The decision to purchase and implement an EHR is a daunting task

1. WHY EHR IMPLEMENTATIONS GO WRONG
The decision to purchase and implement an EHR is a daunting task
For physician practices, especially for the 80% of the market who work in practices of five doctors or less. These
practices are faced with a lack of true technical expertise on staff, over 530 fully certified EHR products to choose
from and a limited knowledge of how EHR adoption affects key areas of the practice. These affected areas can
include overall patient volume, profitability, clinical workflow and revenue cycles. With all this in mind, it’s no
wonder the failure rate for EHR adoption remains perilously high.
In many EHR adoption settings, there are a handful of common reasons why the implementation fails.
Understanding these reasons, and how to address them, can lead to more efficient, more successful EHR
implementations.
Lack of Engagement
Engagement runs two ways within the practice. First, the physician has to be engaged and committed
to the reality of the challenges and benefits that EHR adoption will have on their practice. For most practices, this
means that the primary physician is driving the need for implementation but is not fully responsible for the project. In
most successful implementations, the practice has designated a project manager and physician “champion.” Once the
project manager and physician champion are selected and engaged they are required to ensure the critical
components are managed and the strategic goals are accomplished. This is vitally important as it provides the
opportunity for broader accountability and buy in without the already time burdened physician having to mandate the
effort.
Second, the EHR vendor or Value Added Reseller (VAR) must also engage with the entire practice, not just the primary
physician and the champion of the EHR project. This relates to two areas – understanding the practice’s
mindset/reasons for adoption and making sure that the entire staff understands the value of, and their role in, the
implementation and full utilization of the software. For example, if the only reason a practice is considering adopting a
certified EHR is to receive the ARRA incentive payments, then they are significantly less likely to be committed to the
level of change that is required to go from paper charts to fully utilizing an EHR. This will put the implementation in
jeopardy right from the start. Engaging the entire practice will ensure general staff and clinicians are committed to the
goal that use of an EHR will improve patient safety and clinical outcomes. When that goal is realized it generates
compelling motivation to deal with the learning curve and transition issues.

2. Lack of a Strategic Plan
A practice’s strategic plan for EHR adoption should include at least the establishment of goals, timelines,
financial expectations and job responsibilities. Having these items clearly defined will help bring clarity to the adoption
process, outline everyone’s role and build confidence that the practice can take on this level of operational change.
However, an implementation can be completely sabotaged by the lack of a strategic plan. A thorough, well-defined
strategic implementation plan will help ensure all users are prepared and ready to begin using the new EHR software.
In addition to what is listed above, the plan should also take into consideration all transition issues, for example the
transferring of data from the paper charts or legacy EHR to the new certified system can create problems if not
planned properly. Another potential negative impact is the possibility of a slowdown in revenue, as fewer than usual
patients should be scheduled during the first “go-live” days. Taking the time to address these components, especially
establishing goals, will provide a solid foundation for all the operational changes associated with an implementation.
A few examples of goals would include:
• Improve patient safety and promote quality of care outcomes.
• Increase practice efficiency and profitability.
• Participate in Meaningful Use and obtain its incentives.
Additionally, all employees should be informed and committed as a team, without this commitment there will be
uncertainty and frustrations, which can easily lead to a failed implementation.
Inadequate Workflow Assessment
An inadequate assessment of patient and clinic workflows will create a barrier to the progress of an
implementation. The commitment to evaluate and ultimately purchase an EHR system is the perfect time to address
workflows within the practice. Focusing on the four main tenets of a healthy physician practice – revenue,
profitability, efficient workflow and patient satisfaction – will allow the practice to assess existing workflows and
make unbiased modifications moving forward. This will also allow for the identification of specific areas where an EHR
could provide significant support. Adding the right EHR system can streamline existing processes and help make the
practice more efficient. Being able to credibly select the appropriate EHR systems for the practice starts with ensuring
the practice is operating in as efficient a manner as possible.

3. Lack of Practice/EHR Alignment
Trying to implement an EHR software solution that does not meet the unique needs of the individual
practice is actually doing more harm than good for the practice. Working in collaboration, the findings from a clinical
workflow assessment effort will layout a roadmap, with milestones, that can help ensure a successful selection of an
EHR package but also the determination of a timeline and process for implementation. For example, the manner and
clinical approach in which a dermatologist practices medicine is different from an internal medicine physician, which
is different from an oncologist, etc… in the same way that small practices have different challenges and needs
compared to large multi-specialty practices. MGMA, (mgma.com) tells us that in a practice with as few as two
clinicians you will likely encounter at least six different charting techniques. All of these considerations, and many
other factors, require an informed comparison between the needs of the office and the features and functionality of
the EHR software.
Access and Quality of Training
With any implementation of an EHR system within the physician’s office, one of the primary factors to success is how
quickly the staff can become comfortable using the system at full capacity. The faster the practice can get to full utilization of the
EHR, the faster they can get back to seeing a full patient load. This has very obvious implications on revenue, profitability, etc. The
key to shortening that timeline is training. The lack of proper training can have very negative impacts on the success of an EHR
implementation. First, if the proper resources within the practice aren’t well trained they become a roadblock to full utilization.
Second, if the proper resources do receive training, but have either lingering questions or the type of training did not fit the
individual, and then they can become a roadblock to full utilization. Many times when looking to cut price, training is an easy line
item to remove. However, training budgets – and access to different modalities of training, including at least web-based and
onsite – must be protected by physician practices. Without it, the timelines to full utilization will lag and the practice will become
mired in underperformance and frustration.
When making the choice to select and implement an EHR, a physician practice must be aware that they are many
potential roadblocks to delay and ultimately failure of the implementation. However, the practice can be protected by
completing a proper assessment of the practice, choosing an internal project champion, working with the selected
vendor to ensure there are a strategic plan as well as ensuring that all staff have access to and complete the amount
of training required.
To learn more got to http://ehrroadmap.mbmehs.com// Contact info@mbmehs.com // (800)236-2498 ext 101