- The implementation of an electronic health record (EHR) system is the hardest part of a hospital’s decision to adopt a system. It involves members from all departments and levels who must commit to the project and be willing to accommodate the project by assessing and adapting their workflows as necessary. Moving from a paper or even an outdated electronic system represents a culture shift, and without the proper support the implementation will fail. To be successful requires the commitment of top brass and most importantly the users of the system. Remember that implementation takes time and the right amount of planning. Keep in mind the old proverb: Measure twice, cut once.
1. Establish a leadership team for the project
A major determinant of any project’s success is leadership. In hospital settings, an EHR implementation project team generally comprises a CIO, project manager, lead physician, superusers, and department liaisons.
The lead physician will be the champion of the clinical side, ensuring that staff buys in to the project. The project manager will assign roles, develop communication plans, develop a project plan, schedule site visits, and compile a log of activities. Superusers will act as point people on the floor, serving as accessible resources for training and troubleshooting on the fly.
2. Scope and plan your project
A. Choose a qualified team member to evaluate servers, computers (PC, laptops, smartphones, tablets, etc.), peripherals (printers, scanners, etc.), and any other hardware key to the implementation.
B. Assess the facilities for accessibility, ergonomics, and ability to support the use of technology and devices throughout the hospital.
C. Evaluate network connectivity (wired v. wireless), remote access (e.g., VPN, mobile), and data storage and backup (e.g., capacity, encryption).
D. Determine that the system can support different types of data (structure v. unstructured), reporting tools, patient portals, customizable templates, forms, or lists if applicable to the given project.
3. Create a schedule of regular meetings and methods for communicating updates
The project team needs to meet regularly and have access to an establish method for communication with each other. Meetings should take place at regular intervals, follow well-defined agendas, and lead to lists of action items identifying who and what needs to be done following each meeting.
4. Identify workflow challenges and resolutions
Front office will use the EHR system to capture patient demographics, code encounters, scan insurance cards, coordinate lab and other billing, coordinate with onsite pharmacy, and handling patient checkin-in and check-out
Nurses and medical assistances staff will use the EHR system for handling patient flow, charting responsibilities, checking vitals and allergies, verifying medications and chronic medical problems, identifying the reason for a patient’s visit, ordering and documenting immunization, and working with the lab for orders and billing
Physician and providers will use the EHR to chart processes, order procedures and medications, request tests and treatments
Other workflows will make use of the EHR to refill medications, reconcile lab results, provide referrals, track immunization history, handle patient recalls and communications, report to grant programs, and capture information for quality reporting and other initiatives
5. Plan migration of existing data into from paper to electronic format
The project team needs to identify what existing information capture on paper needs to be entered into the system and when this conversation will take place. Some paper records will need to be retired and need to be dealt with according to HIPAA requirements. The team should develop a plan for processing external documents and information.
6. Train staff on hardware, software, and workflow
A. Inform the staff of the requisite PC and keyboarding skills they will need to have in order to use the system efficiently and develop plans for remediating any deficiencies
B. Schedule time for the EHR vendor to provide an overview of the system to introduce the staff to the system prior to training
C. Arrange schedule hands-on training that is suited to walks staff through their specific responsibilities
D. Provide super users with additional training sessions that go into more depth and troubleshooting scenarios
E. Offer staff additional opportunities to learn the system
F. Make readily available educational materials (e.g., cheat sheets, reminders, diagrams)
7. Test your system
The project team must allot considerable time to test all aspects of the system:
A. Single modules tests to assess single features
B. Integration tests to assess interactions between multiple modules
C. Interface tests to assess interactions between systems
D. System tests to assess stress and load capacity of system
8. Develop a recovery plan for downtime, system crashes, or major emergencies
Project leaders should develop recovery plans in the event of a system-level crash. They should document the recovery process and ensure that redundancies and system backups are in place.
9. Prepare to launch the system
A. Work with physicians to schedule their time effectively to account for time spent onboarding the system
B. Determine how the system is rolled out, whether incrementally, by department, by user groups, or locations
C. Allot time for providers to sync with staff or extend patient encounters to ensure that the system is used correctly
D. Put extra resources in place to support staff
E. inform staff where they can turn for assistance
F. Coordinate with external staff and vendors to make all parties away of launch date and activities
G. Establish troubleshooting guides in the event that something goes wrong
H. Schedule meeting for the middle and end of the day to evaluate progress and identify any items that require remediation