10 Steps to a Successful EHR Implementation

Electronic health records (EHRs), prevalent for more than a decade, give caregivers and patients a holistic view of a patient’s entire medical history and current treatment protocols. However, the healthcare industry has been slow to adopt more modern and clinician-friendly EHR systems, despite their many benefits. Such systems can, for example, transcribe physicians’ verbal observations and instructions so they can spend more time looking at and speaking with their patients rather than staring at their laptop screens. Standards-based EHR systems can also help healthcare organizations overcome information silos that prevent caregivers from getting a holistic view of their patients. Modern EHR implementations, particularly those that take advantage of cloud infrastructures, are also easier to scale than legacy on-premises systems, and they can more easily incorporate the latest feature updates.

What Is an EHR?

EHRs contain data on patient demographics, health histories, medical exam and lab results, caregiver notes, treatment plans, prescriptions, and more. They’re the connective tissue of healthcare organizations, giving caregivers, and patients via a patient portal, access to a comprehensive view of an individual’s health status.

What Is EHR Implementation?

EHR implementation is the process by which healthcare organizations install their chosen system. In most cases, such implementations now involve transferring existing EHR data from an older system to a more modern one and configuring interfaces so caregivers and patients can access data based on their permissions. Implementation also involves training personnel on how to use the new system. There’s more to this process, of course, and this article will drill down into the various steps.

Key Takeaways

• Modern EHR systems help improve the quality of patient care and overall patient outcomes, and they can help healthcare organizations operate more efficiently and profitably.
• Implementing a new EHR entails extensive user experience testing and training. It will be most successful when the right stakeholders are involved from the very beginning of the process.
• Healthcare organizations, vendors, and implementation consultants and other partners need to be committed not only to the transition, but also to the post-implementation phases to ensure the system is updated regularly and technical support is always available.

The Importance of a Successful EHR Implementation

Implementing a new EHR system, whether as a replacement or as a brand new installation, is a major investment that requires careful planning to get right. A successful implementation can help practices and hospitals improve the quality of care by giving clinicians access to patients’ complete medical histories and treatments and, in the case of modern systems, by making it easier for them to spend more quality time with each individual.

Successful EHR implementations can also help healthcare organizations connect information silos, both internally and with external EHRs, as well as plug into a provider’s finance and HR applications to help it collect revenues from payers and schedule staff appropriately.

On the flip side, an unsuccessful implementation will not only cost precious resources, but it will also discourage caregivers, administrators, and ultimately patients.

How Long Does EHR Implementation Take?

It can take 15 months or longer to implement a new EHR system for each facility in a large hospital system, including full clinical functionality, revenue cycle products, post-implementation testing, and support for educating staff. For smaller medical offices and clinics, implementation times can run from three to four months.

10 Steps to Successfully Implement an EHR

Implementing an EHR system involves a number of steps—some discrete, some overlapping—including conducting a needs assessment, selecting a vendor, planning the project, configuring the new system, migrating data, training staff, testing the new system with a small group of staff, and ultimately switching over and then providing technical support. Finally, there needs to be an objective evaluation of the new system and adjustments should be made as necessary.

1. Needs assessment: Identify goals and requirements. Start by evaluating your current EHR system and identifying the functionality your new system must have—you’ll want to include these details in your RFP. Critical functions generally include the ability to connect to other systems (now a regulatory requirement for new systems in most developed countries); the ability to transcribe doctor-patient interactions (so physicians can spend more quality time with patients); the ability to automate prescriptions and other clinical orders from physicians; the ability to generate reports to track the quality of care (for value-based care and other purposes); and the ability to communicate with telehealth and other mobile applications.
2. Vendor selection: Choose the right EHR system. Picking the right vendor and system has as much to do with your organization as it does the vendor and the system itself. Consider factors such as the scope of your project, as well as the goals you want to accomplish (see step 1). Once you’ve established those baselines, you can put out an RFP and then use the responses to start eliminating vendors and building a short list of likely candidates.
   
   In addition to selecting a vendor based on desired features, functionality, and usability, you’ll need to consider the vendor’s pricing structure and the system’s total cost of ownership. You’ll also need to evaluate the vendor’s willingness to work with you and a partner to not only complete the technical implementation, but also help train staff and prepare self-help instructions. Further, you’ll need to understand the system’s data security and privacy capabilities—which measures are in place to handle data breaches and how the system can help your organization comply with HIPAA and other regulations.
   
   You’ll want to get references from other healthcare organizations of a similar size and with similar needs to establish not only whether the system is appropriate for your needs but also how well the vendor collaborated with implementation teams and partners, and whether it met its deadlines. You’ll want to understand how vendor personnel reacted to user acceptance testing (UAT) and other requests for modifications, and how faithfully they delivered on after-sales service during the critical early adoption phase.
3. Project planning: Define timeline, budget, and resources. Once you’ve selected a vendor and implementation partner (unless your organization has a large and experienced IT staff, you’ll need one of those too) for your new EHR, you’ll need to work with those parties to establish how long it will take to install the new software, integrate it with existing systems, train early adopters, perform UAT, and cut over from the old to the new system. You’ll need to not only allocate money for the new system but also internal personnel, most likely as part of a cross-functional project team that includes senior and frontline managers, clinicians, IT, and support staff. That team can help the vendor and partner understand how your organization works, ensure that your defined business requirements are being met, go through UAT and feedback, and help with training the wider population of employees.
4. Customization and configuration: Optimize processes and tailor the system to meet your needs. One of the advantages of migrating to any new computer system is that it’s an opportunity to review internal processes and substitute the latest industry best practices—best practices that are built into the software. For example, prescriptions in many states are now electronic-only, so any processes that involve the handling of paper prescriptions can probably be eliminated. Modern EHR systems can also alert practitioners to potential adverse drug interactions and patient allergies, and they can surface relevant analytic insights using advanced data visualization tools. This is also the time to ensure that the new system meets your unique business requirements.
5. Data migration: Transfer existing patient data to the new system. Patient data in legacy systems can contain errors. And even if the data is accurate and up to date, it will often be organized differently in your new EHR. This is a data-cleansing challenge with which your vendor and implementation partner should be very familiar. Nevertheless, you’ll need to build time into your plan to thoroughly test the data represented in the new system for accuracy.
6. Testing: Ensure the functionality and security of the system. Before switching over to the new system, your project team should stress test it. Using fake data, double-check that the new EHR system includes all the features and functions you asked for in the RFP and were promised, and that those features can handle any new or revised processes. Don’t forget to test the accompanying patient portal as thoroughly as you do the EHR front end used by staff.
7. Training: Educate staff on proper system use. People are naturally resistant to change, and this is particularly true when their jobs are already stressful and time-consuming. The last thing they think they need is to learn how to use a new system and processes. To get everyone on board and get the most out of your new system, start with a small cadre of power users, most likely members of your cross-functional project team. Those users will not only be helpful (and sometimes critical) assistants to the vendor and partner’s team of dedicated trainers, but they will also advocate for the new system with reticent end users, providing testament that it really does work and is better than what they had before.
8. Go-live: Implement the system in daily operations. Generally speaking, there are two approaches to switching EHR systems: a so-called big bang approach and a phased transition. The big bang approach can be very stressful because tolerance for errors is very small and the window for testing tends to be narrower than with an incremental approach. A phased approach lets teams whose functions transition first share their experiences with subsequent groups, but this approach requires the organization to support two separate EHR systems for as long as the transition takes.
9. Ongoing support: Provide continuous monitoring and troubleshooting. Vendors and implementation partners are on the hook, especially in the early days, to help troubleshoot configuration, data migration, and other technical issues. Internal teams should be trained on how to report issues so they can be addressed in an orderly manner, according to their severity. Expect a lot of user complaints and confusion in the early days after the switchover. Fields that used to be on the left side of the screen might be on the lower right in the new system, and it will take staff some time to get accustomed to those sorts of changes. Ensure that implementation teams (including internal folks) are on hand to walk staff through how to use the new system to accomplish their tasks.
10. Evaluation: Assess performance and make improvements. No major new system will be perfect the first time through. Solicit feedback from users and ensure your vendor and implementation partner are ready and willing to make adjustments as needed in a timely manner.

10 EHR Implementation Challenges

Implementing a new EHR system that accurately replicates or improves mission-critical processes while helping personnel change some of the ways they do things in order to adopt industry best practices is especially challenging in healthcare, where the term mission-critical takes on a heightened meaning. Healthcare data also tends to be messy, and many legacy systems can’t easily be made to work with others.

In addition to overcoming staffers’ natural resistance to change, you need to train them on the new navigation, features, and workflows. Pick the wrong vendor or implementation partner and costs can skyrocket due to missed deadlines, system bugs, and other factors. Even after a successful implementation, your organization and its partners will have to establish guidelines for continuously updating and maintaining the system. Read on for more on these and other implementation challenges.

1. Resistance to change: Staff reluctance to adopt new technology. Most people don’t like change, and they especially don’t like it when they’re being asked to learn a new way of completing a fairly complicated set of processes that they’ve already mastered. Senior management, including senior-level clinicians, needs to clearly communicate up front the benefits and reasons for the change. One way of breaking down the natural resistance to change is to involve people early in the EHR system implementation who are well respected by their colleagues and can become champions of the new system.
2. Data migration: Difficulties in transferring existing patient data. Data labels used in one system are unlikely to be recognized by a new system, and data in one system will have to be mapped to an entirely different set of database tables. Involving subject matter experts early in the process of evaluating data as it flows into the new system will be critical to success.
3. Systems integration: Lack of compatibility with other healthcare systems. Many legacy systems were developed using programming languages that aren’t used by newer EHR systems.
4. Training: Getting reluctant staffers up to speed. Key stakeholders, including physicians and nurses, who are involved early in the implementation process can help coax and train their colleagues (with support from the vendor or implementation partner in the early days).
5. Cost: Outlays for new technology and more. New software and the infrastructure to support it (whether on-premises or in the cloud) will incur costs. Other issues will arise, however, that also result in incremental cost increases, such as challenges in cleaning and migrating data. If an organization requires significant customization of its new EHR system, that, too, will increase costs. Hidden costs include some lost productivity during the implementation phases and potentially higher overtime expenses.
6. Downtime: Disruptions to daily operations. Databases and other systems, such as financial and supply chain applications, may be taken down for given periods of time, especially during data migrations and other key moments of the implementation. Organizations can mitigate such disruptions by giving affected staffers a heads-up and by scheduling key stages of the implementation for times when there isn’t a lot of administrative or clinical activity.
7. Data security: Helping lock down patient data. Healthcare organizations operate in a highly regulated environment; they’re also obvious targets for cybercriminals. The average cost of a healthcare data breach was nearly US$9.8 million in 2024. That’s higher than the average cost for any other industry and nearly US$4 million more than the average for the second costliest industry for data breaches, financial services, according to an IBM report.
8. Workflow disruptions: Adjusting clinical workflows to fit the new system. Clinicians and other healthcare professionals take pride in their work and their ability to thoroughly and rapidly address patient needs. They’ll be frustrated by changes to the screens they’re accustomed to using, such as having to navigate fields not in the same locations or having to switch screens at times they didn’t previously. Steps such as ordering prescriptions electronically and uploading post-visit instructions to the patient portal will have changed. It’s incumbent upon members of the stakeholder team to help ease the transition by assisting with training and evangelizing about the new system.
9. Technical issues: System bugs during implementation. There will inevitably be bugs, misconfigurations that weren’t caught during the testing phase, and other disruptions that will challenge administrators and staff. It’s important to catch these as early as possible, fix them, and not allow them to derail the system rollout.
10. Ongoing maintenance: Continuous updates and support requirements. Resist the tendency to relax your vigilance once the initial implementation phase is over. Plan for a long-term partnership with vendors, implementation partners, and your own personnel to help with regular system updates and ongoing support, especially for mission-critical functionality.

Choose the Right EHR System

Healthcare organizations that put together comprehensive and precise requirements for their new EHR system, organize an effective and representative stakeholder team, and commit to allowing that cross-functional team to take part in the vetting of vendors and implementation partners will have the greatest chance of choosing the right EHR system for their needs.

Create a Better Healthcare Experience with Oracle

Among its many capabilities, Oracle Health EHR can identify needed tests to help keep groups of patients healthy, target those who need follow-up appointments in order to meet quality targets, and combine cleaned-up data from multiple healthcare providers. The EHR system runs on Oracle Cloud Infrastructure, enhancing the security of the sensitive health data it stores. Future versions will include generative AI capabilities that let doctors filter information that’s relevant to a specific illness and navigate the system using plain language commands. Oracle Health EHR, which is a standards-based platform that interoperates with other systems, incorporates a number of other functionalities, including the ability to integrate with Oracle’s financial, HR, and other back-office applications.

EHR Implementation FAQs

Why change EHR systems?

Many legacy EHR systems don’t interoperate with one another or with newer systems, are difficult for users to navigate, and lack advanced features such as AI to automate tasks such as note-taking and creating visit summaries.

What is an example of an EHR?

One leading EHR system is Oracle Health EHR, formerly Cerner, which is being migrated to the Oracle Cloud Infrastructure platform and updated with a host of new AI and other capabilities and features.