By Ladan Moshiri

Medical Records Photo

An electronic medical record (EMR) is a computerized medical record created in a health care organization. As the purchasing and human resources manager at a diagnostics imaging center, I witnessed an EMR rollout. The following story summarizes our experiences with the original rollout and my suggestions explaining how it could have been handled.

Bill is the office-manager at “Success Health Clinic”, and Roy is the office-manager at “Malfunction Health Clinic”.

Bill: “Hi Roy! How are you?”

Roy: “Not well, unfortunately!”

Bill: “I’m sorry. What’s wrong?”

Roy: “Have you heard of EMR?”

Bill: “Sure, we had an EMR rollout in our office four months ago. I love it. It improved my employees’ performance a lot.”

Roy: “We had one too. I thought all of our problems would be solved if we just sent the employees to some EMR training, but now there is so much chaos in our office that it’s making me sick. I’m on my way to see my doctor for a prescription.”

Bill: “I don’t think you need a prescription.”

Roy: “What do you mean?”

Bill: “I think it’s your office which needs an EMR prescription! Didn’t your staff attend training?”

Roy: “Yes! We used the Heal training company. They must have been awful – we’re still having so many problems!”

Bill: “We used that company too. If our staffs attended the same training, other reasons must be affecting your employees’ performance. Tell me what is happening. Maybe we can determine what’s wrong.”

Roy: “It’s terrible! There is so much commotion! My staff gets really confused because they had training five months ago and have forgotten alot of what they learned. Do you have the same problem?”

Bill: “Not really. I asked my supervisors to attend the training and take notes about important information the staff would need after the training. Then we turned the notes into easy-to-understand instructions, laminated them, and posted them next to every computer in our office.”

Roy: “You are lucky to have great supervisors. Mine have threatened to leave if this chaos continues.”

Bill: “Well, I knew that they would initially have to handle more problems, so I gave them and my other employees, incentives to motivate them to handle the situation better.”

Roy: “What kind of incentives? We had a pizza party after the training. Besides, I receive many job applications every day. So, if you ask me, they are lucky to have a job!”

Bill: “We had a pizza party on the day before the training. I have noticed that despite a system’s problems, people are hesitant to change it because they fall into a routine, and are afraid of the unknown. That’s why we had a pizza party before the training. There, we explained what EMR was, how it was going to make their jobs easier, and why the clinic needed to make this change. This way, we ensured that our employees were familiar with the training topic instead of walking into unfamiliar territory. Also, they learned how the rollout would affect them, why the company was doing it, and the importance of their performance in making change to happen.”

Roy: “But what about the incentives?”

Bill: “Well, we tracked the transactions done by each employee and when the staff members performed 20 correct EMR transactions, they were rewarded with a free movie ticket. Plus, we offered a free dinner to the top performer each month. Also, we gave the supervisors bonuses based on the number of correct transactions within their groups to motivate them to closely monitor their group’s performance. After one month, our records indicated that the number of mistakes had dropped by 15 percent.

Roy: “That’s amazing!

Bill: “We also provided practice sessions for them.

Roy: “I thought the training company let them practice?

Bill: “Yes, but we wanted to ensure that they practiced what they had learned in a real office setting so our supervisors could provide feedback and answer their questions. The employees felt more confident after the practice sessions.

Roy: “That’s great, but what about computer problems? We don’t have enough computers in our office. This creates a lot of chaos since staff members take too long to complete the transactions. They complain that the computers are old and the internet connection is slow. Also, our computers are in the reception area, where they are constantly interrupted.

Bill: “I anticipated that we would need more computers after the rollout, so we purchased four more computers and invested in high-speed internet. We also had extra storage room which we cleaned out to make room for the computers. Now the employees make fewer mistakes.

Roy: “Wonderful! So, what should I do now?

Bill: “Glad you asked. I have a whole solution system for you:

  • First, improve your office’s environment. Order high-speed internet and buy four or five more computers. Put them in the unused office so your staff can concentrate on their jobs.
  • Then, explain the significance of the rollout, the reasons behind it, and how it will affect them in the long-run. Knowing these facts will increase their value for the rollout.
  • Next, allocate one hour per day for the next two weeks to have practice sessions. Ensure that your supervisors are available to answer questions, and provide feedback. These practices will help increase employees’ skills, knowledge, and confidence.
  • Finally, don’t forget incentives. Have a contest and reward the employees with the highest number of correct transactions with movie tickets or free dinners. Also, reward your supervisors with a percentage of the increased income resulting from the increased correct transactions. Furthermore, motivate them by offering free lunch when the office’s total correct transactions reach a certain number.
  • If you need more ideas, visit: PIE and How-to-Handle-Rollouts

Roy: “Thanks Bill! I think instead of going to my doctor’s office for a prescription, I’ll go back to my office and start using your EMR prescription.

Bill: “Great! Do you have any questions?

Roy: “One! How much will you charge me for this prescription?

Bill: (Laughs) I was the purchasing and human resources manager at a diagnostic imaging center when this EMR rollout was initiated. I am currently a full time graduate student in Educational Technology at San Diego State University. This work was done in partial fulfillment of requirements for Allison Rossett‘s performance technology class at SDSU. I may be reached at

Rossett, A. (n.d.). First things fast – a handbook of performance analysis. Retrieved from
Rossett, A. (2004). The pie – performance improvement emporium. Retrieved from