EHR Implementation Plan: Your 8-Step Checklist

EHR implementation is complex. You need a plan.

A good plan.

A plan that delivers on schedule, increases adoption among patients and physicians, tests practice processes within the system, migrates patient data…..

….the list goes on.

Your practice may not be ready to achieve success in these areas right now, but you and your implementation plan are going to change that using this 8-step checklist.

 

1. Build your EHR implementation roadmap

Roadmap. Checklist. Matrix. Template. Call it what you want.

The first step in any EHR implementation plan is to outline all the tasks and processes which need to be executed by your team of physicians, practice managers, IT staff (and even patients). Key tasks include:

  • Recruit your implementation committee from stakeholder groups
  • Outline your expected implementation costs and define the total budget
  • Schedule your implementation (best done after your roadmap is complete)
  • Migration of patient and practice data
  • Create a user training program
  • EHR testing (unleashing it in a “live” practice environment at some point)
  • Clearly define go-live activities
  • Define critical success factors and evaluation strategies

Whether you choose to map these tasks in a checklist, roadmap or GANNT chart will depend on your practice’s project management protocols but commonly used tools include:

  • Google Sheets - great for collaborating on roadmaps
  • Trello or Wrike - great for flexible project management (GANNT, calendar, checklists)
  • Asana - great for advanced “to-do” lists

 

2. Recruit your implementation committee

With your implementation tasks defined you need people to execute each process on schedule and budget. The following committee members can be sourced from key stakeholder groups or external consultancy:

  • Project Manager - if you’re reading this, you may have volunteered already
  • Application Analyst - responsible for data migration and cleansing
  • Application Developer - responsible for system customization
  • QA Test Engineer - responsible for system testing and performance
  • Physician Advocate - represent physicians and advise on training, data and testing
  • Nurse Advocate - represent nurses and advise on training, data and testing
  • Billing Advocate - represent billing department and advise on training, data and testing
  • Meaningful-Use Manager - required if MU attestation is required
  • Super-Users - early adopters for training programs

The makeup of your implementation team will depend on the scope of your practice, budget… and project manager’s patience. A key decision to make at this stage is whether to bring in external EHR implementation specialists or consultants…

What does an EHR implementation specialist do?

"Things senior practice management will ask when presented with the bill."

The answer is everything. And, potentially, nothing. It’s not the abilities of an EHR consultant that matter, it’s how you use them to assist with any combination of...

  • Project scheduling and roadmapping
  • Data migration and cleansing
  • User training and change management
  • Testing and go-live activities
  • Security assessment

...just don’t put them solely in charge of the budget (their paycheck).

 

3. Forecast your implementation costs and define a budget

Now you have a team and a to-do list, you are in a position to ask…

What is the cost of EHR implementation?

The only answer one can give with some certainty at this stage is…

… approximately $6,000 more than you expected.

Having said that, a well-defined budget featuring the following elements should ensure no unexpected costs come out of the woodwork:

  • Hardware and network upgrades
  • Practice staff overtime and temporary staff
  • Productivity loss (some estimate as high as 50% reductions in patient throughput)
  • Customization consultancy from the EHR vendor
  • Vendor training fees
  • Consultancy costs
  • Data backups and storage (often bundled with cloud EHR costs)

If you're looking for information on the upfront cost of purchasing EHR software, you can download our EHR software pricing guide here.

 

4. Schedule your implementation

This is often the first thing practices work on. The problem with that approach is clear when you consider what impacts a schedule:

  • Project scope
  • Project teams
  • Project budgets

Luckily for you, you have now defined all three and can begin to add timescales to your roadmap outlined in step one. So the question is:

How long does an EHR implementation take?

611 hours is the simple answer.

The complicated answer is an analysis of our holy trinity of project attributes outlined above.

 

5. Migration of patient data and practice data

This is the point where the everyone has to keep their nose to the grindstone. Or their cleansed patient data to the well-formatted EHR database if you want to be literal.

Key stages in EHR data migration include:

  • Conversion of paper records to electronic records
  • Data cleansing and verification
  • EHR database setup
  • Mapping legacy data to new database fields
  • Data transfer to the new system
  • Testing and verification of legacy data
  • Testing and verification of new data inputs

Get this process right and the rewards are great… a 10% reduction in data errors to be precise.

 

To clarify this process, it is useful to produce a map of your practice data as shown above (source: Advance Healthcare Network)

6. Create a use training program

With $70,000 in annual savings and a 10% increase in productivity at stake, your EHR training program has a huge impact on the final ROI for your system.

Successful training programs include:

  • Super-users as system and program advocates
  • Clear communication channels with vendor support teams
  • Role-based training to ensure relevancy
  • Feedback loops to keep users in dialogue with project management

These steps should not be seen as silver bullets as one of the primary causes of EHR implementation failure is poor user adoption of the system.

 

7. Clearly define go-live activities

If there is ever a day to have a plan it is go-live day. Day one. The start of the rest of your life.

With that in mind, it is prudent to create a zoomed in version of your roadmap specifically for the days (or weeks) around your go-live date. This roadmap can include:

  • System testing processes (pre- and post-go-live)
  • Patient communication guidelines (including expected downtime)
  • Staff scheduling including required overtime or temporary staff
  • Modification of appointments and scheduling
  • Reporting processes for system and project evaluation (see step 8)
  • In-practice communications (signs on noticeboards etc.)
  • Network speed and reliability checks
  • Data backup processes

8. Define critical success factors and evaluation strategies

Congratulations, you made it through go-live. Or at the very least the planning process.

Now you should ask…

How can you evaluate your EHR implementation?

Evaluation of EHR implementation can take many forms and the best one for your practice will depend on your project goals:

  • Perform ROI calculations to assess profitability
  • Record patient throughput to assess efficiency
  • Survey patient satisfaction to assess quality of care
  • Survey physician satisfaction to  assess user adoption and training
  • Analyse data error rates to assess data input and quality

 

A final thought…

Following these steps will produce a plan which gives your project a foundation. It is up to you and your team to execute this plan in the face of practice nuances, disgruntled users and missing data (even the best implementations experience these).

 

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Kathryn Beeson

About the author…

athryn is the editor of EHR In Practice. Whilst she spends a lot of her time coordinating and editing content from the EHR In Practice writing team, she sometimes finds time to put pen to paper too. Outside of work she can usually be found running, bouldering or playing squash

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Kathryn Beeson