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Countdown to the Digital Age: Transition from paper to an Electronic Health Record system

Kelsey Conway, PT

My community’s hospital is going digital –switching from paper charts in binders to an Electronic Health Record (EHR) on a computer or a tablet. This transition has been a decade in the making. When I started this job four years ago, it was already established that a fully integrated electronic system was approaching. As a physiotherapist who is new to the working world, I immediately looked forward to the transition. I’m computer savvy and I’m open to change. What were a few more passwords to remember?  In fact, I already feel comfortable working with EHRs. I had used electronic charting in all of my student placements at hospitals, so pen, paper and faxes seemed more foreign to me.

I have no doubt that many of you have considered or are currently undergoing a similar transition at your workplace. If you are in the position where you are considering a transition, there are certainly two perspectives to this technological shift:

Opportunities

Obstacles

  • Overall efficiency​

  • Notes are more legible

  • Improved speed of charting, less narrative style, more easily accessible

  • Health decisions made using more complete information, resulting in less human error

 

  • Technical glitches, data loss, server outages

  • More passwords and log-ins

  • Anxiety levels high with staff

Bottom line: Better patient care

Bottom line: Change is hard

 

Getting started

The senior management’s strategy to keep all staff informed and to make them feel like they were a part of the process was well executed. The involvement of every staff member was important to create a sense of community and a “we’re all in this together” mentality. Communication between front-line staff and the technological team has included weekly email blasts, bulletin board displays, and guest speakers from other hospitals who have experienced success with similar endeavours.

 

The process

There is no doubt that my hospital made an enormous contribution to this project in terms of manpower, time and finances. Administration tasked a large team of nurses, physicians and allied staff to customize each of the screens to be used in the new system. In fact, this was an excellent opportunity to redefine tasks, eliminate redundancy and cut excessive practices.

This health team of subject matter experts diligently worked as communication middlemen between their own team members and the technical group. Because the technical program experts were based in the United States, our hospital’s health care team used teleconferences to work through numerous changes and customizations that needed to be made, including:

  • Evaluating the computer and tablet screen version of each  assessment and treatment page
  • Creating a physiotherapy chest assessment from scratch to more closely resemble our current paper version
  • Reviewing and customizing their company’s American stock assessment forms for our hospital. This included removing a function for outpatient department with modalities.

Once the system was functional for each department, thousands of hours were spent training the 1,000 employees. For example, each nurse received roughly 20 hours of classroom training on the new system.

 

Challenges – and solutions – to change

In order to give you a realistic picture of what happens during time of change, here are the biggest challenges I’ve noticed during this period of transition:

1. Feedback has included that some of the health care team wants more practical case scenarios on the technology, as opposed to more theoretical instruction.

2. Because the system is still in “training mode”, our health care team needs to imagine how the system will ultimately look, instead of having hands-on practice with the final product. Despite our hours of practice, this situation has led to….

3. Fear of change. Probably the biggest obstacle I’ve observed so far to this transition has been attitude. Because it can be difficult to imagine something different than they’ve done for years, some staff are wary of the new technology and do not feel comfortable using it. This is apparently a normal part of change, as it’s difficult to fully know what to expect when you’re only partway through the process.

 

Setting ourselves up for success

However, the hospital’s senior management team has worked to overcome this “fear of change” mentality through support of its staff. There will be a space provided in the hospital for a re-energizing “oasis”, where staff can go if they need a break. Select ‘super-users’ (identified by a colourful vest) who have received extra training will be accessible for support and questions. I am one of those super-users who have been trained for my position as a physiotherapist and also to support other members of the team.

Despite all of our preparation and team communication, it is expected that fewer patients will be seen in a typical day during the first few weeks of the transition. Our team will need some time to adjust to navigate the chart and documentation in actual practice. Building in this extra time will ideally help the team adopt faster.

 

Moving forward

It seems that no matter how many supportive programs and training hours are put forth, undertones of anxiety and resistance to change exist. At the same time, other hospitals that have implemented an EHR system now say that they cannot imagine going back to the way things were. Despite observing some anxiety and “fear of change” in some of the team, I truly remain optimistic that this technological shift will result in more efficient and safer delivery of patient care for our hospital’s patients.

As we progress to our “go live” day and onward, I’m looking forward to updating you on our transition. I hope that our experience will serve as an opportunity for you to ask questions and think about your own hospital or clinic’s future.  Have you undergone a “paper to digital” change? Do you feel hopeful or hesitant about a change like this happening in your practice? Please share any questions you have in the comments below.

 

About Kelsey Conway, PT

Kelsey Conway is a physiotherapist who graduated from Queen’s University in 2012. She works in acute care at a small community hospital in Eastern Ontario.