Nick Fabrizio


I recently completed a consulting gig with a client using a new EMR. They liked the product and were noting new efficiencies. The only problem: A couple staff members had very weak computer and keyboarding skills, which basically meant they couldn’t use the new system. 

Blithely assuming that your staff and physicians are all up-to-date on their basic keyboarding and computing skills will land you promptly behind the technology adoption eight-ball. Veteran workers in particular may have little to no computer experience, making the transition to a paperless office extremely challenging for them. 

But you needn’t eschew adopting new technologies just because some of your staff - or even your physicians - are not yet computer savvy. Just take some time to bring them on board. Develop a game plan before implementing new technologies to identify and train these individuals. Consider surveying your staff and physicians to determine the following:

How many of your employees and physicians have a computer at home or use a computer more than three times per week?

What common administrative programs (Word, Excel, etc.) have your employees used, and how often do they work with these programs?

How many of your employees are adept at Internet research (to locate patient education and insurance information)?

How many words per minute can each employee type?

The answers to these questions will help you develop a successful foundation for an EMR implementation plan and will shorten your staff’s learning curve. Once you identify the individuals who need a more structured or ongoing training program, you can plan ahead to meet their needs. During the first few weeks of implementation, you will also need to carefully monitor all of your employees and physicians to ensure they are adjusting well to your new processes. 

Failure to bring everyone up to speed on basic computer skills - and, by extension, the skills required to operate your new EMR - will force you to use a dual system of paper charts for some and the EMR for others. This will add costs, promote inefficiencies, and frustrate the rest of the staff - not what you want. Instead, work patiently with the people who need training until they have mastered the necessary computer skills and have integrated working with the EMR into their daily activities. 

The bottom line: Implementing an EMR in your office is a time-intensive process that requires a detailed plan to identify and eliminate the technological weaknesses of your staff and physicians before, during, and after the process. A little front-end prep work will do wonders to ensure your success post-implementation. 

is a senior consultant with the Medical Group Management Association. Dr. Fabrizio also serves on the faculty at Cornell University in its graduate program in Health Administration. He can be reached at 

This article originally appeared in the January 2008 issue of Physicians Practice. 

Articles

Don’t let employees’ poor computer skills (or your own) stop you from adopting needed technology.

Physicians Practice Pearls: You  Can  Teach an Old Dog New Tricks

On a recent trip to visit a client in Chicago, I noticed at O'Hare International Airport a booth set up to administer flu shots. I was surprised to see how many people were taking advantage of this opportunity. My first reaction was to walk past the booth as I do to the other numerous vendors along the hallways. I was inclined to think that these flu shots were for the busy traveler. As a physician or office manager, your first reaction to this may be "Oh well, since they're too busy to come in for an appointment, getting their flu shot at the airport or drug store is fine with me." But much to my surprise, I noticed several elderly patients and families also stopping at the booth for their flu shots.

Since my flight was delayed, I decide to eavesdrop on the booth while eating my sandwich. The primary reason people took advantage of the opportunity? Convenience. Many people commented that it was far easier to stop at the booth than to call their doctor's office to schedule an appointment.

Indeed, the majority of practices today require their patients to call the office to schedule a flu shot appointment. Or worse yet, since offering these shots must be some big "hassle" for practices, offices have created the ever-popular "flu shot clinic," held once or twice during the appropriate months. Understand that the reason for this is that we want these "special" appointments to take place when

 as possible, which often means inconvenient to the patient. Small wonder, then, that impromptu flu shot clinics are popping up everywhere you can imagine, including drug stores, grocery stores, and airports. To suit ourselves and our own schedules, we've created a niche in the market, and we're losing out on a good source of income because of it.

Many medical practices believe that offering flu shots is a money-maker for them and so their efforts are primarily centered on making it as convenient as possible for the practice -- largely through some inexpensive marketing. Fortunately, some practices think that giving patients the flu shot when 

 want it not only satisfies patients, but also provides good quality care and gives patients one more reason to seek out their practice first rather than looking elsewhere.

I urge you to look at your practice with the goal of quality care and patient satisfaction. We are all trekking down a slippery slope that can bring patients closer to retail medicine -- and farther away from their medical homes. Do all you can do to preserve the relationship that you have established over the years with your patients.

Nick A. Fabrizio, Ph.D., FACMPE, FACHE is a Senior Consultant with the Medical Group Management Association specializing in operational, organizational, strategic planning, governance, and customer service. Previously, he worked as a practice administrator for over 10 years and worked with a community hospital managing their ambulatory practices. He has worked for clients in primary and specialty care, hospital managed physician practices and integrated delivery systems.

Dr. Fabrizio serves on the faculty at Cornell University in the graduate program in Health Administration. He has presented at several local and national conferences and written articles on the topics of reengineering, customer service, strategic planning, operational improvement efforts, implementing EMRs, and governance. In addition, he has served on several boards including the New York State Medical Group Management Association, where he served as president and was the regent for the American College of Healthcare Executives serving the New York Empire Area. He can be reached at 

On a recent trip to visit a client in Chicago, I noticed at O&apos;Hare International Airport a booth set up to administer flu shots.

A Shot in the Arm for Flu Vaccine Clinics

I've been working with a medical practice that was trying to improve its patient access. Patients were complaining that the office phone was either always busy or it sent calls directly into voice mail. After observing the front-end operations, here's what I found:

The front-desk staff member checked in patients, registered patients, answered all of the telephone lines, 

 scheduled appointments. As I tracked the volume of telephone calls and other daily demands, it was easy to see that 

the front-desk staffer was tasked with the impossible.

To solve this problem, we segregated tasks and automated many front-desk duties. For example, the front-desk staffer was routinely providing directions to the office, answering questions about hours of operation, and calling patients to remind them of upcoming appointments. These functions are both time-consuming and unnecessary given today's available technology. As such, I recommended that the practice:

List basic operational information on its Web site.

 Staffers should routinely encourage patients to seek such information there;

Provide automated options using its interactive phone system

 to handle routine requests, such as office location and operating hours; and

Upgrade to an appointment confirmation telephone system

 that automatically calls patients to remind them of upcoming office visits. This newer system can also be programmed to make several attempts to reach patients - an advantage over their current system. 

Take time to analyze your staff's current task distribution, keeping automation in mind as your primary goal. Doing so will allow your staff to concentrate on the practice's 

 - caring for your patients in a timely and efficient manner.

To properly assess your automation needs, ask yourself these questions:

Do I have the correct number of staff to handle all necessary tasks?

Are specific tasks matched up with the most appropriate or capable staff member?

Is my staff performing the correct task at the correct time?

Which time-consuming tasks can I automate?

If I do determine a task can be automated, is doing so worth the time, effort, and cost? 

Nick Fabrizio, PhD, FACHE, FACMPE, is a senior consultant with the Medical Group Management Association, specializing in operations, organization, strategic planning, governance, and customer service. Previously, he worked as a practice administrator for more than 10 years. He also worked with a community hospital, managing their ambulatory practices. He has worked for clients in primary and specialty care, hospital-managed physician practices and integrated delivery systems. He also serves on the faculty at Cornell University in the graduate program in Health Administration. Dr. Fabrizio can be reached at 

I&apos;ve been working with a medical practice that was trying to improve its patient access.

Calming the Front-desk Fracas

During a recent consulting engagement, a physician told me countless stories about interviewing and training staff. She spends a lot of time on it; indeed, her practice has had significant turnover, especially in the billing office.

To find out why, I asked three questions:

Does the practice have an office manager, and what is her role in the hiring process?

Yes, the office does have an office manager who contracts with a temporary staffing agency to help with the recruitment process. So far, so good.

When was the last time the practice performed a staff position salary and benefits comparison with other practices in the community?

Some digging around revealed that this practice was paying its billing staff 15 percent less than surrounding offices. This is a problem. To stay competitive and keep your employees, make sure your pay rates are within 5 percent of comparable practices in your area. Your benefits package should also be competitive. For example, if your salary range is in step with other local practices but you offer fewer vacation days than your competitors, and your health insurance premiums cost employees $50 

 than the practice down the street, this could cause your staff to start looking elsewhere for employment. Failure to do this sort of comparison will also cause you to attract those who are eager for a job but not committed to the long-term.

What is the practice's interview process?

This practice's interviewing tactics also warranted some improvement. Checking references is one of the easiest tasks in the interview process; it's also the most time-consuming. This office had the temporary agency handle the reference checks. This is in fact a conflict of interest, as the primary task of a temporary agency is to place candidates. Certainly, a temporary staffing agency is not going to have the same standards you do for finding qualified employees. Make sure 

 check very thoroughly on a job candidate's attendance, performance, and interaction style with previous employers.

Also, you need a sound interview process led by your office manager. This person should take the primary role in setting up the interview and getting all of the paperwork together for the pre- and post-interview process. Providers should have a role in interviewing and evaluating candidates.

Note that the interview process is very costly, so you need to make sure that you cover the basics in the process. 

is a senior consultant with the Medical Group Management Association, specializing in operations, organization, strategic planning, governance, and customer service. Previously, he worked as a practice administrator for more than 10 years. He also worked with a community hospital, managing their ambulatory practices. He has worked for clients in primary and specialty care, hospital-managed physician practices, and integrated delivery systems. He also serves on the faculty at Cornell University in the graduate program in Health Administration. Dr. Fabrizio can be reached at 

During a recent consulting engagement, a physician told me countless stories about interviewing and training staff.