Electronic Health Records

Which phase of the EHR adoption process are you currently in?

An electronic health record (EHR) is software that's used to securely document, store, retrieve, share, and analyze information about individual patient care. EHRs are hosted on computers either locally (in the practice's office) or remotely. Remote EHR systems are described as “cloud-based” or “internet-based.”

Over 75% of office-based clinicians and 96% of hospitals in the United States use an EHR certified by the Assistant Secretary for Technology Policy (ASTP). That means nearly all practices have an immediate, practical interest in improving the efficiency and use of their EHRs. Additionally, some practices may be considering replacing their current EHR for a number of reasons, such as improving care coordination, reducing administrative burden on healthcare providers, or adapting to an organizational change like a merger with another health system.

As part of the 21st Century Cures Act, ASTP is helping healthcare practices improve both how they share information with patients and the quality of care they provide through the use of technology. Optimizing EHRs for patient safety and interoperability — making sure EHRs can communicate easily with each other — is a key part of this work.

This Playbook is a source for clinicians, other healthcare providers, and practice administrators who are adopting, optimizing, upgrading, or changing an EHR system. The tools you'll find here are intended to make your EHR implementation and use more efficient, less burdensome, and more effective.

The EHR journey

Implementing an EHR is an ongoing journey with no single destination or end. Once an EHR is installed, there are always opportunities to optimize workflows or improve the use of data. This section provides resources to support you through each phase of EHR adoption, implementation, and improvement. These include:

• Planning
• Selecting a vendor
• Contracting with a vendor
• Implementing and adopting an EHR
• Using your EHR
• Optimizing or replacing your EHR

After you spend time using and getting familiar with your EHR, it's time to think about how you can optimize your workflows to improve its overall effectiveness. You'll need to revisit this part of the ongoing EHR journey each time you adopt additional health information technology (IT) solutions, such as:

• Adding a patient portal
• Connecting to a health information network (HIN)
• Participating in value-based care or new payment models

The information in this Playbook reflects lessons learned from years of implementation experience across a wide variety of clinical settings. Become familiar with the Playbook and select the tools appropriate for your EHR adoption journey.

Negotiating and interpreting EHR contracts

Selecting an EHR and negotiating its purchase are challenging for any healthcare practice. ASTP's downloadable EHR contracts guide can help you, your business managers, and your advisors select the right technologies for your practice and navigate the acquisition process. It will also help you negotiate contract terms to minimize potential problems and build a stronger relationship with your health IT vendor.

Upgrading your EHR? The guide can also help you upgrade your current system to meet new certification requirements or to integrate new modules, capabilities, and services.

What is in the EHR contracts guide?

The EHR contracts guide contains 2 parts that cover key activities — from planning to contracting and handling disputes.

Part A highlights critical planning steps to help you understand the EHR acquisition process. Making sure you understand this process will help you communicate your practice's specific requirements to potential vendors. Topics include:

• Navigating the types of EHR products and service models
• Researching and comparing EHR products and vendors
• Identifying and prioritizing your EHR’s technical and operational requirements
• Conducting due diligence to find the best EHR for your needs
• Understanding certification and regulatory requirements
• Implementing procurement strategy, planning, and resourcing

Part B focuses on negotiating and contracting, and it contains strategies and recommendations to negotiate best-practice EHR contract terms. The guide also provides example language to show how you might address legal issues in a contract. Topics include:

• EHR safety and security
• How to ensure system performance meets expectations
• How to manage and protect EHR data
• Interoperability and integration
• How to manage risk and liability
• Vendor-dispute resolution
• How to manage EHR transition issues

Choosing an appropriate EHR is key for successful implementation. As a first step, it's important to understand the benefits an EHR brings to your practice. Then, you can start to identify potential roadblocks to implementing an EHR at your organization and establish realistic expectations for the process. Common roadblocks to successful implementation include:

• Incomplete understanding of your organization's information needs
• Uncertain costs
• The effort required to identify and implement an appropriate EHR system

What factors can help your organization overcome implementation roadblocks? Before getting started, assess your organization's:

• Readiness
• Personnel eagerness
• Availability of someone to champion the cause
• Stakeholders who perceive EHRs as useful
• Ability to work as a team

Remember: Your planning must address both the initial and ongoing effects that EHR implementation will have on your clinical practice.

Cloud-based EHRs

Cloud-computing platforms provide scalable, on-demand access to IT services. The cloud can help you rapidly provision and launch an EHR system while minimizing management effort and cost. However, it’s important to thoroughly understand the benefits and challenges associated with a cloud-based EHR.

Common benefits of cloud-based EHRs:

• Reduce upfront hardware and software costs
• Reduce ongoing maintenance costs
• Allow you to start small and increase IT allocations as needed
• Provide higher levels of IT service availability than in-house IT services
• Reduce run-time failures, such as slow performance or application freezing

Common challenges associated with cloud-based EHRs:

• Responsibility for data security is shared by your organization and your cloud EHR vendor
• Less data access and control compared to a locally hosted EHR

Locally hosted EHRs

With locally hosted EHRs, your EHR software and data are housed on server computers at your practice.

Common benefits of locally hosted EHRs:

• Require less investment in internet connection upgrades if your practice does not already have reliable, high-speed internet access
• You won't have to trust an outside organization with the security of your patients' data

Common challenges associated with locally hosted EHRs:

• Your organization is responsible for making sure servers are physically secure
• Your organization is responsible for performing regular data backups
• Your organization is responsible for the costs associated with equipment purchase and maintenance

Deciding on an EHR system

Choosing an EHR system takes planning and a systematic decision-making approach. Understanding your practice’s needs and the capabilities of the various EHR systems on the market will help you find a system that meets your needs.

Successful EHR adoption consists of 2 phases: pre-implementation and implementation. Below, find guidelines for both phases to help you get the most out of your system.

During the pre-implementation phase:

• Establish a governance process and a project plan
• Involve and communicate with staff and patients
• Redesign workflows
• Provide education and training

Establishing a governance process means creating guidance and a stewardship plan focused on data safety and integrity. This will help ensure that your EHR is implemented effectively and sustainably and that your practice manages data appropriately.

As you establish a governance process, the Safety Assurance Factors for EHR Resilience (SAFER) Self-Assessment Guides serve as a comprehensive resource for recommended practices for safe EHR use, including organizational responsibilities, contingency planning, and test results follow-up.

During the implementation phase:

• Tailor the system to meet practice requirements
• Establish a change management process
• Determine how to backload patient medical histories
• Account for training time as staff learn to use the system
• Support the system
• Encourage your staff along the way

Once you've implemented an EHR, you've met a significant milestone on your EHR journey. At this stage, it's important to evaluate the implementation process. Through evaluation, you'll learn what worked — and what didn't — so you can either avoid repeating mistakes or follow a similar path to success in the future.

Issues to consider in your evaluation include:

• Did your implementation process go smoothly?
• Did everyone in your practice participate and feel involved?
• Did events go as planned?
• What were the implementation’s strengths and weaknesses?
• How did the implementation affect workflow — the steps that you and your staff take to complete tasks?
• Can you identify opportunities for improvement?

Answering these questions can help you plan for the future, setting your organization up to continue to improve the value of your EHR system.

Plan for ongoing improvements

Once you have your EHR up and running, you can move on to making ongoing improvements. “Usability” refers to how easy, effective, and efficient a piece of software is to use. The usability of your EHR depends not only on how it is designed but also on how it's implemented. To maximize usability, it's helpful to:

• Take a continuous optimization approach — that is, always be looking for ways to improve the system
• Establish a process to gather feedback from clinicians, other healthcare providers, patients, and other EHR users
• Make improvements based on user feedback and best practices

 

Migrating from paper-based documentation to an EHR system requires careful planning — and so does migrating from one electronic environment to another. But this investment can be worth it if your practice is:

• Outgrowing your current EHR's capabilities
• Expanding
• Joining another practice

Careful data migration planning ensures that your new EHR can both integrate and access historical data.

Have a tool or resource to make this Playbook even better? Share your feedback with us.