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Adding a new technology to any workplace can be a disruption to the workflow process, a test to the staff and, therefore, a great challenge to management. This holds very true when implementing a new Electronic Health Record (EHR) solution for local health departments and other healthcare agencies. Without across-the-board buy-in from both clerical and clinical staff, the planning and execution of EHR implementation can be a challenge. It can cause morale to plummet and productivity to suffer. Done right, implementing an EHR can really boost workflow efficiency. Here are 21 steps to follow for a successful EHR implementation from.

Getting Ready

1. Documentation is key – Keep a Binder of everything! Have a sign-in sheet at all meetings, conference calls, demo, etc.
2. Develop an Implementation Team:
   • Designate a Project Manager.
   • Designate a Lead Trainer for Clerical and a Lead Trainer for Clinical.
   • Designate a Lead Billing/Finance Super User.
   • Assign an Administrative Support Person (Health Director, Nursing Director, or Finance Director).
3. Create an internal EHR Super Users Group – these will be your internal go-to people from here on and should include:
   • A supervisor or representative from every clinic
   • Your designated Project Manager
   • Your designated Clinical and Clerical Lead Trainers
4. Use your local resources, such as Area Health Education Centers and Regional Extension Centers – they will provide valuable input!

Selection Process

5. Have at least 3 or more different EHR vendors conduct demos for all staff that will be using the EHR.
   • Make sure it is designed for your needs rather than a general purpose.
   • Hold recap meeting of all demos.
   • Decide as a group where each company ranked on a scale from (1 to 3) 3 being the best.
   • Eliminate the lowest ranked EHR vendor.
   • Require a follow up demo.
   • Conduct several conference calls and emails to your top choice asking more questions.
   • Contact other health departments that have already implemented your top choice.
   • Compile list of follow up questions still needed answered to make a final decision.
6. If possible, conduct site visits to other similar type agencies who use your top 2 EHR choices. Then conduct a follow up meeting with everyone that went to discuss pros/cons and likes/dislikes, of each site visit.

Implementation Process

7. Dig deeper into your top EHR choice! Your EHR vendor is going to be your partner, long term. Make sure they will provide service you need.
   • Drill down on ongoing services. Unlike buying a piece of furniture, you’re forming a long term relationship with your EHR vendor, and service is critical to success. Make sure your chosen EHR vendor provides:
     • Regular software updates (for free?) at least every three months.
     • User focus groups to provide convenient, relevant, and frequent training of users.
     • Executive access, for example, health officer user group meetings, or direct contact with vendor upper level executives, like the CEO.
     • Free upgrades e.g. to Meaningful Use Stage 3, FPAR reporting requirements, etc. Many vendors have added costs later for required upgrades.
     • Monthly newsletters with tips and updates.
     • Initial services should include on-site in-person training.
     • Does the EHR offer workflow analysis and optimization services or other consultative services? This is key to success as adoption of an EHR will require change and vendor expertise can help maximize return on investment.

8. Decide walk throughs and training dates now!
9. Prepare your staff – Survey all staff on their computer skills using “Computer Skills Evaluation Tool”.
   • Compile and analyze all responses.
   • Highlight areas that need improvement.
   • Offer additional training in these areas.
10. Based on EHR vendor-provided information, have your implementation team compile binders for all clerical and clinical staff with cheat sheets, quick guides, schedule of clinics, sliding fee scales, etc. These should be specific to each clinic.
11. Complete a step-by-step workflow analysis for both clerical and clinical processes
    • Have each clinic make a binder with every form, document and handout that they currently use.
    • Mark which items will potentially need to be scanned.
    • Make sure they also include a section of educational materials they give out.
    • Your EHR vendor can review the binder and should be able to help you streamline your workflow.
12. Hold all-staff meetings to give updates so everyone feels part of the upcoming change – this will boost morale.
13. Schedule the maximum amount of training provided by the EHR vendor and video each training session. Vendor-provided training is critical to success. On-site, in-person training is practice makes perfect. This is highly recommended. Make sure your staff is available and focused on learning the new EHR.

Ramping Up and Going Live

14. Hold mandatory update meetings.
15. Have your staff Practice-Practice-Practice on Test patients!!
16. Hold a meeting with all supervisors, implementation team and director of nursing to discuss required and potential workflow and even staff changes.
17. Have each clinic set aside time every afternoon to work up actual patients that were seen that day in the EHR as Test Patients.
18. Hold a meeting with all supervisors and implementation team and nursing director to discuss last minute details the afternoon before Go Live.
19. Go Live Actions:
    • If affordable, arrange for your EHR vendor trainer to be on-site for go-live support
    • If facilities are spread out, use walkie-talkies to communicate between implementation team and each clinic area, finance/billing department, IT and your EHR vendor representative.
    • Post signs at front doors informing patients of the EHR changes and that wait times may be longer.
    • Assign greeters to greet patients and inform them of the changes.
    • Hold twice daily meetings everyday with supervisors and implementation team to discuss anything that popped up during Go Live and address it immediately.
    • Reward your staff – acknowledge their efforts.
    • Celebrate wins as you go along – it is a big change!
20. After Go Live – This is the time to completely switch over to the EHR post go-live.
    • Hold Bi-weekly meetings with super users and implementation team to discuss current issues and give updates on support tickets.
    • Continue to refine and adjust workflows to maximize value from your new EHR.
    • Make sure staff adopts new technology and does not go back to old ways or implement unacceptable workarounds.
21. Ongoing Optimization: An EHR can do a lot! Just like any new technology, you probably won’t know all the features of your new EHR. Thus, partner with your EHR vendor.
    • Take advantage of monthly newsletters with helpful tips and how-tos.
    • Take advantage of user focus groups, including advanced training.
    • Continue to enhance your processes to get the most out of your EHR.
    • Review information provided in regular software updates, adapt to these updates and new features.
    • Enjoy your new EHR!