9 best practices for successful EHR implementation

1. Create a transition team

When beginning an EHR implementation, healthcare organizations should form an EHR transition team to help ensure a smooth deployment. Since EHR implementations impact nearly every part of a healthcare organization, the team should include representation from the following groups:

• C-suite leaders.
• Clinical leaders.
• End users, including frontline physicians, nurses and other clinicians.
• Informaticists.
• Legal and compliance team.
• Operational leaders.
• Revenue cycle leaders.

Transition team leaders should have some change management knowledge. Additionally, the transition team should establish a partnership with the EHR vendor that includes defined roles and responsibilities, clear expectations and strong communication.

2. Communicate with end users

From early in the implementation process, leaders should outline why the organization is deploying a new EHR and what the expectations for the new system are.

"Communicate frequently before, during, and after the transition," the AMA authors emphasized. "Few users who have gone through a transition felt they received too much communication."

The authors noted that organizations should engage a broad communication strategy that includes the following update methods:

• Emails.
• Internal messaging platforms.
• Town hall meetings.
• Team- and department-level meetings.

Additionally, leaders should implement walkarounds to listen directly to frontline clinicians, instill trust in the EHR transition process and show institutional support.

Communicate frequently before, during, and after the transition. Few users who have gone through a transition felt they received too much communication.

Apprehension about switching to a new system and learning new workflows can become a barrier to using a new EHR. However, making sure end users understand why the implementation is taking place can assuage these worries.

3. Choose an implementation approach

Healthcare organizations can generally deploy their new EHR in two ways: a "big bang" approach or a phased rollout. Both approaches have pros and cons.

A "big bang" rollout refers to a system-wide rollout that engages all departments at once. This approach means less time maintaining the legacy EHR system, which lowers costs. Additionally, a system-wide rollout means less time for the EHR transition overall.

Disadvantages to this approach include the potential for more stress on the EHR transition team since all groups go live at once. Additionally, this approach limits chances for system testing prior to enterprise rollout.

However, a phased rollout uses one department, clinic or smaller hospital as a test case for the health system. This approach can help identify pain points early in the implementation process to inform system optimization. What's more, any major issues linked to the EHR implementation are isolated from the entire patient population.

An important consideration is that a phased rollout requires the cost of maintaining two EHR systems during the transition period. Additionally, while a phased rollout can leave room for EHR optimization, it cannot foresee all system issues.

4. Understand the current EHR

When implementing new EHR systems, organizational leaders should have a detailed understanding of baseline clinical workflows, including existing roles and responsibilities.

"Clinical responsibilities often change with EHR transitions, and it is important to anticipate who will be impacted by these changes," the AMA authors emphasized. "Organizational leaders need to reevaluate unnecessary workarounds and inefficiencies in existing clinical practices that a new EHR could potentially improve."

EHRs use role-based access to ensure the right people can perform certain functions. For instance, a social worker and critical care physician will have access to different EHR functionalities.

Leaders should gather input from clinical, administrative, legal and compliance, and informatics teams to understand the roles different end users play and the type of EHR access they will need.

5. Consider EHR customization needs

While a new EHR should address some of the pain points with a legacy system, all EHRs require some level of customization to meet organizations' specific needs. However, customized systems take time to develop and can be challenging to implement and maintain.

Unexpected issues can develop when an organization substantially customizes the EHR to accommodate existing workflows. Notably, in an overly customized system, the EHR might not function as intended, and the vendor might not be able to troubleshoot problems.

"In general, healthcare organizations should avoid overly customizing prior to go-live and recognize the importance of ongoing customization and optimization later," the AMA report suggested. "Health systems frequently find it easier to implement an off-the-shelf system with minimal customization and plan for more optimization after the transition."

6. Anticipate challenges

EHR implementations are complex projects. Understanding what could go wrong can help organizations anticipate challenges and prepare to address them.

Some commonly experienced challenges include the following:

• Clinician reluctance to embrace change.
• Financial burden of the new EHR, consulting fees and lost revenue from reduced clinical productivity.
• Increased risk of data loss and breaches during data migration.

AMA suggested that to encourage clinician acceptance of a new EHR, organizations should provide extensive EHR training opportunities and create well-being task forces for EHR transitions.

To anticipate financial challenges, organizations should budget appropriately for the cost of the new system. For instance, if an organization takes a phased rollout approach, leaders should be aware of the cost of maintaining the legacy EHR during the transition.

Lastly, to address the increased risk of data breaches during migration, leaders should create a cybersecurity task force to examine emerging security risks.

7. Offer training and support

EHR training and support are critical for clinician adoption of new EHRs. Organizations should compensate end users for training time and provide designated time to learn the system.

Users find at-the-elbow training and support more useful than lecture instruction. EHR learning should also include time when end users can practice common workflows and refer to a workbook or trainer when questions arise.

Healthcare organizations typically provide training and support through a combination of external instructors from their EHR vendor or third-party consultants and internal EHR superusers. Superusers refer to individuals who have a deep understanding of EHR workflows and best practices.

"While external instructors may have detailed knowledge of the EHR technology, internal facilitators are better able to tailor any EHR teaching based on the local context," AMA noted.

The authors emphasized the need for ongoing investment in EHR training and support. Existing users need refresher training for EHR optimization, and new team members will require EHR training resources as well.

8. Mitigate workplace stressors

To maintain care standards and clinician well-being, organizational leaders must acknowledge that clinic productivity will go down during EHR transitions. Generally, organizations can expect two weeks of reduced clinical capacity.

However, sometimes organizations need to extend this period longer as users become proficient with the new EHR. AMA suggests pausing or postponing any elective system-wide initiatives during and immediately after the EHR transition.

Additionally, leaders will need to monitor clinician morale. EHR transitions are stressful and can increase clinician burnout. Leaders must listen to end users, acknowledge concerns and address EHR implementation challenges.

"It will be critical to help clinicians feel valued during this time by listening to them and offering support as they weather the storm," the AMA report emphasized. "Wellness programs may not help address burnout during an EHR transition as these programs can consume more time and do not address the EHR-related stressors."

9. Gather feedback and support ongoing change

Even after going live, EHR systems need continuous improvement. Ongoing internal training and support can help address end-user challenges by ensuring individuals have the resources they need to get the most out of the EHR.

Additionally, as organizations undergo EHR customization post-launch, clinicians must continue to collaborate with administrators and informatics teams.

Key feedback and improvement strategies include the following:

• Provide open communication about expectations and give frequent progress updates on the implementation.
• Invite end users to give feedback on the EHR as it affects their roles.
• Create a ticketing system to track, categorize, assess and resolve EHR issues regularly.
• Examine elements of EHR use, such as time spent outside of work hours, to identify EHR optimization opportunities.

Transitioning to a new EHR is a significant project that requires careful planning and execution. By fostering collaboration among stakeholders, prioritizing end-user training and maintaining open lines of communication, healthcare organizations can navigate the complexities of EHR transitions effectively.

‍Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.