Posted by: Peggy Salvatore
You might have people who accept the evolutionary change and stay, people who don’t and leave, or people who can’t and are eventually eliminated by some organizational variant of natural selection.
In moving from a paper-based to electronic medical records system, change may appear in either form in an organization. It may come in as a revolution and up-end the status quo, sweeping away the old way of business and bringing with it all new systems and processes. For most organizations, federal mandates are the change agent. Do it or don’t get paid (eventually).
Without government mandates, without a doubt, electronic medical records would eventually be integrated into the healthcare environment through a more gentle, evolutionary process. Simply, medical schools are graduating tech-savvy providers who are used to doing everything online. The nurses, doctors, pharmacists, staff and executives in healthcare organizations do everything better, faster and smarter with technology in other areas of their lives. Over time, healthcare providers will expect to take those technological advantages to work with them.
Because the change is being pushed from the top down, rather than being sought from the bottom up, it takes a little more organized effort from the training and human resources staff to pull through the technology. In a revolutionary change model, you’ve gotta prepare people for change and the new technology you are requiring; in the evolutionary change model, you just have to manage the naturally occurring change and supply the technology for people who are seeking it.
Most healthcare organizations are in a revolutionary, top-down mode for managing the change in their environments. Some organizations are in the evolutionary, bottom-up mode, but they are still fewer and farther between. [HIMSS EMR Adoption Model]
In another generation, the full integration of IT into the healthcare environment would be a natural and evolutionary process. And that might seem like a kinder, gentler approach. But you have to start somewhere, sometime, setting standards and goals, and putting the network in place to handle the integration. That calls for a revolution of sorts – change here, change now, and change according to a master plan. That’s where we are today.
By requiring providers to integrate health information technology into their work environments now, the federal government is pushing the revolution from the top down. What that means in terms of organizational development is that the change will require some hands-on management from the people responsible for pulling it off on the ground.
Evolution is nice, things change according to the natural flow of events within the context of their times. Revolution sometimes is necessary to move things firmly forward toward a defined vision in an organized way.
Welcome to the revolution.
You are right Peggy. It is a revolution!
However with all revolutions, blood is shed. In this case, it may be by the private practices that we had come to use for our immediate healthcare.
The "Marcus Welby" types that were endearing to our families will retire earlier rather than undertake the daunting task of digital conversion.
As time goes on, most of us can see the advantage of communication between offices and record transfers . Wouldn't have been wiser to have established a universal system before asking everyone in the medical community to adopt it?
Yes, it is a revolution and it won't be without "the resistance" and some setbacks and some scars.
Posted by: Barbara | 09/23/2010 at 01:58 AM
My practice deployed EMR 5 years ago and we have enjoyed great success. I have an EMR-related blog myself (http://thewiredpractice.blogspot.com) and I am doing all I can to help my colleagues get going with EMR.
Nonetheless I find this article inappropriate because it grossly oversimplifies the problem and fails to recognize the shortcomings on the Health IT side of the equation. EMR products must undergo a "revolution" of their own before they become practical for most providers.
I agree with Barbara that if EMR comes by revolution there will indeed be bloodshed...the blood of our patients whose care is compromised by immature, dysfunctional IT systems that are deployed too quickly and are not well thought out.
I apologize for my tone. But articles like this one hurt more than help. You will not win over any of us docs with that attitude. Please look at my last blog post to see a more balanced approach to this issue.
Posted by: Mike Koriwchak | 09/23/2010 at 03:41 AM
Mike, I read your blog and you're spot on as you get straight to the matter at hand. This is a culture war between physicians and IT. I firmly believe that until medical professionals and IT get on the same page and travel the journey together - hand in hand, EMR implementations are going to be painful for all concerned.
Going from paper to EMR is a HUGE culture change that is going to take total teamwork from all sides of the endeavor. Physicians and patients will always need the human contact and IT needs to build systems that help ensure that medical professionals can still do what they do best: provide patients with the care and knowledge to work together for the patients' healthcare needs.
Posted by: Jonena | 09/23/2010 at 10:03 AM