.
Expect turnover: During a time of exceptionally large vacancy rates in behavioral health programs every employee, particularly a longstanding one is valuable. Yet the longstanding employees may be most resistant to learning new skills. An employer needs to balance the need to fill a vacant position with the need to have employees who can do the work. Technology has made jobs in many industries different than they were in the past. This point is another reason ongoing training is an important career development activity that benefits the employer and the employee.
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