I arrive at my hospital each morning with conflicting goals. Do I meet the OR budgetary and financial benchmarks that I've worked so hard to reach for the last 2 years, or do I move the electronic medical records implementation forward full speed so we're on schedule with our go-live date of Sept. 17? Yes, I've still got a surgical department to run, but I'm moving the EMR project forward because the timeline we set up waits for no one.

EMRs or ORs?
But serving dual masters is never easy. As EMR project manager and surgical services director, I'm working essentially 2 full-time jobs and getting by on 4 hours of sleep per night. The EMR project has also taken me away from the thing that I love most about my job: face time with staff. Nowadays, I hardly get a chance to round with my staff. That really rips me apart, because being with my staff re-energizes me in a way that staring at a computer never will. "Only a few more months," I keep telling myself.

My OR productivity stats have dipped by about 25% due to the time our staff has spent cleaning up our databases. But that's what it takes to undo and repair more than 15 years of inconsistent data entry. We've been working on entering clean data for 3 months now and are about halfway done (we've submitted 7 of 16 very large databases). It's tedious, time-consuming work, don't let me kid you, but it's absolutely critical to a successful EMR launch. The capabilities of our new system are amazing, but if we don't upload clean data into it, it's all for naught. You know what they say: garbage in, garbage out.

Our initial introductory EMR site visit was overwhelming. By the end of the week, the core team was stunned by the amount of data needed in a pre-built system. Our supply list alone has more than 49,000 items that we needed to rename, reorganize or delete. We had about 20 spreadsheets to complete by the end of April. We've used every spare minute to abstract, copy and manually input data into preset spreadsheets, using precise entry and scrutiny to make sure there are no spaces or periods in the wrong places.

More than 20 of us have spent many hours poring over databases. The good news is, once the data is done, the training begins. That is our exciting light at the end of the tunnel. I wish we had reassigned a few full-time RNs to assist with the 9-month EMR project. It's just me and our "system administrator," a circulating RN who's an expert on our old system, as the only full-time staff dedicated to the project. We're making it happen, but we're spread too thin. The others who are contributing to the project are also squeezing it into their already overloaded schedules.

The Change Train
My other functions as project manager include gaining and maintaining stakeholder buy-in from the end users by keeping them involved in the change process. I realized something as I began meeting with the different areas of the department to review the workflows that they'd submitted. The staff who for years had been listening to me discuss the efficiencies of updated technology were really excited and ready to jump on board the Change Train.

That's not the case with registration and billing, areas where I hadn't been as vocal. Staff there weren't prepared for the magnitude of the change I was asking from them. Some familiar refrains I've heard: "No, we cannot change that." "I need that piece of paper." "If you change that, it will collapse the whole process."

Our system administrator has been the expert in our old EMR and is now transferring that expertise to the new system. We sent him to AORN Congress on an informatics track and he went to last month's EMR Congress. The benefit of selecting a veteran OR nurse from our department is the intimate knowledge he has of "how it is done here." That knowledge will be tested many times over the next few months as we move to change processes that haven't changed in 15 years. Another strength is his relationships with all of the staff moving to the new system. He can help spread the positive aspects of the system and encourage staff through hard, but necessary, changes to their practice.

Going live a month early
Being so close to things, it felt like we were behind, but we're actually a lot further along than I thought we were — so much so that we've bumped our go-live date up a month to Sept. 17. Our vendor was amazed with how much we accomplished before its first on-site visit. Once we go live, for 2 weeks we'll chart all cases in both the new and the old systems.

We surgical facility managers are used to wearing many hats and juggling many balls. I have to keep my focus on the short-term project goals, knowing that we began this journey in January as part of our long-term strategic plan to be truly paperless. That really is light I see at the end of the tunnel, not a speeding locomotive.