The Roof of Africa. It's as beautiful as they say it is. The top of Mount Kilimanjaro is over 19,000 feet above sea level, and climbing this mountain was the most physically demanding thing I've ever done.
Preparing to Climb
Going live in the digital clinic is a life-changing event. You could call it one of the summits of practice life, because once you've been there, your perspective on practice changes. It's a task that takes a certain mental and physical preparation to be done successfully. It's a lot like climbing a mountain. As a veteran in helping chiropractors transition their practices to electronic health records (EHRs), I saw a strong analogy in the preparation I did to climb Kilimanjaro to what every practice should do to prepare to go live as an EHR practice.
Last month's column was all about those lessons of preparation. To go digital, you need to mentally and physically prepare, as well as do the simulations that test-drive your preparation. I wrote my last column before the journey up Kilimanjaro, which I planned to climb as part of team raising money for the Prostate Awareness Foundation.
Now that I've gone through the incredible Kilimanjaro experience, I see preparation is a necessary prelude to a more challenging task with its own lessons: actually making the climb. If you happen to have missed those lessons of preparation, I invite you to read my last column.
My experience on Kilimanjaro confirmed everything I wrote about last issue. It's the foundation on which I've built these lessons of the climb; lessons which I hope will serve you, too, as you make the transition to EHR.
Lesson 1: Seek the help of experts. As I wrote last month, the mental and physical preparation for our climb depended on our American colleague who had made the climb before. His advice on how to mentally and physically train got us to the foot of the mountain. But there was no chance we were going up without a local guide; we needed someone native to the territory.
On the side of Kilimanjaro, local men from Tanzania were with us, shoulder-to-shoulder. They planned our route, helped us set up camp, cooked our food and supported us by making sure we had water and supplies, and paced ourselves accordingly. Once we reached a certain altitude, they constantly checked our vitals, looking for signs of altitude sickness. They knew where we were going and how long it would take to get there. They knew when to take a break and when to press forward. We trusted them with our lives.
The depth of our trust became apparent to us as we came back from the summit and learned that two other climbers (not in our group) had fallen ill. One of the men, in fact, had died from cerebral swelling. Our group of nine climbers, including four DCs, realized once more the potential consequences of the challenge we had just overcome. We knew we couldn't do it without our local experts.
Who Is Going to Be Your EHR Expert?
Many of you know as much about EHR and digital documentation as I knew about Kilimanjaro. I had never climbed a mountain of more than 14,000 feet before. Likewise you may be comfortable with some buzzwords, like clinic integration or electronic documentation. But do you know what it's like to think, move and interact in a completely digital environment? Can you predict how it's going to change and shape your patient interactions, or your relationship with your staff? How will you recognize the vital signs that indicate you're not quite ready to integrate the next part of your practice? Who will tell you when to keep going? Who will tell you when you need a break?
Last month, I said you need a guide to prepare for your climb up the digital mountain. I advised to find more than just a software vendor, but a partner who can help you get ready to go live. Now that I've made it all the way to 19,000 feet, I'm convinced that I didn't go far enough. You need more than just mental and physical preparation for this practice transformation. You need a native expert to guide you through the whole journey of taking on digital. That means having a guide for the weeks, months and even years beyond adopting electronic documentation. Your expert has to be more than just a company who sells and installs, but someone who remains part of your team as a silent partner.
Lesson 2: Strength comes in numbers. I needed a team to go up Kilimanjaro, and I'm glad I had one. The temptation to turn back is too strong without the camaraderie of a group. Everyone has a role to play, and I learned that those roles can change quickly based on the challenges offered by the mountain.
No one could predict how altitude acclimation would affect us. Surprisingly, a marathon runner suffered more dramatically from the altitude than I did. It wasn't about preparation, per se, but about genetics. Even though some in our group were in marathon condition, that didn't guarantee high enough hemoglobin counts to handle the altitude. Some whom you would expect to be stars on the trail weren't because of variances in human physiology. That meant we relied on people to set the pace who perhaps we didn't expect to do so. We were most encouraged by a female group member (chiropractor and Olympic athlete) who had little mountain climbing experience at all, but brought incredible enthusiasm and stamina to the trail.
Who Is Going to Bring Your Team Together?
Last month, I said that the most important part of mental preparation for your adoption of EHR is getting your team together. Make sure everyone is on the same page because one person cannot drive the project if the others aren't even interested in going up for the climb. As I learned on the side of the mountain, this is more than just about preparation; it's about facing the challenges of the climb. Leaders will emerge when they're needed, and the stars may not be who you think they'll be.
Getting your team together is most especially important when you, the doctor, have the most anxiety about the transition. If you're the current practice superstar who's going to need to acclimate the most to the technology involved, having a cohesive team is critical. You're going to have to learn your new part, and your staff will have to learn theirs. But you don't have to be afraid of the unknown, especially if you have EHR experts involved that understand what you're going through, who can bring the leadership and enthusiasm your team needs. Like climbing a mountain, you'll learn by doing, but you'll need the cooperation and encouragement of a group that shares the same mission.
Lesson 3: Set a pace and don't stop moving. In Swahili, pole pole (rhymes with "holy") means "slowly, take it easy." That phrase was on the lips of our local guides at every hour of the climb. They were telling us to pace ourselves and not overestimate our ability, especially because of the altitude. They told us to take it easy, but pole pole also meant to keep moving, keep moving. Especially as we closed in on the summit; stopping would have robbed us of the psychological and emotional strength to keep going.
Pole pole is the perfect phrase to encourage you in your adoption of EHR. You don't want to rush into the implementation of technology without acclimation, as it could be stressful to your practice without the proper guide. Yet you need to keep moving because you're on the side of the mountain, headed up, otherwise you could be doomed to practice noncompliance and loss of office efficiencies, and simply be left behind. You need to get the right EHR first, and then once you have it, prepare to implement and go live with the EHR by training on it, customizing it, and doing simulation testing with it.
Are You Moving Toward the Future?
You're going to have to summit with EHR and digital documentation to stay in practice. Twenty years ago, only 10 percent of chiropractors had computers in their practice, usually for billing purposes. Today, 98 percent use computers on an everyday basis. In 1988, only 5 percent of health professionals had cell phones; today that number is almost 100 percent.
Technology is on an exponential curve. It's not going to take another 20 years for your colleagues to move to EHR. Most will be there by 2014, encouraged to do so by Medicare standards if they're not required to do so by their state governments, like in Minnesota. According to my own internal studies and a survey of over 800 random DCs in the U.S., 74 percent of chiropractors already acknowledge that mandatory EHRs are coming and that they need to adopt it soon. The longer you wait, the quicker the pace is going to be.
The key is to start and keep moving. Pole pole. You don't need to overdo it, but you do need to do something. Taking it easy doesn't mean doing nothing, but doing something with an intentional exertion. Going slowly is fine, and a good place to start is in finding an expert that can guide your preparation, and help you get your support team together.
The Summit Experience
Jambo. It's another Swahili word that has new meaning for me and the rest of our group. While it simply translates as "Hello" in English, it's a reminder to us of the mission that has brought us together in climbing Kilimanjaro. Jambo is a code word that reminded us how our perspective on life has changed by the camaraderie of our team and the physical challenges of climbing toward the summit.
Chiropractors who have reached the summit of a fully integrated digital practice also have shared an experience that brings new meaning to the life of their practice. There's an enhanced level of clinic performance that has turned the words clinic of the future from just a phrase into reality. They have joined a small but growing group of doctors who are setting the pace for the rest of the profession, and reaping the rewards in doing so. There's no better time to start preparing to join them than now. I hope these lessons have helped you understand what's ahead to reach the next practice summit. We'll see you on the trail as your expert guide.
Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.