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Thinking holistically about EHR selection and implementation

January 24, 2014
by Lisette Wright
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Despite the effort and energy involved a careful selection process, some EHR implementations still fail. But why?

There are a number of reasons, many of which center on a common theme: a failure to anticipate issues and prepare thoroughly at the outset of the implementation project. Failures may happen in a variety of ways:

  • Running out of funding for the project
  • Not being able to go-live due to unforeseen problems or complications
  • Underestimating the level of sustained effort needed to implement and go-live

Rarely does a single problem doom an EHR implementation to failure. More often, it is a number of factors that come together that put your implementation effort “at risk.” As with any major project, each phase of the implementation project poses risks to on-time, on-budget completion. Throughout, if you take a holistic approach - anticipating and outlining the likely risks and then taking steps to mitigate them along the way - you can increase your opportunities for success.

Risks during EHR selection and contracting

Selecting an EHR and contracting with the EHR’s vendor is the first phase of a successful implementation project. During this phase there are a number of important risk factors to consider, each of which is ranked according to its estimated risk to successful implementation. Let’s consider each in detail:


Risk Level

A.  Organizational Awareness and Readiness


B.  System Analysis and Functional Needs


C.  Contracting


D.  Selection Burn-Out


A. Organizational Awareness and Readiness

An organization must be prepared to embark on an EHR journey by thoroughly assessing its current operations, strategy, and future plans. Simply saying, “we need an EHR” is not sufficient. Understanding what role the EHR will play and how it will facilitate improved care and performance is a critical component of organizational readiness. Knowing where your organization is going is very helpful in choosing an EHR with the right mix of functionality. Among the key awareness and readiness concerns to consider are these:

1.  Overall Organizational Planning: While your Strategic Plan may seem like an unusual factor to consider in EHR selection, it is not. With the help of a current Strategic Plan, you will be able to assess likely service line expansions or reductions, the potential for mergers or acquisitions, and future interactions with physical health care through primary care integration, development of a health home, or participation in an Accountable Care organization. Your organization’s ability to collect business intelligence, perform analytics, and measure its own performance relative to benchmarks is vital to demonstrating its effectiveness and driving its improvement.  Understanding these internal, business, and growth goals are essential for ensuring that you get the best Return On Investment (ROI) for the EHR.

2.  Change management and readiness will be challenged in new ways throughout the process of selecting and implementing an EHR. For example: staff will be asked to perform their job duties in very different ways from what they have known. Some will resist or struggle with learning new processes, a new EHR, and even the basic computer literacy skills that they need. I have seen the training phase of implementations disrupted due to computer literacy problems like these. It is wise to assess staff computer literacy and provide remedial training if needed. This step may be vital to preserving your implementation timeline and will improve the quality of learning during the EHR training process.  

3.  Building and standardizing forms and encounter documentation required for an EHR system implementation is often a grossly underestimated, yet time-consuming and costly decision-making process in many organizations. Faced with the need for complete standardization, work groups often find small, but important discrepancies in processes and forms and end up building or configuring far more specialized forms than they expected. While this effort is necessary, it can unexpectedly slow down an implementation if the scope of the needed changes are not considered and resourced ahead of time.

4.  Underestimating the implementation budget is a sure-fire way to derail success. From the moment you execute the vendor contract, your organization is paying for a system that must produce a predictable return. Any delays in project completion will be costly and will ultimately put the project at risk. Thus, it is essential to comprehensively understand, prior to EHR selection, all of the elements and associated costs needed to make it fully functional.

This category poses the highest risk for EHR failure for those organizations who are not critically thinking through industry forces, trends, and their market position in the industry. Being aware of the tasks, chores, and items that are necessary to make the EHR a value-added asset in your organization will provide the end-goal for selecting and implementing an EHR.