When implementing a new health IT system, hospitals, clinics, physician practices and other care settings must take a number of tasks into account.  Developing strategies for chart conversion, staff turnover, technical support, ongoing communication among staff and continuing provision of quality care for patients may seem overwhelming.  The below resources can help first-time implementers create a plan.

There are two main approaches to EHR implementation: big bang and phased.  As its name suggests, in a big bang implementation, most or all functionality of the new system is introduced to the entire organization all at once.  A phased implementation, on the other hand, introduces functionality incrementally.  This phasing can be achieved in two main ways.  The provider can introduce most or all functionality in test departments and then move on to other units of the institution.  Alternatively, one can base the phasing on functionality by implementing several functionalities across the entire organization, followed by the addition of new functionalities once the first few have been mastered.

In both the inpatient and outpatient settings, most providers choose a phased approach to the implementation to make the process easier on IT staff and users, to minimize the disruptions in care, and to manage the budget.  For go-live, outpatient settings may choose to have individual or a small group providers and their staff start using the health IT application and then gradually introduce the software into the workflow of the others.  Alternatively, a clinic may decide to conduct a big bang go-live based on the size and needs of the organization.  In such cases, efficiency may be reduced significantly for 2-4 weeks and the organization may find the need to reduce its patient load by as much as 50 percent during that time.  While this can be difficult especially for smaller and rural practices, a significant advantage to this approach is that multiple workflows and systems do not need to be maintained simultaneously during the transition phase.

In general, due to the complexity of inpatient workflows, hospitals generally will find the use of a phased go-live approach often by department/unit or software module leads to less disruptions.  For example, a CAH may choose to have a go-live of the EHR in the emergency room before introducing the software on the floors.  When choosing a phased approach, however, careful attention should be made to ensure that communication is maintained among the various departments and that important information is not missed.

Resources:

• Louisiana Health Care Quality Forum: Electronic Health Record Resource Toolkit, Volume 1: the Adoption Process (PDF - 228KB)
• EMR Implementation in Critical Access Hospitals, Small Community Hospitals, and Affiliated Clinics (PDF - 402KB)
• Implementation Process - DOQ-IT University
• EHR Implementation Checklist (PDF - 77KB)
• Health IT in California: Assessing the Benefits and Barriers-CHCF
• Impacts of EHR Implementation (PowerPoint - 2.8MB)