Your hospital leadership team has finally reached consensus and decided it is time to move your healthcare system to the latest enterprise electronic health record (EHR). As you proceed through the vendor selection process, you assess and analyze the features and capabilities of the software solution and the viability of the vendor who will become a future business partner for years to come.

A vendor is finally selected and your organization is ready to undertake one of its largest and most impactful projects in years. The EHR vendor is by your side and has done countless implementations and assures you the system can be implemented in the time agreed upon.

As with all large expensive projects, there is considerable pressure from the healthcare leadership team to complete this major initiative on time and on budget. There is pressure from the clinicians to transition to the new system with minimal impact to the patients and to the normal day-to-day activities the physicians and nurses are accustomed to.

As the project kicks off, the clinical teams begin the processes of building and converting the existing system(s) to the new EHR. Organizational change management processes begin and your IT department is asked to provide a listing of all hardware devices currently being used throughout the enterprise. This list will be used to determine if the current end user devices are compatible with the new EHR. Devices to be reviewed include items such as monitors, PC’s, barcode scanners, printers, carts, credit card scanners, web cams, and signature pads. The best case scenario is your hospital system has recently refreshed all the devices that will utilize the new EHR. The more common scenario, knowing a new EHR was coming, is your legacy devices are nearing the end of their lifecycle. With the EHR vendors supporting the software portion of the implementation, your IT department is left with the identification, purchasing, deployment and testing of new devices. The EHR vendor is available to provide requirements, but the EHR vendor’s business is software, not hardware acquisition, and deployment. Depending upon the strength of your IT and Desktop teams, this is often an underestimated part of an EHR implementation.

As your teams manage the pressure, complexity and workload to deliver a new EHR and potentially a large hardware deployment, the deadlines and pressure continue to loom. To ensure the software implementation is completed on time, the quickest path is to implement the software as it comes from the vendor with only changing workflows and processes when absolutely required. This is the most conservative approach and reduces the risks of an over time over budget EHR implementation. I liken it to it’s late October and you need to build a house in Alaska before the cold of winter comes; to meet the immediate needs you build the floor, four walls and the roof. You have a home, but you know there are so many more things you would like to do. That is typically what happens in EHR implementations, with vendor assistance you get the core system in place. However, as an organization, your clinicians have their own unique workflows and requirements to best service their patients. This means post implementation requires a large, typically multi-year, effort to optimize the EHR system to truly fit the needs of the healthcare system. It is this optimization of the EHR that surprises many organizations as to the scope and amount of time it takes to complete post the base EHR installation.

The implementation of an EHR system may be one of the largest projects a healthcare organization undertakes. As part of multiple enterprise implementations, we at netlogx advise our clients that an important strategy to ensure organizational acceptance and minimize the risk to the implementation is to have a plan that covers more than just implementing the EHR software. The plan should include a robust organizational change management component and ensure the real beginning starts with the end user devices that provide the inputs and outputs to the EHR. The real end of the plan should not end with implementation, but is when you have engaged your clinical stakeholders to optimize the EHR for your organization and created the strategy and plans to make the EHR tool your organization’s own.