No military commander likes the idea of getting to within sight of a goal only to see defeat snatched from the jaws of victory due to the mutineering of key personnel. If that sounds a bit melodramatic, well, folks in the medical world generally tend to respond best to military idioms, so it helps to make the point.
There are few projects of comparable magnitude to the purchase and implementation of an EMR system for a medical practice. And there is nothing more certain to scuttle (another military term) an EMR project than a physician, owner, or administrator who is not supportive of the endeavor. Obviously, this person has more of a detrimental effect if he is one of the partners and has some control over the purse-strings. He will typically take on one of several personae:
– The Denier – this person will make the claim that EMR is decades away, like some contraption seen in a Star Trek episode. He will usually wait until after the practice has purchased either the EMR software or hardware or both before voicing serious objections to the whole idea of pursuing a paperless office. Even in the face of legislation and mandates from both Republican and Democratic administrations, the Denier will paint the entire EMR project as folly. Apart from this, the Denier does not actively obstruct the implementation process.
– The Passive Aggressor – this person is not quite so vocal in his opposition as the Denier. He will usually abstain when it comes to votes of major significance related to the EMR budget – or he might ask to go on the record as voting ‘no’, knowing that there are enough votes to carry the motion. When it comes time for the rubber to meet the road, the administrative or IT staff have their hands full trying to pin this person down for certification on the EMR system or signing off on templates and commonly weeks of time are unnecessarily wasted.
– The Silent Saboteur – this person has begrudgingly gone along with the EMR process and has seemed to ‘be on the team.’ However, soon there are reports from the staff that they are receiving mixed signals from the doctor regarding everything from second-guessing the decision to switch to EMR in the first place to the possible effects that EMR may have on people’s jobs – not so great for staff morale. Some skillful sleuthing will usually pinpoint this insidious villain who should be outed before his peers.
– The Invisible Spectre – this person could also be called the Passive Pacifist. He usually will go along with the majority but may be swayed by the vocal minority. He often will not show up to mandatory meetings or trainings and, like the Passive Aggressor, makes the job more difficult for the staff.
The unlucky practice that has more than one of these nay-sayers has a good chance of not seeing their EMR implementation come to fruition. While I describe these tongue-in-cheek to some degree, it illustrates how one person in a position of power can demoralize the entire practice – and make things that much more difficult for the administrative team, who has had to get the troops motivated in the first place. Don’t underestimate the effect that the one bad apple can have on everyone else – and your EMR project.