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EMR and the Generation Gap

What is the quickest way to figure out how to use a new electronic device? Read the manual? No – hand it to a child and let them play with it for a few minutes and show you how it works. But the converse is true as well: if you hand it to an older person and expect them to use it without proper planning, you may be asking for trouble.

Previously I have written on the pitfalls of naysayers on your EMR implementation project. These are typically partners in your group who have already decided that the practice cannot afford EMR, the incentives the government promised will never materialize, and the whole thing is just an expensive boondoggle that will bring the business to its knees. Then there are those doctors who say they are willing to go along but in reality become withdrawn or drag their feet.

Most often the cause of this behavior is their anxiety over the new technology as well as the unknown effects it might have on their practice. The majority of people over the age of forty have limited exposure to computers and the like, particularly if they are only high school graduates. But even middle-aged individuals with higher education, such as physicians, may not feel completely facile with the latest gadgets.

If this technology is complex – like an electronic medical records system – and has a significant impact on that individual’s ability to perform his or her job – seeing patients – and make a living, be prepared for downright resistance. It only takes one major stakeholder such as a partner to bring down a project of this magnitude if he or she is not fully on board, so it is best to be proactive when it comes to push-back from doctors.

Katzen Eye Group had to deal with this very issue when they went paperless with NextGen in January, 2004. Janna Mullaney, their Chief Operating Officer, says, “I usually find that older docs fight EMR because they aren’t comfortable with it; they think it’s going to slow them down and it’s just too much of a change in the way they have practiced for several decades.  The trick is to make the transition easier and to get them involved early, to show them that they are going to have some input.”

In the case of our own implementation, we also chose NextGen’s EMR solution because it is fully customizable. This gave us the ability to ensure that the transition would have the least impact on individual physicians’ work schedules and productivity. Those EMR systems that are the easiest to use ‘out of the box’ may be the least flexible regarding customization and their apparent simplicity may in fact hamper the long-term success of your project [read Choosing EMR Software and get our Free EMR Software Checklist].

So what are some ways to stave off a potential mutiny when it comes to your EMR implementation? Ms. Mullaney adds the following pointers for those practices dealing with ‘buy-in’ issues from older physician partners:

  • Provide screen shots early in the process to get them familiar with the fields on each template even before training
  • Make sure that the project manager spends some one-on-one time with them for training to ensure their comfort level
  • Appoint a ‘super-user’ to each older doctor to provide support [n.b. – and each location should have at least one super-user at all times]
  • Start the EMR transition with new patients at first (more established physicians usually have fewer new patients so this eases them into the process at a slightly slower pace)
  • Since older providers tend to remember their patients by personal tidbits, use a system like notes to continue to identify with their patients when they don’t have the thick paper chart in front of them, or use digital “sticky notes” within the EMR system
  • Put patient pictures in the template as a visual reminder of the patient
  • Keep a paper patient router so that they have that last vestige of paper
  • Scribes, scribes, scribes (if they aren’t already using them) – while they can add to implementation costs, these can usually be offset by cutting back on transcription, adding more patients per hour and, because the documentation may be better, you can support a higher exam code

Now, I realize that this is somewhat of a generalization; the issue of resistance is not strictly a generational one. There are younger physicians who are less technologically adept and therefore may balk on EMR and, conversely, there are older doctors who wholeheartedly embrace it. But regardless of whom you are dealing with, it is a good strategy to involve these individuals early in the process to allay their anxieties and to address their concerns before the situation deteriorates to an impasse.

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