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At this point, leveraging technology to provide efficient and high-quality resident care is more than just a trend. It’s a necessity. And one of the most significant advancements is the Electronic Health Records software system (EHR). Of course, the path to successfully adopting EHRs in a long-term care setting isn’t always straightforward, hence the need for an EHR implementation checklist.

But before we review the EHR implementation checklist, it is worth looking into EHRs and why long-term care facilities choose to go with long-term care software vendors in the first place.

For starters, EHRs are not simply digital analogs of traditional paper records. They’re robust, versatile tools that have transformed how long-term care is delivered to America’s seniors. Some of the core EHR functions include: 

A nurse sharing the EHR implementation checklist with a resident, who happens to be the founder and a crucial stakeholder at the nursing home.
As a digital platform, EHRs greatly enhance communication and connectivity among various stakeholders in healthcare.
  • Health information and data capture: Resident demographics, medical history, medication and allergies, immunization status, and laboratory test results are all made readily available in EHRs. That data supports providers in delivering comprehensive and personalized care to each patient.
  • Results management: EHRs can swiftly deliver lab, imaging, and test results directly to providers, eliminating delays and the potential for lost or misplaced results. Providers can then quickly review, annotate, and compare results over time to make more informed decisions.
  • Order entry/order management: The Order Entry/Order Management function, often referred to as Computerized Provider Order Entry (CPOE), allows providers to enter medication orders and other treatment-related instructions directly into the system. This physician orders capability speeds up the process and reduces the chances of errors associated with traditional handwritten prescriptions.
  • Decision support management: EHRs come equipped with clinical decision support systems that assist healthcare providers in making evidence-based clinical decisions. They can provide alerts for potential drug interactions, reminders for preventative care, and guidelines for disease management. This feature enhances patient safety and promotes adherence to established clinical guidelines.
  • Electronic communication and connectivity: As a digital platform, EHRs greatly enhance communication and connectivity among various stakeholders in healthcare. Providers can seamlessly share information with other healthcare professionals, pharmacies, labs, and even patients themselves. This interconnectedness facilitates coordinated and efficient care delivery.
  • Resident support: EHRs are not just for clinicians. They also provide resident support by helping track and manage resident schedules, tasks, and patient interactions to ensure that the next generation of healthcare professionals is well-equipped for the future.
  • Administrative processes: EHRs streamline scheduling, billing, and claims processing to reduce the potential for administrative errors and allow healthcare providers to focus more on patient care.
  • Reporting and population health: Lastly, EHRs generate detailed reports for quality improvement, regulatory compliance, and public health disease surveillance. At a population level, EHRs can aggregate and analyze patient data to identify trends, track disease outbreaks, and inform public health decisions.

The above are some of the core functions of an EHR. So what are some benefits of effective EHR implementation? Here are 11 of benefits of EHRs:

  • Precise and accurate resident information
  • Swift access to resident records
  • Secure data/information sharing
  • Enhanced diagnostic ability and safer care delivery
  • Improved patient-provider communication
  • Reliable and safe prescription practices
  • Comprehensive documentation and efficient coding
  • Superior privacy and data security
  • Boosted work productivity and balanced work-life for staff
  • Increased efficiency and business accomplishments:
  • Cost reduction

In short, the advantages of EHRs range from enhancing care quality to improving business practices. In the next section, we will dive deeper into EHR implementation, and look at how a facility can ensure the effectively implement an EHR in their facility. 

The 10 Stages of EHR Implementation

Before we proceed to the 10 stages of EHR implementation, it is worth mentioning that there is some prep work that must be done in long-term care facilities. The Office of the National Coordinator for Health Information Technology (ONC) provides a detailed guide on how to navigate this process: 

  • Leverage your local Regional Extension Center: Regional Extension Centers (RECs) are valuable resources that can support your EHR implementation journey. They provide a wide range of services and benefits specifically designed to assist healthcare practices during this critical transition. Connecting with your local REC can help you gain expert insights, receive personalized guidance, and access essential resources.
  • Conduct a practice readiness assessment: Before diving into your EHR implementation checklist, take the time to evaluate your practice’s readiness. A practice readiness assessment can help you understand the current state of your practice, pinpoint areas that need improvement or change, and identify potential challenges that might arise during the EHR implementation. 
  • Redesign your workflow: Successful EHR implementation often requires a rethink of your current workflow. It’s crucial to identify key areas that will be impacted by the EHR and consider how processes and roles might need to evolve. Remember, EHRs are not simply about digitalizing your records; they’re about transforming the way you deliver care.
  • Plan your approach: Preparation is key to a successful EHR implementation. Start planning your approach as early as possible, outlining clear objectives, timelines, and responsibilities. A well-crafted implementation plan can guide your transition, keep your team aligned, and help you manage resources effectively.
  • Choose a certified EHR: Finally, selecting the right EHR system is a crucial decision. Choose a vendor that provides a certified EHR system that meets the regulatory standards and suits your practice’s needs. Take into account factors such as the system’s functionality, usability, cost, and the vendor’s reputation for customer support. Remember, the right EHR should not just meet your current needs but also scale with your practice as it grows.

With all these in mind, we can now move on to the definitive 10-step EHR implementation checklist

1. Craft a detailed EHR implementation plan 

An EHR implementation plan is essentially a roadmap that outlines all the tasks that need to be accomplished throughout the entire process. It sets clear expectations, establishes guidelines, and defines the measures of success. This means your plan should include details about: 

  • Forming an EHR implementation team: This is the nucleus of your EHR implementation endeavor. It is crucial to assemble a diverse team consisting of members from different sectors of your facility. This team could include medical professionals, IT specialists, administrative staff, and perhaps even a few resident representatives. A wide range of perspectives and insights will ensure your EHR system is versatile and adaptable, catering to all necessary needs and scenarios.
  • Defining your budget: Like in any other project, the budget plays a significant role in EHR implementation. It’s important to assess and allocate resources in a manner that optimizes costs without compromising the system’s quality. Your budget should account for the software itself, hardware upgrades if necessary, staff training, and ongoing maintenance costs.
  • Selecting the best EHR software: Picking the right EHR system is a mission-critical decision. The software should be user-friendly, interoperable, secure, and scalable. It should align with your healthcare institution’s current needs and future growth. Involve your EHR implementation team in the selection process to ensure the software checks all boxes.
  • Transferring data to the EHR system: Transitioning from paper records or an older EHR system to a more advanced one can be challenging. A thorough data migration strategy is necessary to ensure all patient records are transferred accurately and securely.
  • Providing staff training: Change can be intimidating. Introducing a new EHR system could be met with resistance from staff. To facilitate this transition, you’ll want to invest in comprehensive EHR training programs. After all, staff should be comfortable using the new system, understanding not only its functionalities but also how it improves their daily workflow.
  • Testing the EHR system: Before going live, it’s essential to conduct rigorous testing to identify and rectify any software bugs, compatibility issues, or usability concerns. This step helps in reducing potential disruptions once the system is in full operation.
  • Defining your go-live approach: The go-live strategy determines how the EHR system will be rolled out. It could be a big-bang approach, where the entire system is launched all at once, or a phased approach, where different components are gradually implemented.
  • Collecting feedback: Lastly, after going live, it’s important to gather feedback from all users. This ensures continuous improvement and helps the organization adapt to the new system seamlessly.

2. Form your EHR implementation team

Remember, the EHR system is not just an IT project but a transformation that affects all areas of your facility. Consequently, your team should be a reflection of this diversity, comprising different roles, skills, and experiences. The roles in this team will include: 

  • Project manager: Their role involves setting timelines, coordinating tasks, resolving issues, and ensuring that the project is on track and within budget. They are the team’s go-to person and the primary point of contact with the EHR vendor.
  • EHR superuser: This is someone within your facility who becomes an expert in the new system. Their job is to master the software’s ins and outs, train other staff members, and troubleshoot common problems.
  • Lead physician and nurse: Having a lead physician and nurse on the team is essential to advocate for clinical needs and perspectives. Their clinical expertise will help ensure the EHR system supports care delivery without disrupting workflows.
  • Billing advocate: They will focus on the financial aspect of the EHR system, ensuring it supports accurate coding, billing, and claims management. 
  • Application developer and analyst: They are critical for customizing the EHR system to meet your facility’s unique needs. The developer can tailor the system’s functionalities while the analyst assesses the impact of these changes, ensuring they align with the facility’s workflow and data requirements.
  • Software tester: They are tasked with the crucial role of checking the system for errors or bugs before going live. They carry out different scenarios to ensure the system works as expected in real-world situations and are instrumental in fine-tuning the EHR system.

3. Schedule your EHR implementation

The roadmap is laid out, and your all-star EHR implementation team is assembled. Now it’s time to map out your timeline. This critical step in your EHR implementation checklist forms the backbone of your entire implementation process

To ensure that the EHR implementation schedule is well defined, consider three primary factors:

A long-term care facility team having a meeting to discuss the stages of EHR implementation their facility will undergo.
Before diving into your EHR implementation checklist, take the time to evaluate your organization’s readiness.
  • Project scope: The scope of your EHR implementation project refers to the extent of the tasks you aim to accomplish. Are you simply digitizing paper records or aiming to integrate the EHR with other digital health solutions? Are you planning on training all staff members at once, or will it be phased training?
  • Team size and efficiency: The size of your team and its efficiency will significantly impact your schedule. A larger, efficient team might mean a shorter implementation timeline, whereas a smaller or less experienced team may require more time to accomplish the same tasks.
  • Budget: Your budget is inevitably tied to your schedule. For instance, if you’re on a tight budget, you might need to allocate more time to specific tasks, such as staff training, to avoid the additional costs of outsourcing or hiring new personnel. On the other hand, if your budget is bigger, you might afford to speed things up by employing extra resources or using premium vendor services.

4. Determine your requirements for EHR software

Here you will explore your nursing home’s needs to ensure that the EHR system you choose not only fulfills its basic functions but also optimally supports your unique clinical and administrative workflows.

Remember that EHR systems are not one-size-fits-all. The best EHR for your long-term care facility is one that can be tailored to your specific needs, create efficiencies, and promote quality care. Therefore, consider key features such as: 

  • Automated appointment scheduling
  • Clinical document generation
  • Reporting and data analytics
  • Telemedicine capabilities

5. Reach out to vendors

Your EHR requirements are clearly defined, and now you’re ready to navigate the market for potential EHR vendors. This stage is all about:

  • Researching potential vendors: Start by researching potential vendors in the market. Look for those with a solid reputation in the industry, systems that meet your defined EHR requirements, and a history of successful implementation in long-term care facilities like yours. Utilize resources such as user reviews, case studies, and third-party rankings to get a well-rounded view of each vendor’s strengths and weaknesses.
  • Reaching out to vendors: After conducting an initial sweep of potential EHR vendors, it’s time to start reaching out to them. Initiate contact with each vendor to ask detailed questions about their product and services. Consider preparing a standardized list of questions covering implementation support, training, customer service, interoperability, and scalability to ensure you receive all the necessary information for comparison.
  • Evaluating based on your requirement list: With the information gathered, you can begin to evaluate each vendor based on your specific requirement list. Remember, it’s not just about the software; you’ll also want to consider aspects such as the vendor’s commitment to ongoing support, their responsiveness, and the overall fit with your facility’s culture and workflows.
  • Make a shortlist of top vendors: From your evaluation, identify the top three vendors that most closely align with your requirements and stand out in their service offerings.

6. Select the best vendor

Having whittled down your choices to a few key contenders, it’s time to take a deeper dive into each one’s offerings. You will do this by: 

  • Requesting vendor demonstrations: Each vendor on your shortlist should provide a comprehensive demonstration of their EHR system. This demo should showcase the software’s functionalities, ideally in a way that mirrors your facility’s specific workflows and use cases.
  • Comparing demonstrations: Take detailed notes during each demonstration and compare them afterward. Consider how each system aligns with your specific requirements and assess the ease of use, degree of customization, and compatibility with your facility’s workflows. Be sure to involve your EHR implementation team in these comparisons.
  • Select the best vendor: After comparing the demonstrations, it’s time to select the best vendor. This should be the provider whose EHR system best meets your defined requirements, fits seamlessly into your facility’s workflows, and offers the most satisfactory user experience.

7. Evaluate your hardware needs

Your system hardware provides the physical foundation on which your software will run. When evaluating your hardware needs, you must take into account your: 

  • Hardware requirements: This largely depends on the type of EHR system you’ve chosen and your facility’s unique needs. For example, a cloud-based EHR system might require less robust hardware but a more stable and high-speed internet connection. On the other hand, an on-premise EHR system might require more powerful servers, data storage solutions, and network infrastructure.
  • Budget considerations: Hardware considerations should be factored into your EHR implementation budget from the start. The cost of hardware can vary greatly depending on your specific needs, so it’s important to compare prices from different vendors and look for cost-effective solutions.
  • Office space: The physical space in your facility also plays a crucial role in determining your hardware needs. Servers may require specific environmental conditions, like temperature control, to operate efficiently, and they also take up space. User devices should fit comfortably within the working spaces of staff members and should be suitable for the way they work. For example, mobile devices may be preferable for staff who are often on the move.

8. Transfer your data

Your data is your practice’s most vital asset; it’s the foundation of your patient care and the lifeblood of your operations. It’s imperative that this data migration process is done correctly to avoid any data loss or corruption. This intricate process typically involves: 

  • Cleansing and verifying data: Start by auditing your current data. Any redundant, obsolete, or trivial data (often referred to as ‘ROT’ data) should be identified and cleaned out before the migration process begins.
  • Setting up an EHR database: This is typically done in close collaboration with your EHR vendor, ensuring the database is set up in a way that aligns with the system’s functionality and your facility’s specific workflows.
  • Transferring data to your EHR system: This process can be complex and time-consuming, so it’s often advisable to automate the process as much as possible using data migration tools or services.
  • Testing and verifying legacy data and new data inputs: After the data transfer, you must verify the accuracy of the migrated data and test the new data input mechanisms. Confirm that all legacy data has been correctly transferred and that it displays accurately within the new system. Similarly, test how new data is entered into the system, ensuring it’s captured correctly and aligns with your workflow.

9. Train your staff

With the technical aspects of your EHR implementation taking shape, the focus shifts to one of the most critical facets of this transition: training your employees. A well-designed, comprehensive training program is instrumental in preparing your staff for this digital shift, mitigating resistance, and fostering the successful adoption of your new EHR system. 

Just remember to:

  • Take your time
  • Provide role-based training
  • Encourage peer sharing and training
  • Listen to feedback
  • Plan for ongoing training

10. Prepare for your go-live day

You’re now ready to embark on the final step in your EHR implementation checklist: the go-live day. This is when your EHR system becomes active, and your facility begins using it in real time, marking the culmination of all your preparation and planning. Key strategies to keep in mind include: 

  • Keep all parties informed: Regular and transparent communication is key during the go-live planning process. All stakeholders, including a diverse selection of users, should be kept updated on EHR implementation progress.
  • Set reasonable goals for the EHR go-live: The EHR go-live process should be guided by a set of realistic goals. It’s essential to manage expectations and understand that users will need time to adapt to new processes and learn how to leverage the system effectively.
  • Provide adequate support during EHR go-live: During the go-live period, make sure that sufficient on-hand support resources are available to provide any necessary technical assistance to clinical and ancillary staff.
  • Choose between a Big Bang or Phased Approach: When it comes to launching your EHR system, you can opt for a single event deployment (Big Bang go-live) or a phased approach. Each has its own risks and benefits. A big bang go-live can expedite the process but may exacerbate problems across the entire organization. On the other hand, a phased approach, while more prolonged, allows for a more manageable troubleshooting process and the application of lessons learned in earlier phases to subsequent ones.
  • Plan with Flexibility: While careful planning is key to avoiding common EHR implementation pitfalls, flexibility is equally important. The unpredictability of introducing new software into a live setting necessitates a degree of adaptability. So while you should adhere to your plan as closely as possible, be prepared to adjust your approach as needed.

Your go-live day marks a significant milestone in your EHR implementation checklist. By keeping all parties informed, setting reasonable goals, providing ample support, and choosing the most suitable go-live approach with an emphasis on flexibility, you set the stage for a successful EHR system launch. 

Contact us here if you’re interested in experiencing a flexible, user-friendly EHR system that supports and streamlines your operations.

EHR Implementation Challenges To Keep In Mind

Naturally, there are some EHR implementation challenges you can expect to encounter, especially if you have an incomplete or ineffective EHR implementation checklist. These challenges include: 

A nurse experiencing technical difficulties, which is one of the EHR implementation challenges a facility should expect to encounter.
Human resistance is something to watch out for during the stages of EHR implementation, as change can be hard, and not everyone may readily embrace the transition to EHRs.
  • Technical capabilities: The capabilities of a computer system—influenced by factors such as its age and the location of the practice—can significantly impact EHR implementation. For instance, connectivity and data retrieval may pose challenges in rural settings compared to urban areas. So your technical infrastructure needs careful evaluation and, potentially, upgrades to ensure successful EHR implementation and usage. Of course, if you stick to EHR implementation steps, you will spot such issues well before settling on an EHR.
  • Cost implications: The costs associated with procuring the system, training staff, ongoing support, and maintaining the necessary physical infrastructure can be daunting, especially for smaller organizations. Budgeting for these costs and exploring financial assistance or incentive programs can help nursing homes overcome this barrier.
  • Human resistance: This, in particular, is something to watch out for during the stages of EHR implementation, as change can be hard, and not everyone may readily embrace the transition to EHRs. Some nurses and other crucial staff may resist the adoption of this technology, particularly in the face of initial technical issues. Clear communication about the benefits of EHRs, clarity when it comes to the EHR implementation checklist, and the provision of robust support can help mitigate this challenge.
  • Workflow disruption: EHRs aim to enhance the workflow within a practice. However, if not appropriately customized to the specific needs of a practice, EHR implementation can disrupt established processes. Therefore, it’s essential to work closely with the EHR vendor to ensure the system is tailored to support and enhance the existing workflow, not hinder it.
  • Training demands: Effective EHR implementation requires comprehensive staff training. This can be a considerable commitment of time, effort, and resources, which some practices might find challenging. However, investing in training is crucial to fully leverage the benefits of EHRs and should be factored into the implementation plan from the outset.
  • Privacy concerns: The shift to EHRs can raise concerns about the privacy and security of sensitive medical information. Fears about data loss due to natural disasters or cyber threats can hinder EHR adoption. Addressing these concerns requires stringent security measures, regular data backups, and education about the steps taken to protect patient information.

By anticipating these obstacles and implementing effective strategies to address them, long-term care providers can successfully transition to EHRs and reap the substantial benefits they offer.

Your EHR Implementation Checklist

At Experience Care, we believe in the transformative power of technology in the healthcare sector. For that reason, we’ve developed a five-stage EHR implementation process that you can also include in your own EHR implementation checklist.

Stage 1: Discovery

This is where we set the stage for a successful implementation. We aim to understand your team’s clinical and financial needs and explore your workflow to identify areas that require improvements. By setting clear expectations from the start, we foster a collaborative relationship with your team that sets the groundwork for a smooth transition to a new EHR system.

Stage 2: Assessment

Once we clearly understand your organization’s needs, we move to the assessment stage. Your clinical and financial teams will review the features and modules of our EHR to decide which ones are pertinent to your workflow. We will also send assessment forms and questionnaires to capture additional insights, ensuring we tailor our EHR system to your organization’s specific needs.

Stage 3: Proposal

Following the assessment, we demonstrate how our clinical and financial systems can benefit your organization, effectively integrating within your existing workflow. Our team provides recommendations based on your needs and requirements. Additionally, we provide an estimate for the selected modules, helping you understand the financial implications of the EHR implementation.

Stage 4: Review

Now that we have presented the proposal, it’s your turn to review the details. You’ll want to carefully read the detailed responsibility matrix and the order form. We also set up a training schedule at this stage, ensuring your team is ready to utilize the new EHR system to its full potential from day one.

Stage 5: Implementation

The final stage is the actual implementation of the EHR system. Our goal is to achieve optimal utility within 30-90 days. During this period, we build out your KPI dashboard and begin tracking analytics. You will also meet your dedicated project manager, who will be your primary point of contact throughout the implementation phase.

This five-stage implementation process is designed to ensure a seamless, efficient transition to our EHR system, setting your organization up for success and improved patient care. Experience Care is excited to be your partner in this transformative journey.

For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast

Elijah Oling Wanga