A four-step guide to EHR system implementation

By Liza Dzhezhora

EHRs have become a basic tool used by most U.S. healthcare providers, with a 2008–2021 American Healthcare Association survey showing that 96% of non-federal acute care hospitals have adopted a certified EHR. Additionally, Fact.MR predicts the U.S. EHR solutions market will continue to be vibrant in the coming decade, reaching a market value of $12.4 billion by the end of 2032.

However, EHR deployment is not a one-time effort but a continuous process that needs to reflect changes in industry trends and care provision methods. Providers must review, update, and optimize their systems to ensure their efficiency over time. Here’s a step-by-step plan covering all critical aspects of a future-proof EHR implementation.

Step 1: Project planning and preparation

To properly plan out a future EHR, the team needs to take these preparatory actions:

• Assess the current EHR system, collecting clinicians’ feedback and identifying their core pain points.
• Evaluate users’ needs and requirements and arrange them by priority. This can help to avoid a common EHR project pitfall: wasting a lot of time on developing a function that is not currently relevant.
• Ensure strong leadership from the stakeholders representing each group interested in EHR implementation, like board members, clinicians, marketers, and administrative personnel. Additionally, managers should start promoting the new system’s benefits early on to mitigate staff resistance, a factor that accompanies change.

Step 2: A multidisciplinary team setup

An EHR project’s success depends on more than just qualified developers; it also requires clinicians with industry-specific knowledge of hospital tasks, operations, and workflows. Hence, the EHR implementation project needs both technical and clinical perspectives.

Hospitals should select doctors with medium to high levels of computer competence (superusers), singling them out with the help of online tests. During the project, superusers should perform four essential tasks:

• Workflow mapping. Superusers can map the selected workflows and regularly update them to make sure they fully reflect clinical processes.

• Drafting the needed integrations. Through their awareness of existing digital solutions, superusers can map the necessary integrations and provide the information to the development team.

• Usability testing. Superusers can identify issues that are potentially dangerous for patients, like wrong dosages or units of measurement.
• Mentoring. Superusers can oversee beginners’ training, helping them master workflows and daily tasks.

Doctors’ participation in the project can improve all clinicians’ understanding of the new EHR system and its place in their practice while making the implementation smoother.

Step 3: EHR system implementation

EHR implementation is a multistep process that includes several iterations of testing and debugging, followed by rollout. But before the rollout occurs, the IT team needs to choose a suitable approach: a big-bang deployment or a phased deployment.

A big-bang deployment involves immediate go-live across the healthcare facility. This tactic is fast and efficient, allowing clinicians to begin using the new system at once. However, it is only optimal for superusers and could overwhelm clinicians with below-average computer skills. A phased deployment rolls out EHR system features incrementally. For example, providers can launch their EHR in one department and then gradually deploy it across the facility. This allows users to get acquainted with the EHR at their own pace.

Step 4: Plans for the future

EHR implementation doesn’t end with go-live. The team will also need to perform regular system optimization. This usually involves three steps:

1. Updating the EHR feature set and workflows
2. Adding new integrations
3. Removing underused features

Leaders should plan to start on first optimizations three months after EHR rollout.

EHR implementation challenges to expect

Unfortunately, even a well-planned EHR implementation can be riddled with issues, including initial workflow disruptions and burnout among clinicians.

Fortunately, these issues are manageable. To overcome them swiftly, clinic leaders need to:

1. Set up a support sub-team comprising superusers and tech experts from the IT vendor’s side to be available for support 24/7. This can lower doctors’ stress levels, as they will know they can get help at all times. For example, Valley Children’s in California deployed a new EHR during the pandemic. To prevent coronavirus exposure for the team, they set up a virtual help line for EHR implementation, where pediatricians could call and get help with EHR-related issues.
2. Initially, assign patients to clinicians with regard to their computer skill levels (i.e., give lesser workloads to clinicians with lower skill levels) to reduce clinicians’ stress and minimize burnout risk.
3. Inform clinicians about the ongoing hurdles and their resolution during the first month.
4. Ensure a user-friendly training model. A complicated or confusing EHR training program will increase physicians’ stress, so it makes sense to have a program that is intuitive and engaging, and to interview clinicians and nurses on their training preferences. For instance, Southern Ohio Medical Center in Portsmouth set up at-home training through their vendor to help staff train efficiently while following social distancing requirements. Thanks to the vendor’s efforts, the Center was able to provide in-person support and monitor the progress of their clinicians’ home training.

Summing up

EHR implementation is a difficult task, but with an easy-to-follow guide, it is more than manageable. The key steps include the following:

• Project planning, including assessing the current EHR system, drafting the new system requirements, and ensuring strong leadership
• Project team creation and onboarding tech-savvy clinicians
• EHR system implementation following a suitable method and with superusers’ participation at various stages
• Regular system optimization

The potential hurdles accompanying EHR implementation are also manageable. To solve them efficiently, clinic leaders need to:

• Create a sub-team to provide on-the-go support to clinicians
• Plan clinicians’ workload with regard to their computer skills at the beginning
• Keep doctors in the know about the discovered hurdles and their resolution
• Provide tailored training models for better efficiency

These measures will allow a practice to control the development and implementation processes and resolve issues swiftly.

Liza Dzhezhora is a healthcare IT analyst at Itransition, a custom software development company headquartered in Denver. She looks into the ways IT technologies can streamline healthcare processes and explores how medical internet of things, AI, robotics, and healthcare analytics help solve industry challenges.