Electronic health records are the mothership of healthcare information technology, and integrate with many other IT systems. As a result, implementing these all-important tools is a crucial task to get right.

In this article, four experts in the field of EHRs offer healthcare CIOs and other healthcare executives and health IT workers their advice and tips for implementing EHRs successfully. These experts include: Farrell Sanders, senior vice president, consulting and application services, at EHR giant Cerner; Daniel Kivatinos, co-founder and COO at EHR vendor DrChrono; Dana Bensinger, client solutions executive for consulting firm CTG’s health solutions practice; and John Moore, founder and managing partner at Chilmark Research, a healthcare IT research and consulting firm.

A basic EHR to-do checklist

First things first: Healthcare CIOs should create an EHR implementation to-do checklist, said Kivatinos of DrChrono.

“Generally when implementing EHR software there are multiple things that need to happen,” he said. “Be sure before moving forward with the purchase, you should have physician and staff buy-in and get their ‘must-haves’ listed out before you start implementing. Having that clear direction in how you would like to see implementation happen is important.”

Hospital CIOs and other IT leaders need to clearly talk with the EHR implementation team and walk through end goals, he added. Generally, workflows from organization to organization are unique. So, some example items, he said, on a getting started list would be:

• Set up all user accounts with proper configurations, admins, users, etc.
• Import Consolidated Clinical Document Architecture (CCDA) files from legacy EHR.
• Enroll providers via credentialing and enrollments before going live.
• Have core medical forms built out in EHR, have examples ready of workflows.
• Enable online schedule for patient booking.
• Enable eRx.
• Connect to all labs needs, have the list ready.
• Connect all DICOM imaging machines.

"Focus on this list at every check-in to keep the implementation team focused on your top needs so they know exactly what you want from a successful implementation and get a status update on each item,” Kivatinos said. “Be sure to know all of the stakeholders from the software company. When you understand all of your partners who are helping you get implemented, you can reach out to each specific party for different questions you might have. Have face-to-face meetings or remote video conference calls frequently.”

Studying workflows is key

Bensinger, of CTG’s health solutions practice, suggested that health IT teams do an intensive deep-dive into existing workflows.

“I would encourage a governance committee to charge their implementation team with not simply focusing on which current processes the EHR can automate or streamline,” he said. “Instead, take a critical look to see which of these processes can be eliminated altogether. This is where a governance committee’s willingness to be innovative pays off for anyone in the hospital who is overburdened with data collection and documentation.”

"When forming a committee to spearhead the implementation, be sure this is not just an IT leadership committee."

Dana Bensinger, CTG

Healthcare has become a very “data additive” profession without ever talking about what data the profession can do away with or just not collect, he added.

“Now is the perfect time to assess this,” he advised. “Providers are charged with collecting hundreds of pieces of data, and it is a real contributing factor behind burnout.”

Study patient engagement workflows, too, he added. The foundational and innovative tools for patient engagement exist in many EHRs today, and an implementation is a good time to discover them, he pointed out.

“And to ask questions such as, ‘Is it better to send a text to a patient via the EHR or have your medical assistant reach out directly?’” he said. “For millennials in particular a text might be preferred. So will a patient portal that has a user interface similar to other online experiences – like shopping on Amazon – that the patient is already familiar with.”

Further, consider adding new workflows for future needs, like support for value-based care initiatives and addressing social determinants of health, Bensinger said.

“Here again there are new and robust functionalities available in today’s EHRs,” he said. “It could be as simple as asking your patients to log into the patient portal to fill out a pre-visit questionnaire. By doing this we can have patients provide social determinants of health data, which can trigger workflows that might contribute to a more productive visit with their provider.”

It is known from research that patients are more likely to give honest answers to survey questions about their social situations than they would directly to a provider. The challenge now is that not all organizations are prepared to deal with issues of food or housing insecurities or other social determinants of health findings. Workflows, Bensinger advised, need good referral networks built in to ensure there is a complete closed-loop social determinants of health workflow.

On the subject of workflows, Moore of Chilmark Research added that health IT teams must look closely at existing workflows and how they might be changed and optimized through the use of an EHR.

“This best practice is the foundation for the adoption of any enterprise software in virtually any industry and healthcare is no different,” Moore stated. “Far too often, organizations simply hardwire existing workflows into the EHR without any thought as to are these workflows truly the best way to perform a given task. Post implementation, organizations that do not address workflow typically regret what they have done and it is too costly to go back and reconfigure the software.”

The job of defining and optimizing workflows should fall to the end users themselves, the clinicians, he advised; once workflows are defined, it is the role of IT to implement them in the EHR.

Governance structure should be formalized

On another EHR implementation nest practices front there is governance. Governance refers to the combination of processes and structure implemented to inform, direct, manage and monitor the activities of the organization toward the achievement of its objectives. To have a successful EHR implementation, organizations should formalize this governance structure before the project starts, advised Sanders of Cerner.

“Establishing governance is an important first step to determine who will make the critical decisions at all levels prior to and throughout the project, as well as set the positive tone for change,” he said. “Doing so aims the project in the right direction, with all parties aligned on how the implementation will be carried out. The team should consist of people who are consistently available throughout the project, empowered and authorized to make decisions, representative of each relevant department and facility, and seen as committed leaders in their area.”

"Far too often, organizations simply hardwire existing workflows into the EHR without any thought as to are these workflows truly the best way to perform a given task."

John Moore, Chilmark Research

Successful governance structures include methods and channels to foster communication across teams, track milestones and arrive at decisions. Having this type of organized and formal structure from the start also sends a strong message to everyone involved that the implementation is of great importance and helps communicate the benefits to come, in operations and patient care, he added.

Don’t overlook the role of governance, agreed Bensinger of CTG’s health solutions practice.

“When forming a committee to spearhead the implementation, be sure this is not just an IT leadership committee,” he said. “The EHR touches every part of a health system’s work and mission, so the governance committee should be multidisciplinary. Obviously, you don’t want to overload it with too many people, but it should include representatives from physicians, nurses, ancillary departments such as lab and pharmacy, and senior leaders who bring knowledge of the health system’s long-term strategies.”

Moreover, this governance group should be willing to innovate, take some risks, and stay engaged for the lifespan of the product, he added.

“I have lived through the pain of an EHR deployment that did not take the above approach to governance and I can tell you what happens: Health systems end up with a repeat of what they had before, which is an EHR that does not represent all stakeholders,” he said. “Physician pushback is practically a certainty.”

Staff training for end-users is essential

To properly get an EHR up and running, it is critical that physicians, nurses and others know how to use the software. As a result, high-quality training becomes an implementation best practice.

Healthcare organizations should set up one-on-one sessions with all stakeholders, advised Kivatinos of DrChrono.

“Generally learning any new software takes a bit of time, so expect a ramp-up period for providers and staff,” he said. “If there is a boot camp of some sort or some formal training that can be done, be sure to get all stakeholders involved in the training sessions. Billers, coders, executives, staff and physicians all need to be educated on the EHR to have a fully successful implementation.”

If someone doesn’t have time to join sessions, the organization should have someone work with that stakeholder to get rescheduled and make it a point that everyone in the organization will be using the software, so they all need to fully understand how it works, he added.

“Sometimes there is a legacy HER ramp-down period, and during that period, you will be moving information from one system to another,” he explained. “This can be time-consuming. Make sure that the EHR company can help ease this data transfer burden by moving data for you.”

"It is important that the users are trained and motivated to embrace the new workflows and technology supporting them."

Farrell Sanders, Cerner

To get physician buy-in, a healthcare organization should make sure it has the best workflows possible, gathering providers’ feedback as the implementation team is building out the medical forms and clinical templates that the providers will be using when seeing patients, he added.

“Take advantage of things like macro buttons and medical speech-to-text in the EHR and ask questions about what other features are available that are in your plan and can help with workflow optimization,” he explained. “Learning an EHR can be engaging and fun when you allot the proper amount of time to getting setup.”

Moore, of Chilmark Research added: “We have observed far too many organizations try to reduce total costs of EHR implementations by reducing training costs,” he observed. “This is a big mistake for far too often lack of training of end users leads to significant drops in productivity, frustration and of course clinician burnout. Not to say that all of the above can be completely eliminated by training, but their impact can be substantially reduced.”

Once initial training has been completed, identify who the “power users” are and enlist them where possible to provide peer-to-peer training for those who are having greater difficulties in mastering the use of the EHR, Moore added.

EHRs mean embracing change

Cerner knows a thing or two about EHRs, and Sanders said that a key best practice to EHR implementation is to motivate and empower people to embrace change.

“Nearly every investment and asset in a health system, regardless of size, is there to help deliver high-quality care,” he explained. “The end goal of an implementation is to make health system operations effective and efficient. Technology tools have always been about people, which is why people should be the primary focus.”

There must be substantial focus on building the motivation and ability to effectively use the new workflows and technology, from organizational change management to user training and ongoing support, he advised.

“The importance of adequate, time-efficient training cannot be overstated,” he said. “An implementation of new technology should focus on people as the foundation of change, who can produce more robust outcomes and lasting benefits. It is important that the users are trained and motivated to embrace the new workflows and technology supporting them.”

The result will be competent, confident and satisfied physicians, nurses and other users who adopt the new workflows and technologies – tools only have value if people use them and are able to use them well, he added.

“Users of the technology must also be properly motivated to embrace change and advocate it amongst their colleagues,” he concluded. “A successful implementation results in people being confident and satisfied with their new workflows and technology.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com