Top Challenges of Electronic Health Record (EHR) Implementation

What is an electronic health record and EHR system?

An EHR is a digitized version of a patient’s medical records. It contains the patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies and more. EHRs improve on paper medical records by ensuring accuracy and providing a comprehensive, timestamped history of patient care.

Authorized users like clinicians and front-office staff can access EHRs via an EHR system. These systems store and manage a practice’s patient health records, allowing information to be shared quickly and efficiently with pharmacies, labs, specialists, medical imaging facilities and more. EHR technology also allows practices to enhance internal efficiency by automating previously manual processes and improving patient care. Such systems have also been shown to reduce healthcare costs among providers.

How to overcome EHR implementation challenges

Medical practices typically encounter four primary challenges when implementing an EHR system. Here’s an overview of these challenges and tips on overcoming them.

Challenge 1: Budgeting and finding the right partner 

There’s no getting around the fact that EHRs are expensive and time-consuming. Here are some tips for budgeting adequately and finding the right partner vendor to ease your implementation: 

• Budget for your EHR adequately and generously:Because of the inherent uncertainty in an EHR rollout, hospitals and medical practices should consider creating a generous EHR implementation budget that allows for additional or emergency resources. When planning your budget, the company you choose to partner with should help you estimate the project’s overall costs, including support costs. 
• Remember that you get what you pay for with EHRs: When planning an EHR implementation, you often get what you pay for — and the least expensive contractor isn’t always the right call. As with many other commercial software implementations, choosing the company with the lowest estimate may result in cost overruns from recruiting and staffing shortages that can jeopardize your go-live date. Don’t be dazzled by a low estimate. Evaluate carefully and question precisely what the vendor will deliver.
• Select your EHR vendor:When you select a vendor to assist with your EHR implementation, you must ensure it can handle the job. Additionally, decide on a partner as soon as possible to boost the chances of a successful implementation. Consider creating a detailed list of needs and an implementation timetable when evaluating prospective vendors.  

Challenge 2: Communication breakdowns and training

A lack of communication and poor training can quickly derail an EHR implementation. Here are some tips to avoid communication breakdowns and ensure everyone can use the system confidently: 

• Identify all the variables in your EHR implementation:Effective communication and training start by identifying all the variables in your EHR implementation. For example, you must identify if your chosen EHR prohibits clinicians from working before completing their training. 
• Loop in the EHR system’s vendor personnel:It’s essential to include vendor personnel working on the launch in your training programs so they understand your processes and workflows. When they have a comprehensive understanding of your practice, they can ensure the system meets your clinical and administrative needs. Keep the vendor’s support team readily available during the launch and encourage staff to avail themselves of the support team’s help while they’re there. They should test each feature they need until they’re confident with it.
• Ensure all users complete EHR training:It’s critical to ensure all users finish their EHR training — ideally before launch. You must also create a backup plan for those who must undergo training after the system goes live.  
• Designate an EHR implementation project leader: Practices should designate a project leader to communicate with all stakeholders. This person will be the liaison between C-suite executives, tactical project leads and team members. They’ll facilitate coordination between every entity involved to ensure everyone’s needs are supported. 
• Communicate openly during EHR implementation: Communication at every level is critical to ensuring all requirements for incoming support staff are met. Communication also drives timeframe development, helping you avoid unnecessary implementation delays.

Challenge 3: Contingency planning and leadership support

If there’s any certainty about EHR launches, it’s that something will go wrong. Inevitably, during the rollout, you’ll need to escalate help requests beyond what you planned for with the launch team. Here are some tips for mitigating unforeseen crises:  

• Empower the EHR system’s launch staff:Healthcare providers should empower launch staff to address unforeseen issues. A well-defined escalation plan is essential to address emergencies quickly and reduce staff and patients’ frustrations. 
• Conduct resolution planning for EHR issues:EHR support teams should establish guidelines and approaches for spotting and fixing technical problems with hardware and software. It’s crucial to designate someone to be responsible for each problem type and share fixes for known issues. Everyone should be in the loop as problems are found, addressed and solved.
• Ensure leadership support during EHR implementation: Leadership support is critical during emergencies and inevitable glitches during an EHR rollout. Change can be hard as leaders must understand that the EHR rollout is a success when patients and healthcare professionals accept the new system. Help adoption by communicating the new system’s benefits and assuring staff members that a support team is readily available if any problems arise. Users should be able to access the support team quickly and easily.

Challenge 4: Workflows

Workflows are an essential focus for healthcare professionals when planning, documenting and communicating information about the EHR implementation. However, not all healthcare workflows are the same; some are more sensitive and critical to patients’ well-being. 

Here are some of the more complex and challenging workflows to keep in mind.  

• Blood banks: Lives depend on blood banks, so your EHR implementation should thoroughly address this workflow.
• Medication reconciliation: Before an EHR implementation goes live, healthcare institutions must ensure the system can track medications before and after admittance.  
• Patient movement: Tracking patients’ movements during a hospital stay is critical to ensuring proper care. 
• Level of care: Correctly documenting a patient’s stages — whether they’re in the emergency room or intensive care unit — is crucial for medical and administrative reasons and can even affect the medical billing process.
• Careful transport: How patients are transported physically throughout the facility must be monitored carefully. 

Why EHR implementations are so complex

While EHR systems in healthcare management software often appear seamless and intuitive, implementing one is a massive undertaking that takes time, money and effort. To be considered a success, staff must embrace and adopt the system, it must deliver savings to the practice and patients must notice an improvement in their care.

Here are the primary factors that make EHR implementation so complex:

• Clinicians and front-end staff must embrace the EHR system: Much goes into ensuring all team members accept and use the system. Practices must plot out precisely what their system must do, find a platform that can handle their requirements and configure it to perform as needed for clinicians and front-end staff. Next, they must train all team members to use the system correctly. A “piloting” period will follow, during which the practice must iron out any initial implementation errors. Practices often determine additional functionality their platform needs and then configure and train their staff on those changes. This level of detail and complexity is necessary to ensure everyone embraces the system.
• Technical specifications must be set, adjusted and monitored: Numerous tech hurdles add to the complexity of EHR system implementation. Your information technology (IT) personnel must thoroughly test all EHR iterations before rollout to ensure they’re complete. This includes checking that all hardware, software and network interfaces are compatible, particularly if a telemedicine element exists. Backup and downtime procedures must also be in place and staff will need access credentials. 

With so much complexity and so many variables contributing to a successful EHR launch, medical practices must define the results they expect and mitigate typical implementation challenges. 

Best EHR software

The best medical software improves patient-facing processes, streamlines workflows and supports administrative and back-end functions. Consider the following top EHR platforms to help you find the right option for your situation:

• DrChrono: DrChrono is a superb EHR system with an average configuration time of 30 to 60 days. The company offers implementation and training services for all customers regardless of their service tier, including a dedicated account manager to ensure the platform is customized to their exact needs. Our DrChrono review explains how this vendor helps practices create templates to improve and automate workflows and helps enroll and credential them with app providers, labs, pharmacies and other third parties.
• athenahealth: athenahealth reports an 11-week implementation period with its software, although installations for new practices with minimal data can take as little as a month. As our athenahealth review explains, all practices have their own Customer Success Manager (CSM) and EMR training and live support are built into the subscription price. 
• Tebra (formerly Kareo): Implementation and training costs are included in all standard subscriptions with Tebra. Starting up can take up to six weeks as Tebra sets up an interface within the software to connect to pharmacies and Medicare and Medicaid insurance. Our Tebra review details how the platform’s account manager uses milestones to guide healthcare providers through the setup and how each staff member receives one-on-one training specific to their needs.
• AdvancedMD: AdvancedMD offers a free two-day on-site implementation service to practices with collections of over $200,000 a month. For other practices, the company charges around $5,000 for comprehensive staff training and system configuration. This charge includes 20 hours of one-on-one training, online training courses and help setting up customized templates, macros, workflows and more. Your system can take up to 11 weeks to go live from when you order. As our comprehensive AdvancedMD review explains, you also benefit from an account manager who stays with you after launch.
• CareCloud: CareCloud offers three implementation levels, ranging from complete hands-on with its Enterprise package to online self-training with the Essentials tier. Prices vary by practice size and type and the level of training and support you’ll need. Read our detailed review of CareCloud to learn more.