An earlier column described the challenges that an EMS system was experiencing while reviewing and determining which handheld patient care reporting system to select. During the evaluation of one product a crew experienced significant challenges and switched back to the paper-based system. This was followed by several less-than-positive discussions during their shift change that subsequently trickled through several stations and crews.

The EMS system's leadership team responded to this by following-up with all of the crews in an effort to promote the successful integration of the handhelds. During the meetings three general trends were noted. First there were the crews that were ready to accept the handhelds and to begin using them immediately. Second were the crews that were not quite as eager as the first group, but they were still willing to adopt the handhelds. The third group consisted primarily staff that appeared to be opposed to the handhelds from the start.

After identifying the 3 general groups, the leadership team decided to allow all crews 2 additional weeks to field-test the handhelds. By the time the 2 weeks were over, it was fairly evident that several employees were not doing well transitioning from paper to computer. In fact, because using the handhelds was a mandatory part of their job performance, some of the employees were concerned about their job security. Question such as, "What happens if I cannot get the device to work?" and "It just does its own thing... I'm not even touching the screen and things on the display change," and, "Great, I don't like this thing... am I going to get fired?" arose throughout the crews.

After learning about the reactions, the leadership team met with each employee that had expressed a concern and attempted to determine what could be done to help to assist the employee's success with the handhelds. Throughout the process the leadership team encouraged all employees to approach the leadership team with any feedback or concerns the employees might have so that the concerns could be addressed. This approach had never previously been used in the EMS system and it seemed to be welcomed by a majority of the staff, including those most reluctant to use handhelds.

The leadership gained some valuable insight as to what challenges were being encountered by the crews. They also identified some opportunities for improving the successful implementation of the handheld system. While some of the items were technical issues that would require the handheld vendor's input, others reflected similar challenges experienced around the world by thousands of people in a variety of businesses.

Skill-set
It must be remembered that not everyone in today's hi-tech world is tech-savvy. Employees who are great, if not stellar, healthcare providers, may experience challenges using technology. This is not unique to EMS -- it applies to everyone from first responders to surgeons. Using technology successfully can take time and can be frustrating - for anyone. If an individual has not been exposed to the technology, having to learn while providing patient care can be a daunting experience.

Comfort level
Not all employees have the same comfort level with technology. In this EMS system, the first group readily accepted the handhelds and started to try to push them to the limits. In contrast, the third group had no desire to use the devices and appeared very uncomfortable when trying to demonstrate their ability to use the device to their supervisor. As one provider stated, "I own a home computer and use it maybe once a week for 15 minutes. You really expect me to use this?" Meanwhile, as the employee was describing their situation to the supervisor, their partner replied to an email using a PDA.

Dexterity
The ability to actually use technology can be taken for granted. In general, handheld devices, including cell phones, PDA's, and medical devices range from very small to bulky. Several of the employees who were reluctant to use the handhelds had challenges navigating the screens. It was not the case that the screens were not designed well; rather, the employees had larger fingers and this led to challenges pushing on one icon on the screen. The result: the handheld flashed "error" on the screen even though the employee was doing the correct procedure. This resulted in a lot of frustration by several crews. The first solution that was suggested was to use a stylet. However, the suggestion was almost essentially ignored due to potential cross-contamination concerns.

Accuracy
Several of the skeptical employees also voiced concern about the electronic system's accuracy versus their traditional paper system. While the handheld system had a robust grammar and spell check feature, it would often complete the sentence automatically. This resulted in several providers' re-writing the sentence despite the tools "automation."

Turn-around-times
The crews in this EMS system were well known for their ability to run a call, complete their paperwork, and return to service very quickly. The addition of the handhelds was slowing down some of the veteran medics. In the past the medics were able to respond to a call, document the call during transport, and then be available shortly after giving report. With the addition of the handheld, several crews found themselves having to "hunt and peck typing to finish the paperwork." The veteran medics did not like this and found themselves having to rush to complete their electronic documentation. Over time this improved but it remained a sore subject for several medics for months.

The examples above summarize the majority of the crews' concerns. The management team was then able to meet with employees to address any specific concerns the employees had. It was generally agreed that while the adoption of technology can be a daunting process, it didn't necessarily have to be overwhelming. By reaching out to the employees that had concerns, both the employee and their manager were able to discuss any concerns and strategize what could be done to support the employee with the handheld device. This not only promoted "buy-in" among the employees, it reduced the negative rumors and supported the likelihood that the employee would be successful with the technology.

Paul Murphy has been involved in the emergency medical services and healthcare for more than a decade. He has held a variety of clinical, administrative, and consultant roles. He has functioned as an EMT, Paramedic, Flight Paramedic, and Critical Care Paramedic. He has worked in a variety of settings, ranging from rural volunteer to paid urban EMS systems. Paul is active in healthcare management and has held management roles at start-up companies as well as a Level II Trauma Center. He is a published author and has spoken at healthcare conferences. Paul has Master's degrees in Computer Resources/Information Management and Healthcare Administration.