Electronic Health Record (EHR) Implementation Guide

10 Steps to Successful Electronic Health Record (EHR) Implementation

Implementing an Electronic Health Record (EHR) is a multi-step process that will impact all staff members. As with any new process, a learning curve is involved. Having a solid plan can save hours of stress for everyone on your team.

Here are ten essential steps to take for a successful EHR Implementation.

1) Build your electronic health record (EHR) implementation team

As you implement your EHR, you’ll need a strong team to help the process go as smoothly as possible. The team can include staff members such as physicians, nurses, medical assistants and administrative staff. Team members will assist the process by teaching colleagues EHR skills and serving as messengers to the implementation team to identify challenges along the way.

A lead superuser, lead physician, and project manager are three essential roles to consider while building your team.

Lead Super User

The lead superuser is the resident in-house EHR expert. A few duties may include template creation and developing workflows. This position may also be responsible for creating standard operating procedures to address problems users come across as they use the system.  

Lead Physician

The lead physician’s role is to guide the organization through EHR  implementation by serving as a link between the front line users of the system and the technical staff. Consider utilizing a tech-savvy physician who welcomes the new process as the lead physician.

Project Manager

The project manager will become the main point of contact with the EHR vendor and staff. This position will also help everyone keep focused on implementation timelines, track progress and deal with user issues.  

2) Prepare the software   

When implementing your EHR, ensure security measures are met to not violate HIPPA. Your organization may need to conduct a HIPPA risk assessment. You can work with your health IT vendor to make sure the software is compliant.  

3) Determine your hardware needs   

Your hardware choices will have a significant impact on the time and money your practice uses. For example, having a printer in every room can save physicians up to 30 minutes a day. Some practices provide each staff member with their own tablet or laptop to save time logging in and out between each patient interaction.  

If the idea of doing all this seems overwhelming, IT service companies can help practices with system hardware needs by helping find the correct equipment at the best price. Many companies will also install and troubleshoot the devices, taking the burden off your office staff.

4) Consider the patient treatment room layout   

As the EHR program requires electronic data entry, the room layout can have a substantial impact on patient engagement and satisfaction. If the staff and physician face away from the patient while entering data, patients may feel like they are not being heard.

One way to solve this is by using the “triangle of trust.” This is a room configuration where the patient, physician, and computer form a virtual triangle, allowing the patient and physician to see each other. This layout helps because the staff member or physician only has to turn slightly while entering data, helping the patient feel they are being seen. Consider placing semi-circular shaped desks in patient rooms or use moveable carts to help the patient feel at ease during their appointment.    

5) Transfer data

Once your hardware and software are ready to go, the next step in EHR implementation is to transfer the data. To begin, you’ll need to determine how to migrate data from your former record system to your new EHR.

There are a couple ways to do this step. You can assign existing staff, or hire additional or temporary staff to upload information into the new EHR.

To make this process as smooth as possible, you’ll want to prepare a checklist of information to be entered into the EHR. Having a process in place will help ensure no critical information is missed.

6) Create workflows  

Speaking of process, now is the time to get solid workflows in place. It is vital to establish workflows prior to EHR implementation to decrease the amount of stress your team will face.

Having inefficient workflows, including an insufficient number of staff members who are trained and ready to use the EHR will exacerbate issues during the implementation process.

Consider these questions as you create workflows:

  • Is this necessary?
  • Does this add value for the patient?
  • Does this increase efficiency for the staff?
  • Is this the right order?
  • Is the right person doing this step?

7) What to do when your EHR is down

As with any type of technology, you must be prepared for the occasional glitch. Start by brainstorming issues and come up with a solid game plan for how to handle potential problems.  

For example, what will you do when the power goes out? What if there is a system-wide malfunction that requires the help of IT to fix? You will want to develop procedures that give clear instructions to physicians and staff on what to do when the EHR is unavailable.

Consider these questions when developing your procedures:

  • How will physicians and staff be notified of downtime?
  • How will the patient care flow continue?
  • How will patient check-in occur?
  • How will physicians and staff document the visit?

Having electronic and paper procedures available to staff will increase their confidence on how to handle EHR downtime. Some medical practices compile the instructions in three-ring binders and store copies both in-house and offsite. Also, consider storing PDF copies on a secure cloud, so staff members have multiple options to get the instructions quickly.   

8) Have a training program in place  

Extensive training is imperative to ensure success with EHR implementation. Create a training plan so that all physicians and staff, current and future, can gain the knowledge and skills to use the EHR successfully when you are ready to launch.  

Here are a few principles to consider:

Start slow

Provide physicians and staff with basic skills before launching. It can be difficult for users to fully understand the system until they are able to use the program. Once users are able to “drive” for at least a week, additional training can be introduced to increase skills, learn time-saving tricks and get more comfortable with the technology.

Let colleagues teach colleagues

Consider training super users in each specialty and for each role. For example, nurses teach nurses best and surgeons teach surgeons best. Besides, if you have a super user in each specialty, they can become an ongoing resource for their colleagues.

Map out ongoing training needs

Have a plan for ongoing training. As time passes, users will find shortcuts and new ways to use the tools, and will want to share these findings with their colleagues. In addition, the EHR will need to be updated with new and/or improved functionality that will require extra training.

Ways to effectively handle these situations include:

  • Develop a system for users to submit EHR recommendations so changes can be made.  
  • Encourage active EHR users to share input and offer solutions for enhancing usability, either by a formal tracking system or through an online discussion that encourages the sharing of ideas.  
  • Create a system for continuous EHR customization. Once physicians and staff have a handle on the new EHR, they will identify modifications that can improve workflow.
  • Preserve the EHR vendor relationship and utilize IT support to:
      • Develop or customize data entry templates
      • Revise EHR generated forms and letters
      • Enable new clinical decision support rules (if available)
      • Modify order sets
      • Look for integration opportunities with other commonly used systems in the practice
  • Plan group training in advance. Training will take time from seeing patients, so advanced planning decreases disruption to the practice workflow.

9) Decide on launch approach – “Big Bang” or Incremental?

Once your EHR implementation plan is ready to go, it’s time to decide how to launch. There are typically two ways to do this, all at once, the “Big Bang” or slowly, in an incremental approach.

Some practices use the “big bang” approach and roll out the EHR system for all patients and functions on the same day. This approach minimizes time spent managing paper records as well as the new EHR system at the same time. The disadvantage is it can be very disruptive and small problems can seem monumental.

Some practices take a slower approach and implement the EHR incrementally. By introducing EHR functions one at a time, such as e-prescribing to begin and then introducing other features later, some practices find the disruption easier to manage. Larger practices and organizations may implement slowly by rolling out the EHR in specific sites or departments first and introducing the program to the rest of the organization later.  

Once the launch approach is decided, physicians and staff can get ready for the new EHR system.

On the actual “Go Live” day it is recommended to lower the patient volume which will ensure a smooth transition for both patients and staff. It is also recommended that the front desk staff informs the patients either pre-appointment or the day of that the practice is transitioning software and that the process may be slightly interrupted. They will appreciate the insight and have more patience should there be a  delay during their visit.

10) Gather feedback for continual improvement

Now that you’ve successfully implemented the EHR, be sure to gather feedback from the users to continually improve the process. Be sure to keep the lines of communication open so staff members and physicians feel comfortable providing feedback. If everyone works together, the EHR system will be an improvement to your practice.

Implementing an EHR is a multi-step process that requires advanced planning. Use these steps to help make the transition as smooth as possible.

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