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The process of selecting and implementing a new Electronic Health Record software can be plagued with many unexpected challenges if not well planned out.   In 2015/2016, Aaron Davis, Project Manager for the Center for Public Health Initiatives of the Community Engagement Institute at Wichita State University worked closely with a large group of Kansas public health departments to guide them through the selection and implementation process.  The following tips are the lessons learned throughout this year long endeavor and successful EHR implementation.

Tip #1: Don’t implement a new system if you don’t need one

Not everyone needs an EHR – especially if there are 3 or less users.  Assess your needs and know what you want to accomplish.  If you love the system you’re using, don’t feel pressure to follow, however, make sure your system is federally certified and up-to-date on privacy and security.  If you have severe pain points, those should be the motivation to switch.

Tip #2: Culture & processes are just as important as the EHR System

If you’re struggling now, analyze your issues.  The issues could be related to either your EHR software or processes or people, or a combination of all three.  If your EHR software is old, chances are it requires a mix of paper and electronic data which can complicate processes and frustrate people.  If you have culture issues, fix those first.  When you have a new system selected, make use of the vendor resources to help optimize your workflow and processes.  When you select a new EHR system, make sure you let your people know there is no going back and encourage appropriate culture.

Tip #3: Be realistic & selective

There are many options available on the market today, so you need to be selective.  General purpose EHRs may not best meet your needs.  Look for an EHR which specializes in your function such as public health, FQHC, or behavioral health.  An EHR vendor focused in your area can shape best practices to help streamline your workflow and maximize efficiency.

Tip #4: The group approach helps

Being part of a group of local health departments, which all have the same end goals, can make the selection and implementation process much easier.  Creating a forum to discuss issues and questions with other departments, conducting group meetings and conference calls, or even having mentors from other departments, can drastically increase the confidence you’ll have with the EHR selection you’ve made. After implementation, the benefits increase to include group training which can reduce overall costs.  A group approach will help all clinics and users together and share best practices.  Some clinics can becomes experts and guide others on immunizations for example, while others can shine on billing.

Tip #5: Team approach (Tech savvy, leadership, buy-in)

For a successful outcome, first you must have a tech-savvy champion that can lead the challenge. (This supports Tip #4 above.  If you do not have one within your own staff, rely on neighboring health departments for their expertise. Second, you need to have a back-up.  Third, you need across the board buy-in so that everyone will move forward together.  If you only have a staff of 2 or 3, you need to think through staff capacity and capabilities. If you don’t have this, be prepared to struggle in the beginning -refer back to tip #1.  Good communications will lead to good cooperation.   Tip #6: Put in the time to set goals and do cost/benefit analysis The #1 regret noted from the departments within this group project, was that they wish they would have made more time for setting clear goals and time for cost/benefit analysis.  Too often, these are things people don’t track and don’t have methods or time to track. Unless forced, small departments will not want to take a measured approach to implementing and evaluating change.  It’s like eating vegetables; just because it’s good for you, isn’t enough of a reason.  Outline your current costs & future goals for increased productivity.

Tip #7: Learn the features & benefits before you buy

Some lessons learned from the group and the various differences in EHR software include connectivity to state immunization registry, lab connectivity, scanning in documents, electronic charting, and report building.  These are all very different objectives, and all are necessary. Not all vendors will meet all your needs.  Ask lots of questions during the selection processand demos.  Make sure the EHR and vendor you select focuses on your functions (e.g. public health).

Tip #8: Recognize traps & pitfalls

Realize that sales people often will promise the world. Be cognizant that future development and customizations will require time.  They will also require effort on your end to insure the right end result.  Take responsibility for what you don’t understand and ask questions.  Requirements vary from state to state – make sure your vendor understands your special clinic needs. Again, ask lots of questions.

Tip #9: Selecting a system is important

Buying an EHR system is a lot like buying any new technology. It is a huge investment that requires leadership and staff commitment (focus and time) to succeed.  Conduct demos with multiple systems, use a selection criteria matrix to compare and rate each contender, and never purchase a system until you see it live in action.  Most importantly, make sure you assess your people’s capability to adopt new software.  Make sure you select a vendor who knows your clinic type, provides in-person training (at your site) and provides ongoing free education via webinars and user focus groups, and of course, vendor should include unlimited video training modules.

Tip #10: Plan! (Don’t take shortcuts!)

You can take as long as you want to implement a system – short or long time-frame. A doctor’s office will average 3-4 months from start to finish, while a local health department should be able to complete the full implementation process, from contract signing to full utilization, in 8-12 months.  Plan a phased approach to training, data migration, and go live schedules.