Working Effectively with Your EHR Vendor — Go Live

After months of preparation for the implementation of your EHR, the fateful go live day is just around the corner and the better prepared you are, the more successful you will be. What do you have to do to ensure that your go live will proceed smoothly? We have prepared a list of items you should review with your staff and EHR vendor.

General Advice

  • Expectation setting is critical to the success of an EHR implementation. If members of a practice have unrealistic expectations, (e.g. that they will not have to change any of their documentation practices) they are likely to be disappointed with any EHR. Dealing with expectations in advance will reduce disruption and dissatisfation.
  • It is important to define a few initial goals. These goals need not be complex, but they can provide a mechanism to measure short-term success (e.g. 100% of problem lists available through the EHR).
  • EHRs are complex and, as with any new technology or process, it takes time to learn the system. Give yourself at least 1–3 months to become comfortable with the EHR.
  • Make sure that the business side of your practice is operating smoothly. Billing and demographics are the first and most important part of your practice to test and get working properly whether you are using an integrated practice management system or one that is interfaced with your EHR. A significant disruption to cashflow can have dire consequences for your practice irrespective of which EHR your are using.

The following is provided to assist you when preparing your go live checklist.

  1. Depending on your EHR vendor and change management guidance, you may decide to go with a “big bang” or an “incremental” go live. With a big bang approach, all systems are brought up at the same time, reducing the time to a fully operational EHR, but increasing the complexity. Many practices choose to take components of the EHR live incrementally and phase in the system over a period of time. Discuss the recommended approach with your vendor.
  2. It is best not to go live on a Monday. This is the busiest day of the week in many practices. It is also good to choose a quiet time of year, although due to demand, it is not always within the vendor’s ability to meet your needs. Whichever date you choose, ensure that all members of your practice are present during the implementation. This will reduce the need for repeat orientation and training. It may be common sense to most, but make sure that everyone comes in at least 30 minutes early on the day of go live.
  3. Set clear target dates for the go live. This will help everyone in your team to focus.
  4. Ensure there is an individual who can make decisions quickly during the go live phase so that processes do not get bogged down. Small practices may have a single individual with overall responsibility to lead the EHR implementation. In larger practices, designate a physician and staff champion throughout the go live.
  5. Staff and practice communications — Keep channels of communication open and ensure that your entire team is updated on progress through the early phase of your EHR implementation. Identify as many concerns as possible prior to go live and address these wherever possible. This will reduce delays.
  6. Patient communications — Place signs in the reception areas and examination rooms to let patients know that an EHR is being implemented and request their patience with delays. If you have a phone message, make sure to update this. Some practices also elect to send out a letter in advance of EHR implementation.
  7. Pre-populate the system as much as possible with provider preferences for medications, diagnostic codes, and templates. Some EHRs may provide intuitive templates that are easy for users to design. Other systems require templates to be designed in advance by your EHR vendor.
  8. Ensure the critical workflows are mapped out with all the involved individuals.
  9. Many vendors provide pre-training of key individuals and champions. It is very effective having a member of your practice who can function as a super user during the early stages of EHR implementation where small issues can be very challenging.
  10. You cannot do too much training. Because vendors have to spread their resources between many practices, encourage members of your practice to do as much remote/online training as possible before the onsite training. This will allow you to maximize the time that the trainer is onsite.
  11. Expect that there are processes that will need to change as you become more comfortable working with the system. Hold off on customizations for a minimum of three months. This will give you time to adjust to the system, rather than trying to anticipate in advance everything that you require.
  12. Finally, reduce your workload during go live. Expect to reduce it by 50% for the first two weeks, then progressively increase as you become more comfortable with the EHR. Most people take 3–4 months to return to normal levels of productivity.

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.


One response to "Working Effectively with Your EHR Vendor — Go Live"
  • May 6, 2011
    Michael Wilkinson, M.D.

    Overall good advice, except for point #12. I have seen this sort of recommendation elsewhere as well. Although it may be ideal (from an implementation standpoint) to reduce workload by 50% for 2 weeks, and slowly ramp back up to normal workload over 3-4 months, that is not practical for most medical practices. The reduction in cash flow that this advice would engender would destroy most practices.
    Of course, you cannot go live at full workload, but most practices need to return to full workload within 1-2 weeks.

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