Tips and lessons learned for a successful clinical EHR implementation

Electronic Health Record (EHR) implementation is so much more than just an information technology project—it’s a vitally important transformation that impacts every clinician and staff member within a healthcare organization. While the planning and transition may feel daunting, with the right people and processes in place, your organization can achieve the highest return on investment and drive clinical productivity from Day 1.
The following tips and lessons learned have been gathered from experience throughout hundreds of implementations and are designed to prepare your organization to achieve a successful adoption of your EHR:

Foundation

Establishing the project charter
The creation of a comprehensive and detailed project charter sets the stage for a successful implementation. The charter acts as a blueprint referenced throughout the duration of the project and should include a detailed outline of the scope of the project, a mission statement, vision, measurable benefits, tangible goals, and the governance and decision-making structure.

Aligning goals and establishing a benefits-driven approach
Working across stakeholders, it is critical to articulate the value the EHR will bring to the organization. Establishing measurable benefits and outcomes will align the project’s objectives with the organization’s strategic goals. Therefore it’s essential to establish strong communication, buy-in, and excitement from the start.

Securing executive buy-in
The visibility of the executive team throughout the implementation is vital to success; they need to support the project and share the identified mission, vision, and goals with the entire organization. Scheduled status meetings through the duration of the project ensures any challenges are recognized and remediated. An executive sponsor outside of IT, such as the CFO, CMO, or CNO, also must be visibly in support of, and committed to, the project. This sponsor will emphasize the magnitude of the implementation and its importance to the organization.

Branding and communication
Branding an implementation provides an opportunity for the organization to rally around the project and make it visible to those within the organization and community. Get creative and lay out a detailed plan incorporating the mission, vision, and benefits of the project—thus helping to alleviate fears, encourage participation, and create and maintain enthusiasm for the project. Have fun with it and create posters, flyers and brochures to display at nursing stations, doctor lounges, and staff cafeterias.

Internally, regular updates about the EHR implementation should be provided through as many avenues as possible, such as newsletters, emails, intranet posts, and town hall-style meetings.

External communication is also key. It’s highly recommended to leverage newsletters, local publications, and social media to communicate with your patients the positive impact the EHR implementation will have on their care at your organization.

People and process

Identifying project managers
Project managers are responsible for ensuring that the right set of resources are identified upfront, coordinating stakeholders to execute the project successfully, ensuring the project is meeting critical milestones, and mitigating any risks. When selecting project managers, it’s critical to choose someone who has a deep understanding of the project charter and goals, and can navigate the people and politics within the organization.

“While clinical workflows can be complex, another important aspect to always consider is the impact the workflows will have on other operational and financial areas of the organization.”

Identifying champions
It’s essential to identify champions across multiple departments and teams. These leaders will assist others in visualizing the end goal. This includes not only a physician lead who has respect from his/her peers and is able to hold the line on full adoption of the EHR, but departmental leadership as well. Good champions work effectively with others, understand workflows, and are constantly looking to the future without getting caught up in the paradigms of the past.

Fostering clinician synergy
Clinician participation during an implementation is critical to achieving higher adoption rates and evolving the organization for a successful future. Clinicians bring a unique perspective to the table during an EHR implementation, and involving them early and regularly will positively influence attitudes toward the project.

Leading the change
According to Kotter’s 8-Step Process regarding change management, 75% of an organization needs to buy into the change for it to be adopted successfully¹. Stakeholders must clearly communicate the vision and goals while assessing the organization’s readiness for change. Individuals will become more invested if they have tangible wins and can see the value the project will have for them.

During an implementation, users need to get out of the “because we’ve always done it this way” mindset. By performing a current and future state analysis, users can identify where challenges exist and determine what they can realistically attain.

Assessing process redesign
In order to make this a transformative project, organizations need to do a clinical workflow analysis focusing on “current and future state” to allow stakeholders to identify opportunities for improvement. Stakeholders need to identify where there is variation and waste, so workflows can be streamlined. Since workflows can vary across specialities, departments, and service lines, it’s important to involve users across the organization. Evaluate and leverage standard content offered by your vendor, such as quality reporting, clinical decision support, clinical assessments, and order sets.

While clinical workflows can be complex, another important aspect to always consider is the impact the workflows will have on other operational and financial areas of the organization.

Planning the project inauguration
A project launch is a perfect way to officially kick off an EHR implementation. Invite stakeholders from across the organization such as board members, executives, the IT department, department heads, physician champions, and core team leads. This is an essential way to make executives visible, build excitement, and discuss the mission, vision, and benefits of the future EHR.

Capturing pre and post LIVE data
Success requires a data-driven approach to meet the objectives detailed in the project charter. Capture a snapshot of baseline clinical metrics, such as length of stay, mortality, readmissions, and patient satisfaction, as well as financial and operational metrics, before the go-LIVE. Using these metrics, incorporate measurable benefits into the project charter.

Improvements won’t be realized on Day 1 of go LIVE, therefore, a comparison of metrics must be performed within a predetermined timeframe in order to substantiate a successful EHR implementation. The HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) is a great methodology that scores hospitals’ EHR capacity through an eight-stage model to calculate adoption and utilization².

Success

Scheduling pre-LIVE trial runs
Integrated testing, parallel runs, and system validations reaffirm that the system is built appropriately and is ready for the go-LIVE. A true parallel run should mirror actual workflow of the clinicians, following a patient through their experience as opposed to scripted scenarios. This fundamental phase in an EHR implementation begins months before go-LIVE.

Resources at go LIVE
Make sure the users feel supported during the initial go LIVE period. Super-users should be visible in every department and accommodate 24/7 support for up to two weeks. Those that are known to be a challenge should be provided at-the-elbow support to assist them with their first rounds or shifts.

Running post-LIVE assessments
Upon go-LIVE, an EHR project journey is just the beginning—organizations are in a constant evolutionary mode and always focused on improving. During the post-LIVE phase, physician adoption and satisfaction must be evaluated. During the weeks following the go-LIVE, it’s important to address training and education gaps, ideally through real-time elbow-to-elbow support.

Work with stakeholders to identify processes for ongoing optimization of the system. Prioritize and address any workflows that need further refinement, content adjustments, and improvements. The process of incorporating updated clinical guidelines is constant—engage physicians in developing new clinical decision support tools that improve care delivery and outcomes. Vendors are constantly delivering more advanced features, so it’s important to always review quality improvements and ensure the organization is continually evolving.

Proper planning, strong leadership support, and involved clinicians are the keys to successfully implementing a fully-integrated EHR, and a key step in transforming into a healthcare organization for the future.

References:

1. https://www.kotterinc.com/8-steps-process-for-leading-change/
2. https://www.himssanalytics.org/emram