The implementation of an electronic health record (EHR) is a complex process that requires much time and effort from healthcare facilities and their staff. Those involved in the process will undoubtedly have many questions and concerns. This article covers the five most frequently asked questions regarding an EHR implementation, offering answers, tips, and tricks along the way.


1.    How long does an EHR implementation process take?

This is often the very first thing healthcare facilities wonder about when faced with an implementation process. Unfortunately, there is no single, definitive answer to this question. The time frame within which an EHR is fully implemented throughout a healthcare facility greatly depends on the chosen supplier. Generally, it ranges from one, all the way to five years – or more, in some cases.

There are many factors that affect the duration of the implementation process. One major factor is the decision of an implementation approach. In a big bang implementation, all elements of the EHR are adopted at once. In a phased implementation, elements are adopted in phases, over a period of time. Healthcare facilities looking to rapidly have the new EHR up and running will often opt for the big bang approach. This will put them through a short, but rigorous process. With a phased approach it will take longer before the EHR is implemented fully. Both approaches have their pros and cons. A big bang implementation will have care providers quickly experience all the benefits of a fully integrated workflow, but will also mean that the users face a tremendous amount of work during a short period of time. In a phased implementation, this work is spread over a longer time frame. However, interfaces and subsystems will need to be active for longer – meaning an increase in cost – and care providers will only have certain elements available from the start. This hybrid workflow may be sensitive to error. It is essential for a healthcare facility to be fully aware of the consequences of either approach.

As such, it is wise to discuss this topic with the various EHR suppliers: what implementation strategy would they suggest, and why? Try to have an open dialogue and listen to their ideas. What may seem incompatible with your healthcare facility, could turn out to be greatly beneficial – given the correct approach.


2.    What are the major risks and how will these be managed and/or controlled?

Implementing a software solution that covers the complete patient flow is no small task. Risks should be mapped out and assessed thoroughly, and sufficient time and effort should be dedicated to both risk mitigation measures and to solutions, should anything unforeseen occur. Special consideration should be given to an unexpected delay of the project, the possibility of additional costs, the system not complementing the work processes within the healthcare facility, and poorly trained end users.

Some risks may amplify each other: a delayed project completion, for example, often comes with additional costs. In order to keep all of those involved in the project motivated and avoid unexpected costs, it is important to discuss any concerns in advance with the supplier. Make sure all parties are on the same page with regard to the project planning, well before the start of the project. Are there any potential obstacles along the way? Talk these through with the supplier. Ensure that each party understands their responsibilities and obligations, and allow project coordinators to use their knowledge and experience in making informed decisions when needed. Make and document agreements with the supplier, and select a supplier with demonstrable experience and past success.

Throughout the implementation, make sure that the EHR is being tuned sufficiently to the work processes within the hospital. During the tender, inquire about the level of participation and involvement available to the healthcare facility. Do not be hesitant to test the supplier's knowledge and experience, and be critical of what you learn. After all, having a system that perfectly complements the various workflows is essential in meeting the needs of the end users. Finally, these end users will also need to be adequately trained to use the system effectively. To this end, a comprehensive training programme is a necessity rather than a luxury. End users should only be able to access the system when they have completed the required training courses.


3.    What organisational capacity should be made available to bring the implementation process to a successful close?

An excellent question, as the manpower required on the part of the hospital is a strain on their resources. The capacity required is also dependent on the supplier and the selected implementation approach. In a big bang implementation, all staff members are trained and prepared at once. Combining this with their regular workload can put tremendous pressure on the staff. In a phased implementation, staff members can be trained in alternating groups. While this does reduce some of the additional pressure, the lengthy process may lead to "implementation fatigue". At the end of the road, this approach may require committing as much, if not more, full-time equivalents (FTE).

The topic of capacity requirements is important in the discussions with the various suppliers. Have a clear picture of the required number of project staff members prior to the start of the process. Keep in mind that not only IT staff, but also physicians, nurses, allied health professionals, administrative staff, etc. will need to be available during the implementation. If a supplier does not mention such profiles, verify whether this is intentional. For the system to be tuned to the work processes within the hospital, input and feedback from these user profiles is essential.


4.    What are the key success factors?

A successful implementation project not only benefits the implementation of the EHR, but is also an important component in the acceptance of the EHR and of end-user satisfaction during the operational phase. As such, it is vital that the critical success factors are taken into account. Cooperation with and faith in the EHR supplier are crucial. Get to know the supplier's approach and strategy, and ensure there is space for cooperation, participation, and open dialogue. This, in turn, leads to the support from the organisation and end users that is needed to bring the project to a successful close, and ensures an EHR that complements the workflow of the healthcare facility.

This manner of cooperation also implies a certain level of commitment from the relevant project staff within the healthcare facility. These should be available at the correct times. They will also need to be aware of their responsibilities throughout the project and will need to conform to any agreements and deadlines. This requires the project staff to be adequately trained and informed by the supplier.

A clear, detailed, but manageable, test plan is another fundamental component. Indeed, all elements of the EHR must be thoroughly tested before its final release. It is recommended that this test plan be available right from the start of the process. Inquire with the supplier how problems that arise during the testing phase are managed and resolved.



5.    What happens to the existing data, registered in the previous system?

The conversion and/or migration of previously registered data is an important aspect of implementing an EHR. Care providers need to be able to access and use (historical) data from the previous system, or systems, in the newly implemented system.

Ideally, data conversion is an automated process, so as to minimise the risk of (human) errors and to reduce the workload during the implementation. Ask the supplier how they manage this aspect. Additionally, give due consideration to decisions about the data that is to be converted. What data should be transferred to the new EHR, and where will it be stored? Is the process limited to a certain time range, or does it include all historical data? Can the data be transferred as is, or will it need to be converted to a different format (e.g., as flat text)? Et cetera. Testing the converted data is an important next step. This can be done in a variety of ways, such as data counts, checking samples, validations, etc.

In summary, it is critically important to discuss all aspects of an implementation thoroughly with the EHR supplier. Knowing and understanding the approaches favoured by the various suppliers helps when weighing your options and may even result in new perspectives. Choose a supplier that is able to deliver on their promises, and do not be afraid to verify this with healthcare facilities that have worked with this supplier in the past. All these aspects contribute to a qualitative implementation process and a successful go-live of the new EHR.