System Selection Phase
The system selection process is critical to EHR success and involves structured evaluation of vendor options.
| Document | Purpose | Key Details |
|---|---|---|
| RFI (Request for Information) | Preliminary market research | Gathers general information about vendor capabilities and products; used to narrow the field of candidates |
| RFP (Request for Proposal) | Formal solicitation for detailed proposals | Includes specific requirements, evaluation criteria, timeline, and budget; vendors respond with how they will meet the requirements and at what cost |
| RFQ (Request for Quote) | Price-focused request | Used when specifications are well defined and the primary differentiator is cost |
Evaluation methods include: vendor demonstrations, site visits to reference organizations, due diligence reviews, proof-of-concept testing, and scoring matrices with weighted criteria.
Planning and Governance
- Steering committee: Executive-level oversight body that provides strategic direction, resolves escalated issues, and approves major decisions
- Project manager: Responsible for day-to-day project coordination, timeline management, risk tracking, and communication
- Project charter: Formal document authorizing the project, defining scope, objectives, stakeholders, and high-level timeline
- Work breakdown structure (WBS): Hierarchical decomposition of project deliverables into manageable work packages
- Budget planning: Includes hardware, software licensing, implementation services, training, interface development, and ongoing maintenance costs
- Communication plan: Defines how project information is distributed to stakeholders at each phase
Workflow Analysis
Workflow analysis is essential for successful EHR implementation. It maps how work currently flows and identifies opportunities for improvement.
- Current-state analysis: Document existing workflows ("as-is" processes) using flowcharts, swim lane diagrams, or process maps
- Gap analysis: Identify differences between current processes and the capabilities of the new system
- Future-state design: Design optimized workflows ("to-be" processes) that leverage the new system's functionality
- Clinical decision support (CDS): Plan alerts, reminders, order sets, and documentation templates
- Key stakeholder involvement: Clinicians, nurses, ancillary staff, and administrative users must participate in workflow design
Data Migration
Data migration is the process of transferring data from legacy systems to the new EHR. Critical considerations include:
- Data mapping: Aligning data fields from the old system to the corresponding fields in the new system
- Data cleansing: Identifying and correcting errors, duplicates, and inconsistencies before migration
- Data validation: Verifying accuracy and completeness of migrated data through reconciliation reports
- Scope decisions: Determining which historical data to migrate (full history, summary, or specified timeframe)
- Legacy system access: Planning for continued read-only access to historical data not migrated
Testing Phases
| Phase | Purpose | Participants |
|---|---|---|
| Unit Testing | Test individual components and functions in isolation | IT team, developers |
| Integration Testing | Test data flows and interactions between system modules and interfaces | IT team, analysts |
| System Testing | Test the complete system end-to-end in a production-like environment | IT team, select end users |
| User Acceptance Testing (UAT) | End users validate that the system meets requirements and supports workflows | End users, super users |
| Performance Testing | Evaluate system speed, stability, and scalability under expected loads | IT team |
Training Strategies
- Super users: Staff members who receive advanced training and serve as first-line support and mentors during and after go-live
- Role-based training: Customized training based on job function (physicians, nurses, registration staff, coders)
- Training environments: Sandbox or training domains that mirror production without affecting live data
- Training timing: Ideally conducted 2-4 weeks before go-live to maximize retention
- Multiple modalities: Classroom, e-learning, one-on-one, quick reference guides, and tip sheets
Go-Live Approaches
| Approach | Description | Pros | Cons |
|---|---|---|---|
| Big Bang | All units/locations switch to the new system simultaneously | Shorter overall timeline; no need for parallel systems; clean cutover | Higher risk; requires extensive support; significant organizational disruption |
| Phased | Implementation occurs in stages by department, location, or functionality | Lower risk; lessons learned applied to later phases; manageable support | Longer timeline; requires interfaces between old and new systems; may cause confusion |
| Pilot | One unit or site goes live first as a test case | Real-world testing; limited scope of impact; builds organizational confidence | Pilot site may not represent other units; extended overall timeline |
| Parallel | Old and new systems run simultaneously for a period | Safety net if new system fails; data comparison possible | Double workload for staff; expensive; may delay full adoption |
Optimization and Regulatory Considerations
- Post-go-live optimization: Continuous improvement of system configuration, workflows, and user experience based on feedback and usage data
- MIPS (Merit-based Incentive Payment System): QPP track that adjusts Medicare payments based on quality, cost, promoting interoperability, and improvement activities
- Promoting Interoperability: Replaced Meaningful Use; measures the use of certified EHR technology to support health information exchange and patient engagement
- ONC Health IT Certification: EHR systems must be certified to meet technical standards and functionality criteria
- Clinical quality measures (CQMs): Standardized measures of healthcare quality reported through the EHR