Home Forums Discussions General Discussion Office staff refuse to give up paper

We went fully live with AC 1/3/12. At that time I told staff to NOT print any notes from AC unless they were going to send it some where. We are just in process of bringing up UpDox for direct faxing of our reports to referring MDs.
I still have the paper chart brought in so I can quickly enter the ICD9 and Dx from last visit on those for whom this is their first "AC visit".
What do I find, inspite of my injunction on the needless printing of notes that exist in AC, the are still insisting on doing it, and spending my money to staple, punch and file those notes. Ditto lab and other inbound documents we receive electronically (Long standing MFC fax machine). And we have been scanning 6 years!
I'm really pissed! They say "we don't trust the computer".
Grrrrr!
So, now that I've vented, has any of you good docs seen this? If so, how did you handle?

I think it was getting rid of the chart racks.

We scanned every current patient, then got rid of the chart racks, and put all old charts in storage. There was a while that we needed to get a chart from 2009, but then that disappeared when we scanned old charts and are now back to 2006.

Anyway, paper is only useful if you have a place to store it. I doubt they want to store it at their desk.

It took us a lot longer than that to get fully comfortable, so maybe patience is the issue. We stopped the print and staple after a few weeks, but waited over a year to start scanning and shredding. I was as much a luddite as anyone, and it helped that I was closely involved in the creation of the backup plan, which is the IT version of the survivalist camps in rural Montana. Maybe sitting down with the "offenders" and going over the backup plan will help. Best to make sure it is really robust before you do, however; if you wave your thumb drive at them and say "I take this home pretty much every evening unless I forget," you are hosed.

We've been scanning and filing for 6 years. We've used in house "EMR" for 20 years.
It's not unfamiliarity with IT.
To hijack my own post:
I find the long threads on the back up plans interesting.
If we were to translate that kind of effort into the paper world, we would be copying each chart, in full, everyday, and carting it home, PLUS faxing every chart to an offsite "cloud" fax machine.
No, we assume paper will last forever and will be there.
Even modest back up plans are orders of magnitude better than what we did in the paper world. becuase while down time "happens", so do fires and break ins, floods and other disastors that don't just cause interuption is service, but can destroy the paper record FOREVER.

Roger, we had also been dictating and storing electronically in an in-house database for a few years, but printing and charting. Somehow the psychology of "going electronic" just felt all different. Made no sense, it just did. Like the difference between training wheels and just riding the bicycle.

What is the "power structure" in your office? Can you just growl, and say "I'm the boss; just do it!!"? Or do you have partners you have to cajole and wheedle?

Partner is a bit of a luddite, but actually coming along nicely. IS completely paperless at the hospital (even though the medical staff has not yet mandated we go paperless, it's all been voluntary).

We went thru marriage counseling about 10 y ago, had staff playing off one against the other (2 man group). We're over that.
So I can say "I'm the boss, and Dr. __ agrees, do it my way or . . .", but we've never actually ever used the "highway" part of that.
Staff meeting here in a few minutes to go over this again.

Roger,

I went live with AC first week of Nov 2011, (and much thanks to David's recommendation dictated notes as initial entry a week before visit)but noticed that I went through more paper than I have ever done in 18 years of practice, until I started using Updox about the first week of January 2012. After about 2 weeks the paper trail started falling off considerably and the scanning fell off as well. Once my nurse got comfortable with no paper the tendency to file paper diminished significantly to essentially nil. I only have a simple operation 2 exam rooms and one nurse that does everything--scheduling, filing, patient care. But the front office handles the billing side of things.
So I suspect once you integrate the Updox a bit longer things will change for the better--my nurse absolutely loves the updox because of the incoming /outgoing electronic faxing/messaging efficiency along with the patient portals--maybe this doesn't apply to you with the MFC fax machine--hope this helps--jimmie

I hope things went well. Best of luck.

We scanned in the paper charts then destroyed them. No paper charts for staff to cling to. Maybe you need to sneak in some weekend and just make all the paper charts go away.

We scanned in paper charts, then destroyed them. I banned creation of new paper charts for new patients,so for those patients there is no paper chart. We actually never finished scanning in the old charts, but the ones left are people who haven't been in for a few years.

I also unabashedly have told people that they must embrace the change, or I will find someone else who will.

Ok, that is an extreme solution, but I have done it. The real point is that you can't oversee all of this yourself because you have doctor work to do. So you delegate it to your office manager or practice manager. You set up a timetable with milestones for the transition. You tie their compensation to their performance. They could not get their bonus (or it may be reduced) this year if they did not meet their performance goals, and this is a significant part of their performance goals. That's how I do stuff like this...the same its done in corporate where I was trained. And remember, when making major changes, some people will resist or outright refuse to change. When this happens, you need to be prepared to "make heads roll" as a last resort.

One thing you may want to do is set an example. Have a staff member go through each chart and enter the last ICD-9 code and diagnosis in an Excel sheet. As they do this, at the end of the week, burn the charts. I think by having them bring in a paper chart rather than your just being able to browse to the Excel sheet, sends a message that paper charts and paper are still necessary. Plus, you always want the lowest paid staff member doing the mundane stuff that makes no money.

I guess I am confused, because here it sounds like everyone should be used to it, but in your first posst, it sounds like they are deathly afraid of technology.

I don't understand what people aren't listening? The other doctors or the other staff. If it is the latter, I fail to see where they have a choice. Just put an ad in the paper for them to see that states, "Needed. MA for busy nephrology practice that despises paper." They'll get the message.

I like the classified ad suggestion!!!

Definitely worth the money. I am sure they would see it while they surfed the Internet.

Bert has a nice point with being an example. Alice actually still likes to take her notes from talking with the patient on paper. Just major points to jog her memory. So we have the assistants write the patients name, age, reason for visit and vitals on a sheet of paper (now a standard form) on a clipboard for her to take with her. She then finishes the formal note in AC between patients, or at the end of the day.

I did it just like Alice for a while, now type brief notes into hpi, and actual dictation later. I do sometimes make very brief written notes about labs I will want to order, since we can't build up a lab order as we go.

How did the meeting go, Roger?

Found out my MA wants the paper for rapid lookup of lab orders so she can make sure they are back (we are not reconciling anything yet). She claims that is faster than looking in the previous visit in AC (yeah no concept of the time spent printing, data piling, filing the paper in the first place).
I think I will make a new job for her, reconciling the lab.

Easy! Stop supplying the paper.

@Catherine, Or better yet, make them pay for it.

Roger,

I am not sure how your MA gets to even weigh in on the decision. And, it is rather easy to find the lab orders in the chart. I am sure she will find a quick way once she does this.

Bert, it was by serendipity that I found it (printing a note) was still happening.
I may have exagerated by frustration level, no wait, not the level, that was real, just the source was not just the printed notes issue, or even office staff. Lot's of other frustration at that moment.
I'll conquer it, on way or another.
Thanks for all the feedback.

Roger,
I have lived through frustrating office scenarios more than once. You have my sympathies.

The fact is, I am a good enough doctor, but a lousy business manager. For instance, I could hardly ever bring myself to fire someone, no matter how awful his/ her work was. It is much, much better since I turned the business management over to my partner 20 years ago, but since we are married, there is no friction or paranoia about the economic goals of a decision.

Assuming my solution is not an option for you, can you consider outsourcing some of the management duties? You are obviously describing management issues, not medical ones. There is no law that says you have to be good at everything.

I need to rant less.
Two events Help to make this issue trivial in comparison.
One finding out today we have grandchild number ten on the way, (number nine is on the way too, that we already knew)
Two also finding out today my sister in law suffered a major stroke following her spine surgery.

1)new grand-babies, congrats man that is awesome!
2)stroke, even though I don't know you except through these posts and don't know your sister-in-law, I will pray for her.

Thanks Adam, so are we!

I as well. So sorry.

She could just look up the orders under view->orders. And even print out that one page if it helps her that much.

Really sorry to hear about the stroke.

Of course I need to keep in mind that my staff didn't even know what alt-tab was until recently, even though we have been using windows machines since win95.

Well, I think they are ready to make the leap to CTRL - ALT - DELETE.

Don't be too hard on them. I don't know what alt-tab does either. I'm a menu person, not a shortcut person.

This has been a good discussion to read through. I have found the HR management side to be much more frustrating than medicine and probably the most difficult part of my job. Partly it is the drama surrounding, and emotional nature of, my employees. Recently there has been friction between them. I got so frustrated I just about shut them in a room and told them to work it out or someone was going home. I really just want to focus on medicine and have everything run smoothly. Eventually I had to explain that one person's actions and attitude toward another employee were causing more damage than the 'faults' of the other employee in supposedly not doing her job. I have had some relief by letting my Office Manager (and partner) take a more active role and directing complaints to her, even though she is not in the office much.

The single best thing an office can have is an office manager on a higher level that can discipline the staff. I have never have one.

I have had an office manager and he about tore the office apart with his Neo-Nazi ranting and demands. Employees hated him and hated coming to work. It showed in their lack of concern for patients and for me. Mine is a small office. I see more of my employees than I do my husband. I believe coming to work should be fun and having people around with whom I can joke, socialize and plan our futures is critical. Neither I nor my employees (maybe I am just lucky) have had trouble knowing when to be friends and when to be Boss/Employee. We seem to be able to switch hats easily and have done so for the last 25 years.

Its a tight rope walk, but I agree with Leslie--there has to be a mutual respect and your office manager has to concede to your directives, but out of respect not out of fear. My father in law who has retired ran a 20,000 acre dry land wheat farm for years, and told me something over a decade ago I never quite forgot. He said never ask a hired hand to do anything you wouldn't do yourself, which I think translates well to the present discussion. He also has a sign hanging up on the wall of his shop that says "screw up one more time and you will be on permanent vacation" I think we have to try to understand our employees and their needs, but at the same time demonstrate that we are the one who pays the bills for their screw ups. If anyone figures out how to do this gracefully please send me a memo!!! jimmie

Alice is lucky in that. She has me. Well, when we could afford employees.

Well, not all people placed in a management position are good at it. Some just need training. Others can't be trained to do it. Sounds like you had a really bad one.

I've been lucky in that I only had to report to maybe 3 bad managers in my life. So far.