A Road Map to Electronic Medical Record System Implementation


Originally published - May 28, 2008

Today, health care organizations are looking to adopt time-saving technology. Electronic medical record (EMR) software uses online technology to deliver automated processes that can save health care organizations a lot of time and resources.

Not only does an EMR solution reduce the amount of paper used by a health care facility (because it no longer needs to make as many copies of documents), it helps the facility to save on resources too, including transcription and storage costs. In addition, nurses and doctors spend less time searching for patient data, because it is stored on servers in digital format, taking up a minuscule amount of space. This enables health care organizations to convert valuable space, previously occupied by file cabinets and paper storage systems, into areas for patient care and treatment.

All this helps to reduce patient waiting times, and physicians are able to see more patients daily.

This article lists and discusses the guidelines a health care organization should follow when implementing an EMR system. These guidelines will explain what health care organizations should expect, and they will help to ensure a smoother transition from manual to electronic processes. However, following these guidelines still cannot guarantee that your implementation will be a complete success; some problems are likely to arise regardless of the measures you take to avoid them, and should be expected.

Stage 1: Defining the Needs

Let's start from the beginning. Before an implementation project gets off the ground, there is a lengthy process that needs to occur, as errors or oversights at the beginning of an implementation project can be very costly to a health care organization down the line.

The client (usually a person holding a high-level position in the organization, such as the chief of staff, for example) must first identify and document what aspects of patient care need to be improved within its facility. The client then submits this document, including the reasons for embarking on the project, to the chief information officer (CIO) for review. If the CIO determines that the request is feasible, it is then submitted to senior management for approbation (funding). Senior management's approval of funding the project depends on a benefits analysis and a detailed breakdown of time, resources, and budget to determine if the project will be a beneficial endeavor to the health care organization.

If senior management approves funding, the proposed implementation becomes a project mandate. The CIO will then appoint a project manager (PM), who will be given the scope and relative time frame in which the project is to be completed. The PM will write up the project charter (the project's mission statement and guidelines), and develop a document referred to as the work breakdown structure (WBS). The WBS is a high-level schedule that documents each phase of the project. The PM will then give the human resources (HR) department his or her staffing requirements so that the positions needed for the project are filled. Such resources may be internal or external, depending on availability and on the skill sets of the employees.

Stage 2: Evaluating Project Requirements

At this stage, the PM identifies the client's requirements and becomes familiar with the daily operational roles within the health care organization—before contacting software vendors. In collecting the client's requirements, the PM sets up interviews with all industry professionals and senior managers in the health care organization to find out their needs. The PM will designate the appropriate subject matter experts (SMEs) and business analysts to validate the current process model's capabilities and to determine what capabilities will be required for the future process model.

This is a critical stage because every vendor has its own methodology for implementation. It is essential that the PM and the implementation team know the organization's requirements and to convey them to the vendor. This helps to keep the vendor focused on what the health care organization is looking for.

Once the PM knows the client's requirements, he or she will then define the project to the implementation team so that the objectives, roles, deliverables, and targeted milestones of the project are clear to everyone.

The PM must also consult with executives and senior management, because even though they are not directly involved in the implementation life cycle, their input is definitely being considered. They are spearheading the project (behind the scenes), and they are well aware of the implementation's progress at each phase.

The PM's job is to make certain all aspects of the project run smoothly and that deadlines are met. You could look at the PM as the glue that holds the entire project together. This individual should show leadership and be capable of keeping the project on track and on budget. Once a plan is set in motion, the PM and the implementation team must stick to that plan religiously. If the PM can't lead the team, mistakes will be made and deadlines will be missed, which will impact the allotted budget.

Stage 3: Quality Assurance Testing and User Validation

During the weeks leading up to deployment, a trainer from the vendor site will go to the client's site to train a select group of people for a few months. Once these individuals become proficient and have mastered the system, they will have become SMEs, and they will be responsible for training the entire health care staff on the new EMR system.

During the validation period, two types of testing are performed: technical or stress testing and user acceptance testing (UAT).

Technical testing is crucial before deployment, as this is where quality assurance (QA) performs system and stress testing to avoid any major problems that might arise, before “going live.” This form of testing helps determine the stability of a system. Stress testing involves testing the system beyond its normal operational capacity to observe the results and to weed out or discover any hidden problems not found during initial testing. If the system passes these tests, then the client can rest assured the system is capable of handling the health care organization's workload.

The last stage prior to “going live” is UAT, where the client tries out the system to ensure that everything is working properly and that QA has fixed all the system's bugs.

Stage 4: Deployment (“Going Live”)

If all goes well during the testing and validation stage, the deployment phase is the last step in the implementation life cycle. It usually follows the testing and validation stage by a few weeks.

Once the EMR system “goes live,” the health care employees begin to work with the new system, performing their day-to-day tasks using the new solution. If problems arise at this point, the vendor needs to be informed immediately. It is likely to take some time for the solution to work properly and to align with the health care organization's business processes.

A few weeks later, a post-project assessment is performed. This assessment is a checkpoint to determine if the system's performance aligns with the project charter, as well as a way to audit the vendor. Did the vendor meet the requirements stated in the request for proposal (RFP)? If not, additional enhancements could be recommended as a secondary phase of the project.


Once the EMR system is in place, the benefits can be seen almost immediately. An EMR system guarantees increased productivity and improves staff communication. However, getting to that point has its unique challenges.

For many health care organizations, budgeting for an EMR implementation is a difficult process. This is largely due to a lack of familiarity with such an in-depth IT project and its associated requirements, including the time is takes to implement the system and to train the staff. Health care organizations must also keep in mind that the budget largely depends on which EMR model is chosen (i.e., on-premise or on-demand—please see Choosing the Right Electronic Medical Record System for Your Health Care Organization), as well as the number of staff and workstations that will be required to accommodate the new system.

For an EMR implementation project to be successful, it must be well planned out in advance, and its scope must be precisely defined to obtain buy-in from stakeholders and senior management—the people running the show behind the scenes. If they're enthusiastic about the initiative, kept well informed during its progress, and are clear about the objectives, they will offer little or no resistance to proposed changes and their costs, thus ensuring a smooth implementation.

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