Wild West of Orthopaedic EHRs

August 26, 2015


Cutting 'Em Off at the Pass

As a Texan I was raised watching "Spaghetti Westerns" on Saturday afternoons with my father. Often during the climactic chase scene the good guys (note the white hats) would be on horseback in pursuit of the bad guys (note the black hats) who were getting away. On cue, the leading man would shout, "We'll cut 'em off at the pass!" In short order the good guys would take a short cut (unknown to the bad guys), get in position (at the pass, no less), and thwart the bad guys, saving the day.

Perhaps you're wondering what this has to do with orthopedics? In a business version of life imitating art this formulaic plot sequence can be used as an excellent tool for averting major conflicts and knee-jerk reactions from clinical staff members – especially when implementing an EHR. We will first outline the actors, crimes, and getaway route before teaching you how to cut 'em off at the pass, allowing you to avoid catastrophe and save the day.

Recognizing the Actors

Unlike our western, the individuals in our conflict do not give us the benefit of wearing white and black cowboy hats. On any given day any one of us is prone to be a hero or a villain, but the usefulness of this tool depends on (1) you recognizing that YOU are ALWAYS wearing the white hat (yep, you're the good guy), and (2) you recognizing that those wearing the black hats are NOT actually bad guys – they are simply actors playing out a predictable role in a scene.

Since this article is focused on the use of this tool with respect to implementing an EHR, you can assume that your black-hatted actors will be concentrated in the clinical department. While the perpetrators may be limited to physicians, other major stakeholders and key clinical staff members (especially those with influence over your physicians) can don a black hat as well. Keep a sharp eye. Stay alert.

Recognizing the Crimebluecallout
"Sheriff! There was a loud explosion and we saw smoke coming out of the bank!" Ok, pretty obvious – someone robbed the bank. But what sort of "crimes" should raise our ire and how can we be on the lookout? Human behavior is often quite predictable and one of the biggest triggering elements for "criminal behavior" is change.

Implementing an EHR is a very disruptive change in that we are modifying codified behavior patterns across virtually every task in the clinical workflow. This change can be very stressful for some in that it is much harder to engage automatic or rote functioning of routine tasks. The result is that staff members, already overwhelmed with a typically busy schedule, quickly run into exhaustion as they are forced to think through EVERY task. 

The crime in our example is that when these stressed staff members succumb to this pressure, they steal "peace". In truth, you will not be able to stop this crime – recall our goal is to cut 'em off at the pass. The ones in the black hats are those who have stolen our peace. It is your job to get back "peace" and restore it to your practice.orangecallout

Recognizing the Getaway Route
Shifting back to our western, the guys in the black hats always abscond to a faraway location to enjoy their loot. Predictably they ride out of town "guns a blazin' " on the straightest, fastest route to security. Our black-hatted villains will do much the same – lots of noise, predictable getaway.

So, what is the getaway route for our villains? You might have already guess it; quitting and going back to paper. This route is fast, easy, and predictable.

Cutting 'em off and saving the day
There are two keys to saving the day: (1) taking the short cut, and (2) standing with courage once you get to the pass.

The short cut here refers to proactivity long before you "go live" on your EHR. You must have early, frank conversations with your clinical staff letting them know that they are either "all in" on success or they should NOT MOVE FORWARD AT ALL. Let them know that they will be tempted to quit, that change is difficult, that they will be stressed, but they WILL get through. Let them know that they will be tempted to pick up a black hat and steal the peace from the practice. Let them know that you are their elected officer of the peace and that quitting is NOT an option. tealcallout

Standing with courage means that you will need to confidently and patiently remind our black-hatted friends of their crime when the peace has been stolen. Find out what caused their stress and let them know that you can work through this together – but that there is no need to steal peace to get the issue resolved.

Your task is not an easy one and you will not always be thanked for keeping the peace. But in the end, as in our western example, you can ride into the sunset at the end of another successful day knowing that peace has been restored.


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