In the last decade technology has influenced healthcare and EMS. For organizations that have not yet transitioned to a more technology-rich environment, the decision to move in that direction can appear to be daunting. The staff's reactions to technology are likely to span the spectrum from complete acceptance to defiant rejection. These reactions can influence the organization's "success" of accepting the technology and it may even have system-wide influences. Consider the following example.

EMS system "X" has used paper-based charting for decades. Over the past year system X has been exploring the potential of transitioning to an electronic patient care system. A small project team was created and numerous meetings have occurred. The project team obtains information from 6 vendors that offer mobile electronic patient care document systems.

While the project team reviews the proposals and conducts due diligence, the EMS crews learn about this project through their shift meetings and message boards. Several staff members have expressed their concerns about the potential of using a mobile device. Comments such as "...great, another thing I have to carry...." and "...I can hardly type as it is...and now they want us to do this in the field", are voiced.

During "B" shift one unit has a mobile device that they are testing in the field. This unit is located in a high call volume area and has not been overly supportive of the idea of going "paperless". During the shift the unit runs a lot of back-to-back calls. When this unit was using the paper charting they were able to be back in service very quickly. Today's shift is the complete opposite. The crew is not having a successful day using the mobile device and they are falling behind on their documentation. In addition, the printing system for the mobile unit keeps having problems.

Before the shift ends the EMS crew calls their supervisor, explains the situation, and informs them that they are going back to paper for the duration of the shift. The supervisor understands and helps the crew get back in service.

During the shift change the EMS crew shares their frustration using the mobile system with anyone that will listen. Other crews hear about the details and start dreading using the handheld when they are rotated to that unit. As the conversations continue the resistance against using the handheld increases. The supervisor arrives at the station and begins to hear the conversations and soon realizes that the crews are not happy. The supervisor realizes that the management team and staff will need to get together to discuss this so that they can overcome this hurdle.

What to do in a situation like this? While EMS system "X" could benefit from the technology, it is going to be helpful to have buy-in from the staff. The above situation, which is based on a true event, will not be solved in a few minutes. It will require input from a variety of people as well as additional planning. The event described above was eventually resolved. Several key lessons-learned and opportunities were identified. The following highlights some of the findings.

Management buy-in
The management team of the organization supported and believed in the idea of using the handheld device. This originally was not the case and had to be addressed. Comments similar to "Here we go again. We tried this 3 years ago and the project lasted all of 2 weeks. When is senior management going to get with it?" When managers, regardless of their rank/role/title, do not support the project or product, it can easily undermine the project. This can also trickle throughout and organization and lead to resistance.

Not everyone likes change
This is not new. Depending on the person, change may be the best thing in the world, or the final push to a resignation. Technology can be daunting. The staff's ability to use the tool is likely to range from expert to novice. Holding meetings and open forums to discuss the impact of the change can help to reduce the anxiety.

Change for survival
In today's world, change is often necessary to support an organization's survival. For this EMS system, the decision to go "paperless" was not done at a whim. The company conducted an audit of several months' worth of billing and patient care reporting. It was identified that an electronic system, with the ability to submit and track claims in real-time, would potentially lead to cost-savings and a higher reimbursement rate. This in turn could lead to more funds to be available for operations, such as new equipment. This type of information was provided to the staff so that they could learn more about the process involved in reaching the decision.

Technology can be cool
Several of the staff were opposed to the handheld system from the start. They did not volunteer to test the devices and attended the information sessions because they were mandatory. On the other hand, there were several crews that were very positive about the handhelds. Not only did they offer to test the devices, they "pushed" them to the limits to give them a "real" field test. The crews had some recommendations for minor improvements, but overall supported using the handhelds. One staff member made a statement similar to "Hey, we are a cutting edge system. Why not use the handhelds -- it'll make life easier in the long run. This is cool!"

What about the accounting staff?
A concern was raised that going electronic would eliminate some of the tasks currently performed by the patient care report reviewers as well as the claims staff. Would those staff members be asked to do more? Would they need to find new jobs? The management team addressed each question and explained that the handhelds were intended to support their roles, not eliminate them.

Uncertainty
There were a lot of questions regarding the handheld implementation plans in general. Several staff members expressed concern about their inability to use the devices in an efficient manner. The management team assured the staff that efforts would be in place to support everyone as the handhelds were introduced. This was followed by several trainings and user-support sessions.

Adopting technology does not occur overnight. There are a lot of events that need to occur for them to be successful. While adopting technology can be cool to some employees, others may dread it. Promoting open communications and answering questions can help to resolve anxieties. The leadership of the organization should promote a positive perspective or risk the chance of undermining the effort.

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.

Related Columns by Paul Murphy:

• Supporting Employees to Adopt Technology
• Why Technology?