Mastering EHR implementation: Challenges, strategies, and a checklist

For private healthcare practices, electronic health record (EHR) systems can optimize workflows, transform data management, and lower costs. Successful EHR implementation can also improve the quality of patient care.

If you're new to EHRs, it's important to understand the distinction between “EHR” and “EMR” (electronic medical records). An EHR software makes patient health records available across multiple healthcare settings, providing a comprehensive, multidisciplinary view of a patient's medical history. While often used interchangeably, EHR differs from EMR, which manages digital patient charts accessed within only one organization.

A well-matched EHR can help your practice reap many benefits. However, a system that doesn't align with your practice's specific EHR requirements can have the opposite effect — creating hassles and delays for providers and staff, burying crucial clinical information, and potentially compromising regulatory compliance.

Careful EHR evaluation can significantly alleviate such concerns. However, it's not uncommon for smaller practices, especially those just starting out, to feel overwhelmed by the EHR implementation process. To help, we've broken down this complex process into a clear, actionable guide that includes tips and helpful recommendations.

Integrating an EHR system with existing workflows is a multi-step process requiring careful planning and precise execution.

The following EHR implementation checklists explain the key steps and considerations for implementing an EHR system and what each one requires.

Tebra's 2024 survey of healthcare providers from small private practices using EHRs revealed that developing a training plan for staff was the top action they would take to prepare for a new EHR (41%). A dedicated project team ensures accountability and smooth coordination across departments. Include representatives from clinical, administrative, and IT teams, and consider these steps:

Analyzing workflows ensures the EHR system aligns with your practice's specific needs. It involves the following tasks:

A well-defined timeline keeps the implementation process on track. Here's how to create one:

In 2024, Tebra surveyed 183 healthcare providers exclusively from small private practices who use EHRs regularly. When asked about the most important actions they would take to prepare for a new EHR, developing a training plan for staff was the top answer (41%). Here are the typical steps:

Proper installation ensures the EHR system is set up correctly to meet practice requirements. Set it up by following these steps:

Complete data migration supports a smooth transfer of existing patient records into the new system. The steps are:

Confirm all functions are tested and operating correctly before the go-live date by doing the following:

The launch phase marks the official switch to the new EHR system. Here's how to do it right:

Post-implementation monitoring ensures the EHR system continues to meet practice needs. Make sure you:

In addition to the steps above,the following points can smooth the process as you implement your new EHR system.

According to Tebra's 2024 EHR study, 28% of private practice providers say that managing downtime is one of the most significant challenges they face when using their current EHR. Downtime can be disastrous when it means you can't access a patient's record when needed. You may have to reschedule patients, leading to wasted time overall and lost revenue.

Downtime during EHR implementation is inevitable, but careful planning can minimize the impact on your practice. Keep these planning recommendations in mind:

Monitoring and evaluating the new EHR is vital to ensure it operates correctly and meets practice needs. It's also a way to identify any issues. After EHR implementation, consider the following recommendations:

Adopting an EHR system can provide significant benefits to healthcare practices, but it also comes with several challenges that can hinder successful implementation. Understanding these obstacles and implementing proactive solutions can help practices plan effectively and avoid common pitfalls.

The high expenses associated with EHR implementation, including software, hardware, training, and maintenance, can strain a smaller practice's budget. Practices must also account for potential hidden costs, such as lost productivity during the transition period.

Solution: Careful financial planning is essential. Create a detailed budget that includes initial purchase costs, ongoing expenses (such as maintenance and upgrades), and hidden costs like staff overtime. Investigate funding options or set aside resources before starting implementation to ensure financial stability throughout the process.

Technical limitations, such as inadequate hardware, limited internet connectivity options, and insufficient IT support, can discourage practices from adopting EHR systems. Additionally, systems that fail to integrate with existing workflows or other organizations can reduce efficiency and create frustration among users. A literature review by the Office of the National Coordinator for Health Information Technology (ONC) highlights that poor system integration and functionality issues, such as problems with electronic ordering, can negatively impact EHR adoption.

Solution: Address technical gaps before implementation begins. Replace outdated hardware, purchase necessary equipment, and switch to a high-speed internet provider if needed. Additionally, choose an EHR system that offers seamless integration with your practice's existing workflows and systems, and ensure IT support is readily available during and after implementation.

Resistance from both clinical and non-clinical staff is a major challenge. Less tech-savvy team members may struggle with the system, while others may resist the change due to unfamiliarity with new workflows. Mandating immediate compliance without input from providers can further increase resistance, as noted in the ONC-commissioned literature review.

Solution: Foster a supportive environment by engaging your team in open discussions before implementation. Build consensus by encouraging questions, considering differing opinions, and showing empathy for concerns. Involve staff in the selection process to increase buy-in and create a respectful, collaborative work environment that emphasizes the benefits of the new system for everyone.

Comprehensive training is critical for ensuring a smooth transition and maximizing the benefits of an EHR system. The ONC review found that insufficient training is a common cause of implementation failure, leading to lower system usability and increased stress for users.

Solution: Plan and budget for comprehensive, mandatory training for all staff members. Allocate dedicated training time in staff schedules and tailor training to match users' skills and roles. Communicate the importance of training to team members and provide ongoing support as they adapt to the new workflows.

Data security is a top priority when implementing an EHR system. Practices must address potential risks, such as data breaches, cyberattacks, or data loss, before implementation. Ensuring compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations and implementing robust privacy measures are essential steps to safeguard patient data.

Solution: Budget for and implement cybersecurity protocols and safeguards before EHR implementation. Review HIPAA and other regulatory requirements carefully and work with vendors to ensure compliance. Establish robust security measures, such as encryption, regular audits, and staff training on cybersecurity best practices to protect patient data and mitigate risks.

Inadequate planning during the implementation phase is a leading cause of EHR adoption failure, as the ONC study highlights. Common planning issues include failing to involve providers in the decision-making process, neglecting to invest in workflow analysis, and offering limited post-implementation support.

Solution: Invest time in the planning phase by conducting workflow analyses, gathering staff input, and allocating resources for post-implementation support. Work closely with your vendor to ensure the EHR system aligns with your practice's needs and establish a clear roadmap for implementation that includes continuous support and adjustments as needed.

Fabius Santos, CEO at Optimal Psychiatry and Wellness, shared insights on successful EHR implementation during a recent Tebra webinar. For Santos, adopting a one-stop, customizable EHR solution transformed his practice, saving valuable time and reducing burnout: "As an independent practice owner, I can tell you that the EHR does help us providers optimize workflows — from clinical charting to patient documentation to specialist referrals. And it saves time, valuable time, that we use on manual tasks or paper charting."

Santos emphasized the importance of preparation, including defining requirements and understanding associated costs: "This is a big decision … Writing it all down ahead of time will really help you ensure compliance with all the relevant regulation standards. There's different state regulations, and obviously understanding the associated costs."

Team communication is also critical to overcoming resistance: "If there's a big gap between how I see things and maybe how they see things, maybe that would provide a good opportunity to discuss why that is. And hopefully we can make people more comfortable with the change."

Santos acknowledged the learning curve but stressed the payoff: "Learning EHR is difficult, and it takes a commitment from everyone involved. You have to be ready to do work on your part if you want to get results."

By customizing his EHR system, Santos was able to improve workflows and streamline operations: "We were able to customize everything the way that I wanted to and hopefully work on improving our workloads and our processes. Today, luckily we're doing a lot better and everything's running smoothly."

For more details on Santos' experience, watch the full webinar here.

Tebra's all-in-one, ONC-certified practice management software, Tebra EHR+, empowers private practices with highly customizable features and ease-of-use across functionalities. Our platform puts everything you need to run your practice at your fingertips so you can spend more time on what matters most.

If you're considering EHR or switching EHR systems, Tebra provides seamless integrations, features that streamline scheduling, charting, coding, and billing, and robust training and support. Take a product tour (no credit card required) or schedule a demo to see our solution in action: