Online Reputation Management for Doctors
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Online Reputation Management for Doctors
Curated and Written Articles to help Physicians and Other Healthcare Providers manage reputation online. Tips on Social media, SEO, Online Review Managements and Medical Websites
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Physicians: Safeguard Your Online Reputation in 5 Steps

Physicians: Safeguard Your Online Reputation in 5 Steps | Online Reputation Management for Doctors | Scoop.it

In my previous posts, I've walked you through the challenges and burdens of suing a patient for online defamation. Such lawsuits are expensive, time-consuming, stressful, and full of risk. In short, they are a last resort, only to be used when your reputation is so severely in peril that legal action is your only viable option. This final post will offer a few ideas of proactive steps you can take to safeguard your online reputation.

Given the prevalence and influence of online reviews, physicians cannot ignore their online reputation. A simple Internet search will turn up reviews of your practice in seconds. Survey data makes clear that potential patients will read those reviews and form an impression of you before they've ever set foot in your examination room.

You cannot stop a patient from defaming you online, but taking these steps can help lessen the reputational damage of a single negative review. The goal is to create a substantial and positive online presence

You should be aware that on many doctor rating websites, anyone can create your profile. For example, on RateMDs, the patient need only complete the most basic information about a doctor (name, specialty, address) to create a physician profile. Then the patient can review the doctor, and the profile and review are available for anyone to see. Other websites (such as Healthgrades) pull practice information from public sources to create profiles. Either way, you may not be aware that such profiles even exist.

Here are a few steps you can take right now:

First, if one does not already exist, create a profile on the major review websites, including general review sites like Yelp.


You want to be the person to describe your practice, ensure that contact information is correct, and provide an accurate description of your specialties and experience. It sounds silly, but a warm, approachable headshot —taken by a professional — can offer a strong first impression.

Second, if someone else created a profile for you, "claim" your profile to make any necessary changes to the information in it.
For example, the patient may have listed an incorrect subspecialty or the wrong fax number. By claiming and verifying the profile, at least you will be sure that prospective patients can find your office and contact you.

Third, take steps to create a substantial and positive online presence so that a single negative review will cause little harm.


You can ask patients to write reviews when you have treated them or their close family member. It is not right to pay for reviews, write your own reviews, or post negative reviews on another doctor's profile. Some websites prohibit the solicitation of reviews. But there is nothing wrong with asking your patients to review your practice if they are happy with it.

Fourth, constantly monitor your online reputation.


If you do not know what is being written about your practice, you have zero chance to protect your reputation. You need to check your profile regularly and read all the posted reviews. A staff member can be assigned to this task on a daily, weekly, or even monthly basis, depending on the size of your practice. Apart from finding reviews that you may want to try to remove, this effort also provides you with invaluable feedback about your practice and may help provide ideas to tweak your office policies to fix problems that patients identify. As I have written before, there may be times when you need to respond to negative reviews on the review website itself.

Fifth, be aware that the presentation of online reviews on some sites may not accurately depict all of the reviews of your practice.
Yelp has come under considerable criticism for its internal algorithm that decides which reviews are prominently displayed and which reviews are hidden on a separate page. I talked with one home renovation company that had several one-star reviews on their Yelp profile page but numerous five-star reviews hidden on a second page. The upshot is that even if current patients write positive reviews, this is no guarantee that those reviews can be found easily by potential patients. This is simply one of the problems with online review sites.


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Making Digital Connections with Patients between Visits

Making Digital Connections with Patients between Visits | Online Reputation Management for Doctors | Scoop.it

The traditional care model, through which primary-care physicians check in with patients in the office during regularly scheduled visits, is "not going to work anymore."

That's according to Danny Sands, chief medical officer at Conversa Health, Inc., who co-presented a session with Philip Marshall, MD, chief product officer at the health IT company, during the Healthcare Information and Management Systems Society (HIMSS) Conference in Chicago.


During their session, "Staying Connected with Patient-Generated Health Data," Sands and Marshall said it's time for physicians to "bridge the gap" with patients between visits. 


Sands said the shift toward value-based payment, the need to reduce healthcare spending, the growing elderly population, and a looming physician shortage are all factors driving the push for more interaction and health information feedback from remote patients. "We have got to figure out how to scale our healthcare system," he said.  


Another factor driving the push, he said, is the increasing number of patients with multiple chronic conditions. "If we are dealing with an epidemic of chronic conditions ... we need a new model for healthcare," said Sands. "What we are doing is not working. It's expensive, we are not getting the quality we want; we are not getting the engagement we want."


So how can physicians better engage with, and receive more health information from, remote patients?


Sands said it's time to "space out" visits a bit more, improve health literacy, and have frequent "light touches" with relevant patient populations between visits to monitor progress, blood pressure, pain, medication adherence, and so on.


Frequent check-ins  


When attempting to acquire patient-generated health data (PGHD) from remote patients, Sands said it is critical to consider work flow. The information received from patients should be automated, simple for patients to provide, and it should not overwhelm the physician. Too much information is not a good idea, he said, but if you can help create information from the data then that is going to be useful.


While remote health monitoring devices such as those that track patients' steps or calorie intake are popular among patients, they don't necessarily provide the type of information that physicians need to receive from patients on a daily basis, said Marshall. During their presentation, Sands and Marshall pointed to a pilot PGHD study that Conversa partnered with in which an adult primary-care practice explored how it could receive health information from 1,300 chronic disease patients.  The patient population they decided to start engaging with more outside the office, was a


They practice started by analyzing the EHR data of that patient population, and pulling it through the system so that they could profile each patient and target a "set of rules" on what to ask them when checking in with them remotely, and how often they should reach out to these patients.


They then arranged for the patients to receive a digital alert indicating it was time to answer the questions related to their condition and/or share biometric data through "digital check-ups." Once patients completed the questions, the data then went straight back into the EHR.


"Seamlessly integrating into the EHR was absolutely a kind of critical requirement for us, the practice would not have had it any way and frankly we wouldn't have either," said Marshall.


The practice then used the data to determine if a clinical intervention was necessary, and if they should be checking in with patients more or less often.


The results:


• About 73 percent of the patients in the pilot completed one or more digital check up, and 81 percent stayed engaged after the first check up.

• Twenty-nine percent of the patients had a clinical intervention during the pilot in order to get them back on track, said Marshall, adding that many of these issues had to do with medication adherence and most of them could be fixed by a quick call.

• Seventy-two percent of the patients stayed on track or improved during the pilot.

".. As we push for value-based care and increased provider capacity, we have to more efficiently manage this gap and bridge patients and providers," said Marshall. "It is possible to automate this process, by knowing the patient, knowing their profile, knowing which rules will be triggered in what situations."


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ICD-10 Testing Tips for Small Physician Practices

ICD-10 Testing Tips for Small Physician Practices | Online Reputation Management for Doctors | Scoop.it

Small physician practices of one to five doctors may find ICD-10 testing more challenging than bigger medical facilities. Luckily, the Workgroup for Electronic Data Interchange (WEDI) released a white paper last week that offers a comprehensive plan for small physician practices looking to begin ICD-10 testing.

The publication targets external testing with payers. Starting in October, payers will incorporate ICD-10 codes in payment decisions and coverage. By performing ICD-10 testing, medical offices will be ensuring that their claims will be appropriately processed once the new coding system is in place across the country.2014-10-02-WEDI

The white paper goes into detail about some of the risks that ICD-10 testing will minimize. The risks include:

1) Claim denials and claim delays associated with ICD-10 coding errors

2) Cash flow disruption

3) EHR and other software applications’ inability to produce ICD-10 claims

Small physician practices may be experiencing a number of challenges with regard to ICD-10 testing such as few testing opportunities with payers or clearinghouses due to limited number of testing spots, inadequate ICD-10 training available for staff, and scarce provider resources available on ICD-10 testing.

To overcome some of these common challenges, the white paper covers key steps a small physician practice will need to take. First, it is important to speak with your EHR vendor and confirm that all software products and applications are ICD-10 compliant.

Then, identify the payers that process the highest percentage of your claims and be sure to test ICD-10 readiness with your top payers. Work with your clearinghouse or billing service to see how they can assist with ICD-10 testing.

Be aware that some payers are creating web-based, self-service testing opportunities for small medical practices. After speaking with your clearinghouse, the next step to take is to seek more resources through payer ICD-10 websites and provider newsletters.

Confirm that what you need to test aligns with what your payer is testing so that every base is covered. While there is still time, be sure to contact Medicare Administrative Contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) to register for ICD-10 testing during the remaining testing weeks.

For those wondering the best time to test, be sure to set aside plenty of time before the October 1 implementation date to complete your ICD-10 testing. Before you begin testing, determine if your team and needed resources are ready. Additionally, it’s vital to confirm that all payers and other partners are also ready to start ICD-10 testing. Contact clearinghouses and billing services to find out when their testing sessions take place.

CMS, for instance, offers end-to-end testing on April 27 through May 1 and July 20 through July 24. For the July testing session, providers have until March 13 to sign up. Creating a timeline for your ICD-10 preparations would also be a worthy goal.

Once you’re ready to begin ICD-10 testing, follow the instructions received from the payer or billing service end. When incorporating the new codes, it is important to pay attention to qualifiers, headers, and other key format items.

After you have completed ICD-10 testing, be sure to review the results and compare the actual data to predicted information. Analyze both the successes and failures of your submissions. Additionally, work with your payers to understand any errors that may have occurred and develop strategies to prevent the issues from taking place in the near future.

If you are a small physician practice, follow these ICD-10 testing tips to minimize any risks after the implementation deadline.


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DrChrono helps small medical practices use iPads for patient records

DrChrono helps small medical practices use iPads for patient records | Online Reputation Management for Doctors | Scoop.it

Michael Nusimow and Daniel Kivatinos were college friends at SUNY Stony Brook on Long Island. Then Michael went to work at Bloomberg, while Daniel studied further before joining New York startups. When Michael took his father to hospitals and doctors, he was frustrated by how inefficiently patient data was handled. In some cases, paper forms needed to be filled out repeatedly. At another site, a doctor had a terminal, but he was so busy typing he hardly had time to look at the patient. Despite recent improvements to document interchange standards, sharing data between different medical institutions can be difficult given incompatible systems, complicated workflows and privacy concerns.

So Michael and Daniel decided that doctors could perform much more effectively with a web-based system. Initially, they started by automating patient communications. Their system would remind people of appointments with text and email messages. Then they added billing and interfaces to existing financial systems, learning requirements as they visited small ambulatory doctors' practices. They launched DrChrono in 2009.
 
According to Black Book Rankings, in 2008, only 12% of office practices had even the most basic electronic health record (EHR) systems. By 2014, 51% of office-based practices were using a fully functional EHR systems, and 82% had basic electronic medical records.

In 2010, the iPad was launched. A tablet enables a doctor to face a patient while taking notes. Also in 2010, the government was moving to make Electronic Health Record (EHR) systems more open. So DrChrono decided to build an EHR system from scratch that would work on iPads. They launched their new system in 2010 at a Health 2.0 conference in Florida. It was an exciting time. Instead of struggling to sell a web-based system, Michael and Daniel closed deals at the conference as doctors enthusiastically saw the iPad's potential.

DrChrono applied to join Y Combinator's funding program, which Michael describe as being like "a startup's coming out ball". The program requires three months intense work in Silicon Valley. So Michael thought he would come to Silicon Valley for about six months. However, the experience was so transformative, that he started raising money and hiring employees in Mountain View. The company is currently based near 101 and Rengstorff.

DrChrono focuses on making small medical practices more efficient. The system manages forms securely, submits insurance claims, schedules patients, enables email correspondence, helps doctors manage inventory, transcribes medical notes, checks for drug interactions and handles prescriptions. The doctor can share diagnostic images, from X-rays, for example on an iPad with a patient.

Patients can download an app, On Patient, to track their health and share information with their doctor. It works on both Apple or Android platforms and is only useful if your doctor has the iPad DrChrono system. On iOS8 devices it works with Apple's HealthKit, that integrates information from other health-related apps and displays them using Apple's Health app. If you have a newer iPhone or iPad you might want to check that your fitness and health apps are set to share information with Apple Health.

The company is constantly looking for technologies that can help doctors and tried offering Google Glass. The display in the glasses was useful for certain types of doctors like surgeons, who need hands free information. In general, most doctors found tablets more useful. Wearable devices to track heart rates, exercise and more will transform the doctor/patient relationship as their output is fed into doctors' systems. Michael quoted Vinod Khosla who notes on his blog that over time 80% of what a doctor does can be replaced by smart hardware, software and testing, with technology also improving a doctor's ability to perform.

The Electronic Health Records space is crowded and fragmented. DrChrono started by bootstrapping and has been extraordinarily capital efficient, compared with San Francisco's Practice Fusion, which has raised $134M from investors that include Kleiner Perkins and other big name firms. With major companies like GE, McKesson and Quest Diagnostics in the market, and many fast growing startups chasing for market share, DrChrono is racing to hire software engineers and customer relations staff so it can keep ahead of the game.


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HHS’ $30B Interoperability Mistake

HHS’ $30B Interoperability Mistake | Online Reputation Management for Doctors | Scoop.it

Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. A staggering amount of money has been paid out under HITECH to incentivize providers to make EMR progress, but we still have countless situations where one EMR can’t talk to another one right across town.


When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay.


Now, don’t get me wrong, I realize that “interoperability” is an elastic concept, and that the feds couldn’t just demand that vendors bolt on some kind of module and be done with it. Without a doubt, making EMRs universally interoperable is a grand challenge, perhaps on the order of getting the first plane to fly.


But you can bet your last dollars that vendors, especially giants like Cerner and Epic, would have found their Wilbur and Orville Wright if that was what it took to fill their buckets with incentive money. It’s amazing how technical problems get solved when powerful executives decide that it will get done.


But now, as things stand, all the government can do is throw its hands up in the air and complain. At a Senate hearing held in March, speakers emphasized the crying need for interoperability between providers, but none of the experts seemed to have any methods in their hip pocket for fixing the problem. And being legislators, not IT execs, the Senators probably didn’t grasp half of the technical stuff.

As the speakers noted, what it comes down to is that vendors have every reason to create silos and keep customers locked into their product.  So unless Congress passes legislation making it illegal to create a walled garden — something that would be nearly impossible unless we had a consensus definition of interoperability — EMR vendors will continue to merrily make hay on closed systems.  It’s not a pretty picture.


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Pay doctors and nurses for the time they spend charting

I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.

One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I will continue to do so. Because all across the country the same problems, the same frustrations are evident. And the institutional lack of concern is well-entrenched and well understood by everyone affected.Whether working in an academic teaching/trauma center or a small community department, one theme emerges.


EMR is so inefficient, and patient volumes and acuity so high, that charting isn’t done real-time. Unless it is accomplished with scribes, or by dictation, doctors stay after their shifts, or chart from home, or come in on their days off in order to complete their documentation. Needless to say, this is unlikely to create the best possible chart. Not only is this true, I have watched as nurses sat for one to two hours after their busy ED shifts, catching up on the ever increasing documentation requirements in their EMR systems.

Weary from a long day or long night, they sift through notes and charts, orders and code blue records, trying to reassemble some vague estimation of what happened in the chaos of their 8 or 12 hours on shift, when they were expected to function simultaneously as life-savers and data-entry clerks. Further, the nurses are frequently tasked with entering specific charges for billing as well. It all constitutes an unholy combination for any clinician.

Dear friends, colleagues, Romans, countrymen; dear politicians and administrators, programmers and thought leaders, this is unacceptable. Entirely unacceptable. If the charting system is so poorly designed, and so counter-intuitive to the work we do that it can’t be used real-time, then it should be replaced with something far better. And if it isn’t replaced, then everyone needs a scribe to chart for him or her, or we should allow dictation all around. And if none of that is acceptable, if even those reasonable options are rejected, then every nurse and every physician who stays after shift should be paid their regular hourly rate for time spent charting.

The thing is, these systems are generally not the idea of the clinicians who are saddled with them. They are imposed by corporations and administrators who believe the salesmen and hope to capture more billing and data. They are imposed by the meaningful use regulations of the federal government. But as a rule, when we clinicians say a system is bad, or won’t work for us, we are patted on the head and dismissed.

“It’s fine, it’s an industry standard. You can learn to use it. You don’t want to be a problem doctor do you?”

One of my friends is in a group shopping for new systems. When his partner asked to take the potential EMR for a test drive, the salesman said, “Sure, as soon as you sign the contract.” Pathetic. I call on everyone involved in implementation of EMR to find the simplest, most physician and nurse friendly systems possible. And to do it by asking and involving the end user. By which I mean those who provide patient care, not those who cull through it for billing and documentation. Some people chart more slowly than others. That can be an individual issue.

But when a system consistently causes good, efficient doctors, nurses, NPs and PAs to stay long past their shifts, or come in on days off, or chart from their homes (which should be places of recuperation and rest), then we need to give them something back. Equally toxic, some physicians and nurses can only get out in time by charting in a manner that results in a pages long list of checkboxes, rather than a descriptive, informative story.

America’s emergency departments are overwhelmed with passwords, required fields, clicks and key strokes, at the same time as they are overwhelmed with the sick and dying. They are the last safety net for the uninsured and underinsured. They are the point of rescue for the poor, the brutalized, the traumatized, the addicted, the psychotic. Day in and day out, nurses and physicians in emergency departments, indeed all over the modern hospital, do their best against sometimes overwhelming odds. In the midst of this, poor charting systems constitute a crushing blow.

Pay the staff for their time spent charting, or fix the systems. Or both. But something has to give.


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Efficiency of Remote Clinical Documentation Improvement Work

Efficiency of Remote Clinical Documentation Improvement Work | Online Reputation Management for Doctors | Scoop.it

Would working remotely on clinical documentation improvement (CDI) improve efficiency at a healthcare organization? Some may not think so, but the results from Baystate Health indicate otherwise.

As part of its CDI program, Baystate Health in Springfield, Mass., began teaching CDI specialists to work from home with the help of health IT tools, according to the Journal of AHIMA.2014-10-15-Doc-at-PC

So far, working remotely has led to greater accuracy and efficiency among CDI employees. Several years ago, the organization began expanding its CDI hiring base and moving some staff members off-site.

By 2014, the CDI team rose from four specialists to ten. The original four workers were transitioned to working from home after establishing strong relationships with physicians and coders when working on-site. Both email and EHRs were used to run queries by CDI specialists working from home.

This allows providers to focus on their patients and get back to documentation questions afterward. Essentially, it brings better care to patients by preventing interruptions to workflow.

Often, CDI specialists work on hospital floors and ask physicians or nurses directly about queries, but supervisors explain that little has changed by allowing this work-from-home program. The health information management department has also developed software that allows CDI workers and coders to communicate about cases and records.

Another useful tool that simplifies working remotely is an instant messaging platform the organization incorporated. This system-wide messaging capability allows CDI specialists to pose questions and manage issues with anyone from Baystate Health, whether it is the billing department, the health information management department, or medical and surgery.

“We don’t interrupt the productivity of our individuals by having them pair or mentor off another individual, but we use these tools to understand where the variations lie and where there’s other opportunities,” Jennifer Cavagnac, CCDS, Assistant Director of Clinical Documentation Improvement at Baystate Health, told the news source.

One of the main reasons that the organization introduced working remotely was to improve job satisfaction. Moral in the workplace rose due to increased flexibility. This also led to better retainment of top CDI employees.

Cavagnac goes on to explain that team members who work remotely are encouraged to communicate with the rest of the team and ask questions about cases in order to keep them connected to the workplace. The supervisors attempt to ensure workers don’t feel isolated and that resources are available even when working remotely.

Technology like instant messaging, EHR systems, and telehealth services has not only allowed employees to work remotely but also enabled patients to receive basic healthcare assistance outside of a medical office.

The Federal Times reported that caregivers are able to reach patients on a daily basis through telehealth services but a more integrated system will need to be developed so that patient data can be stored securely and shared in real time.

The Department of Veterans Affairs (VA) began a telehealth network four years ago in order to provide healthcare services in rural areas without a strong hospital system. The medical industry will continue to adapt and improve technologies such as videoconferencing, image storing, and wireless communication in order to strengthen the capabilities of telehealth.

Whether it is to increase work flexibility or improve telehealth services for patients around the nation, technology plays a vital role in connecting individuals across the healthcare spectrum.


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Keeping Employees Happy During System Implementations

Keeping Employees Happy During System Implementations | Online Reputation Management for Doctors | Scoop.it

Implementing a new patient management system is a huge investment in terms of time and dollars. It can also be very stressful on all involved. Changes in the healthcare climate often contribute to an organization’s decision to implement a new system in an effort to meet current and future healthcare mandates. New systems often offer technology that is more technically advanced and robust, causing concerns among employees about their ability to learn new functions and workflows in a relatively short amount of time. These concerns often result in real and imagined barriers to staff adapting to the change. So how do you get employee buy-in during a system implementation?

Foster Employee Involvement

In any organization, change is better received when not strictly mandated downward. It is important to create an environment that allows employees to feel that they are a part of the decision making process. The transition to a new system can be successful when opportunities are developed for active engagement among the management and staff. Several steps should be taken to encourage participation and keep employees engaged during this time of significant change, while still keeping the timeline and projected costs in check. We recommend the following:

  • Create a workgroup to categorize, review and understand current state policies and procedures.
  • Create a repository for the existing policies and procedures. Review these policies often throughout the system development and implementation phases. The goal should be to identify gaps and opportunities between current state and future state.
  • Be ready to share. Hold monthly “town hall” meetings during the build phase to provide staff with glimpses of the new system and provide information about next steps, answer questions and concerns.
  • Develop training that is role-based and centered on policy and procedure workflows. It is not uncommon for end users to be highly stressed at the thought of learning and adapting to a new system. Providing training specified on workflows creates a real world environment, allowing users to practice scenarios that are relevant to their job role and improving their comfort level.

Cultivate System Champions

In order to be successful, it is imperative that there is involvement from different employee groups that utilize the system, both non-clinical and clinical. Often, organizations approach a project of this magnitude with a rigid project management stance in order to keep the project timeline and budget intact. Not enough time is spent on gathering “buy in” and system acceptance to reduce the anxiety of the staff that is most impacted. I Involving staff early and often can pay huge dividends in terms of buy-in, satisfaction and timeline. We recommend the following strategies:

  • Map current workflows from start to finish with the aid of designated staff who utilize the functionality
  • Ask staff to list opportunities for improvement and identify workflows that are currently working well.
  • Review workflows for redundancy and encourage new ways of looking at an old issue or process. There are always different ways to obtain the same result. Avoid the all too common idea of, “we’ve always done it this way.”
  • Create access to the new system that is based on user role, testing and training by role. This way, people can learn in an environment that mirrors production. This will greatly decrease potential end user frustration.
  • Choose staff from each modalitythat can act as “super users” who are willing and ready to:
    • Disseminate positive information to his/her department
    • Bring questions and concerns back to implementation team
    • Help develop/update policies and procedures based on new system workflows and best practices
    • Help users understand the new system functionality by utilizing the approved workflows defined at the beginning of the project

Involving staff is important, not only to gain insight into job functions and activities but also to create system champions excited for change.

Participation, Not Delegation

System implementations can be both exciting and exasperating at the same time. Involving staff in a strategic way will improve the overall end result. Allowing staff to have input will ensure that all end user needs have been identified, reviewed, streamlined and implemented if appropriate. Staff buy-in will be heightened if employees feel they are involved. Allow for input, understand current processes, and track employee feedback regarding both current pain points and needs when developing a system implementation strategy.


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