1. Guaranteeing successful EHR
EHRs implementations are difficult, don’t go it alone
Shahid N. Shah, CEO
Who is Shahid?
20+ years of software engineering and multisite healthcare system deployment
12+ years of healthcare IT and medical
devices experience (blog at
15+ years of technology management
experience (government, non-profit,
10+ years as architect, engineer, and
implementation manager on various EMR
and EHR initiatives (commercial and nonprofit)
Author of Chapter 13, “You’re
the CIO of your Own Office”
Why listen to me?
Adopt the EHR
ideas I’m proposing
Tell your boss this is the
best EHR presentation
you’ve ever been to.
Do you have a well
plan that will
Pat yourself on the
back and try not to
make fun of the rest of
us mere mortals.
Stay and tell me why
I’m wrong or nod your
head in agreement.
We can help your project today
• EHR implementations are very difficult and you will
probably need help. Your EHR vendor will not be enough.
• If you like what I presented, we are available to help with
your EHR implementation efforts, especially where
technology and clinical / business folks must
• Our contact information is at the end of this deck.
Why are you implementing an EHR?
Most obvious, dangerous
Most noise, least attention
Where are you in your journey?
Made the decision to go to an EHR
Created the leadership team
• IT, Clinical, and Business participation is required
Created the selection team
Created the implementation team
Implementation planned and ready to execute
How do you know you’re successful?
Demand success metrics early on
• What are staff and physician
• Have you defined how much
faster /better clinical services
will be provided?
• Did you define reduction in
tests, staff, malpractice
insurance, data entry, etc.?
Quality of care
• What quality metrics have
EHRs are NOT IT projects
Staff Involvement Guidelines
Successful EHR Projects
Evaluate the current workflow
Define documents that will be electronic vs. paper
Figure out whether care standardization is possible
Redefine and plan for new EHR workflows
Evaluate whether staff and physicians are ready for culture
The EHR is a tool to
care for patients and
should be as minimal
as possible so that it
can be see as a
harming patient care
or causing staff
Plan for change
not be “born” all at
once and must be
First, do no harm
Resist the “big bang” approach
There is a beginning
for your EHR project
but probably no end
– assume and plan
reconfiguration as the
to the system (don’t
let people create
for system problems).
Transforming workflow before EHR
Reduce culture shock by doing the “human centered” work before technology implementation
EHR implementation is a perfect opportunity to optimize your clinical and business
Do not try to change processes and simultaneously try to deploy a new system and
configure it “on the fly”.
Always repeat a process manually before you attempt to automate it.
If the first time you try out a new workflow process is after you install an EHR then
the EHR will get all the blame and it will take longer to implement the change.
IT Implementation Roadmap
Visit existing sites serviced by EHR vendor
Define the staff to hardware ratios and usage patterns
Plan network bandwidth, wireless / wired networking
Plan data interfacing and data storage (NAS, SAN, etc.)
Plan hardware upgrades (clients, servers, scanners, etc.)
Practical IT Considerations
How do you
get out of a
Paperless document management
Create a matrix of every document you work with to see how it should be handled
All paper charts
Mostly paper charts
Some paper charts
No paper charts
•This is pre-EHR for some
•Even after EHR for others
•Even after EHR, charts are
printed before handling
•Staff task management and
email help here
•Most charts are eliminated but
without CPOE not all can be
•Need nursing automation tools
•Physician documentation tools
•Signed documents, faxes,
correspondence are still tricky
so scanning is the only option
Ancillary Software Considerations
EHRs aren’t enough
Microsoft Office and
Patient registry and
CCR bulletin boards
If you’re going paperless, you’ll need
much more hardware than you think
Regular desktops on the existing
cabinetry (which may not have room
for the desktops
Laptops on the existing cabinetry
COW carts with desktops or laptops
Wall mounted or pole mounted
computers/monitors or laptop
• Does every room with a device have a network drop?
• Consider bandwidth and wall jack locations
• Can WiFi be used for securely for business- and safetycritical work?
• Consider bandwidth, coverage, etc.
• Is the EHR securely and easily available on cellular
• Consider size of data and app UX (screens, etc.)
• Will medical devices feed into the EHR?
Data storage considerations
Storage isn’t just about hard drives. It’s really about all the different kinds of data
and how you will collect, store, extract, interface, retain, and manage it.
Mobile & Wireless Devices
Your EHR implementation must support remote devices, BYOD and mHealth
EHR Security Considerations
Your EHR MUST support all of the following
control to patients,
“VIP” patients and
access to specific
areas of a chart
Redaction of certain
data when releasing
IT Security goes beyond encryption
• What level of access do technical staff—both internal staff and vendor—
need to support the system?
• Does system support require access to the application database where
patient data are stored?
• Can all sensitive information be blocked from support staff’s view and
• Can troubleshooting be achieved through the use of test data rather
than live records?
• What means are used for remote support?
• For systems hosted by vendors, what audit trails are in place to monitor
vendor staff activity? Does the vendor provide access to these logs?
• Are audit trails of routine maintenance available?
Confronting EHR Myths
fixed by an EHR.
Loose reports are
no longer a
You won’t need
You will never
lose charts again.
You don’t need to