View source for EHR Implementation/Strategies to Increase the Likelihood of Success

== Assess the Readiness of Your Practice ==
Prior to implementation, you should establish the minimum hardware and software requirements.  You should determine the network bandwidth required for optimal use.  It is important to decide whether your organization is fiscally ready as electronic health record (EHR) implementation can be costly.  Finally, you should assess your end users.  If your staff is not ready and willing to adopt an EHR, the likelihood of success will certainly decrease. 

EHR implementation is a catalyst for [[From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare|organizational transformation]]. <ref name="Abraham 2011"> Abraham, C., & Junglas, I. (2011). From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare. The Journal of Strategic Information Systems, 20(2), 177-197. doi:10.1016/j.jsis.2011.03.005. http://www.sciencedirect.com/science/article/pii/S0963868711000217</ref>

== Assess Your Practice Needs ==
By identifying the strengths and weaknesses of your practice, you can select an EHR that will capitalize on your strengths and address your weaknesses.  You should select an EHR that allows for sufficient customization so that it can be tailored to your practice, rather than the other way around.

== Research Your Options ==
It is important to research your options.  Try to demo as many EHRs as possible.  Certifications and standard lists can assist you in making your decision.  You should seek guidance from neutral resources such as HIMSS, CHIME, and regional extension centers.  When conversing with EHR vendors, ask as many questions as possible.  Consult with your colleagues who have already adopted an EHR.  Arrange a site visit to observe the impact it has had on workflow and documentation.

== Involve Your Staff ==
Be sure to include the front office staff, nursing staff, and clinicians when selecting an EHR and when developing a training plan and timeline.  Demonstrate how the EHR will affect workflow, documentation time, time spent with the patients, and the staff’s ability to communicate.  Address both administrative and practice needs.  Be sure to consider the needs of primary care providers and specialists.

== Manage Expectations ==
Anticipate that there will be challenges.  You should expect Murphy’s Law - “Anything that can go wrong will go wrong.”  The process will be more difficult and time-consuming than anticipated and many things will go wrong.  You should expect a drop in productivity of 30-50% the first 3 months of going live.

== Create a Realistic Timeline ==
Involve staff, IT personnel, and your EHR partner when establishing a timeline.  Allocate time to chart abstraction, or converting information from paper charts into the EHR.   

== Ensure Adequate Staff Training ==
Consult with the EHR provider when determining how much time should be allocated towards training and who should be responsible for conducting the training.  It is best to train before, during, and after implementation.  Consider training at 3-month intervals to review updates and offer assistance to those who are struggling.  Elect EHR “champions” or "super users" within your organization who will serve as the go-to resource for questions, training, and assistance.  These users will more likely be in touch with the needs and concerns of a particular department.  Do not train your staff too far in advance, as they will forget what they have learned.  Reward staff members who dedicate extra time to becoming familiar with the EHR.  Set aside time for training during office hours as staff may be unwilling or not allowed to dedicate additional time outside of their designated hours.  They should not be conducting business while completing their training, as they should be free of distraction.  Use sample patient charts to test different scenarios.  Training should be as reality-based as possible.  Use live patient simulations to document visits and place orders.  Practice major workflows such as rooming patients, ordering common tests and procedures, and checking-out the patient at the end of the visit.  Nothing replaces hands-on, face-to-face training and many vendors will provide on-site training when requested.  Most importantly, ensure that there is sufficient real-time support when you go live.

== References ==
<references/>

1. HealthIT.gov. (2013). ''How to implement EHRs''. Retrieved from http://www.healthit.gov/providers-professionals/ehr-implementation-steps

2. Hummel, J., & Evans, P. (2012). ''EHR implementation with minimal practice disruption in primary care settings: the experience of the Washington & Idaho regional extension center'' [PDF document]. Retrieved from http://www.healthit.gov/sites/default/files/ehr-implementation-wirec.pdf

3. Krisik, K. M. (2013). ''Lessons learned: how to smooth your EHR implementation''. Retrieved from http://www.healthmgttech.com/articles/201303/lessons-learned.php

4. McBride, M., Marbury, D., & Ritchie, A. (2014). Study examines best practices related to EHR implementation: physicians, consultants, and vendors offer real-world advice on getting your EHR up and running. ''Medical Economics, 91''(3), 32, 35-6, 38.


Submitted by Sarah Lock

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