Imagine: You have just completed an exhausting selection process and determined which electronic health record (EHR) is right for your practice. You think the hard part is over, but in reality the process is only just beginning. The most important factor in determining whether you are successful with your EHR is not which product you select, but how you and your office staff choose to use it.

The Centers for Disease Control and Prevention (CDC) performed a survey in 2009 and found that almost 44 percent of U.S.-based physicians said they had an EHR system in their offices; however, only 6 percent of these respondents had a fully functional system. Most physicians were not using their EHRs to their full ability, which has the potential to reduce efficiency, patient quality of care and productivity. To gain these benefits from your system and realize a maximum return on your investment, it is best to fully implement an EHR throughout your practice.

The first step in any implementation process is reviewing your adoption plan of action with your vendor. The vendor should have notified your practice of an implementation timeline consisting of training, issues management, and roll-out strategies. Every task required for the implementation should be listed on a chart along with the expected date of completion.

Most physicians were not using their EHRs to their full ability, which has the potential to reduce efficiency, patient quality of care and productivity.Your plan of action must also anticipate common problems and solutions. Understand that you may encounter resistance from staff during the implementation process. To help alleviate this concern, you should continually meet with staff to explain the implementation process and provide them an outlet to discuss their concerns with the system. Create an issues log to document these concerns and ensure they are addressed. Make sure you involve them during each step of the implementation process.

Training staff

In addition to creating a plan of action, you will need to assure that all of your staff are trained on the new system. The success of your implementation hinges on all of your staff, including the front and back office, feeling well-equipped to use the EHR system. Contact your vendor to learn how many staff they are willing to train. Make sure all of these stipulations were spelled out in your software licensing contract with a timeframe.

Once your staff are trained, determine how best your hardware fits into your implementation plan. Are you planning on having one desktop computer per staff member or can staff share computers?  Would it be easier to give laptops or tablets to physicians and other clinical personnel?  Re-visit the workflow diagram that you developed at the beginning of this process to determine which option is best for your practice. Don’t limit your decision on cost. Although multiple computers may increase your licensing fees, it is best to choose an option that provides your practice with the greatest efficiency.

Roll-out strategy

After your practice staff has been fully trained, and you have determined which hardware options are best, you will need to finalize a roll-out strategy. Rolling out your EHR is not akin to flipping a light switch. The process must be thought out in advance to minimize disruption to the practice. Decide if you want to begin using the EHR with all processes (e.g., e-prescribing, labs, etc.) and staff on one day or whether you want to gradually convert everything.

Keep in mind that you will also have to determine whether it is worthwhile to manually enter all of your old patient chart information into the EHR, scan these charts, or keep them as paper files off-site. For more guidance on scanning strategies, refer to the online EHR FAQ Manual’s chapter on Chart Conversion and Preload at (see related resources, right). Consider hiring a high school student or intern to perform these tasks as they will require a significant amount of time.

Once you determine a strategy for all these issues, inform your patients so they are aware of any delays while the practice is becoming accustomed to the EHR. Also understand that your productivity and revenue may drop in the beginning of your implementation. This is a common challenge; however, as long as you remain patient and implement your EHR fully across your practice, you should begin to see beneficial returns.

Required maintenance

Once you have implemented your EHR throughout the practice, you cannot simply wash your hands of its maintenance. Just as you would perform various maintenance tasks on a car throughout its lifetime, you must do the same with your EHR, especially with respect to privacy and security updates. It is the practice’s responsibility to work with the EHR vendor to keep every patient’s chart confidential.

Every computer terminal should only be accessible through a password, and each staff member should have a unique log-in. The practice manager may assume or reassign to another staff member the responsibility  of maintaining all passwords and ensuring they are changed every few months as well as deleting accounts for staff members who leave.

This same person should also monitor system storage space and relevant updates from the vendor — in effect, manage the business expectations and relationship with the vendor. Security and privacy updates are released frequently and the practice should be aware and must install these on a regular basis. Also make sure to institute a regular backup schedule as files should be backed up daily on a different device.

In the event of a hardware or software failure, you must ensure that you still have access to your patient files through a business continuity plan. All of these issues play a role in the implementation and adoption process. As long as you and your staff take the time to account for all of these issues and plan accordingly, you can increase the likelihood that your practice will experience a successful EHR implementation.

This is an edited version of an article that originally appeared in the November 2010 issue of Dermatology World.