Ready to implement a new EHR?

It’s time to implement a new Electronic Health Record.  Now what?

Whether you are looking to move to a new platform, or this is your first time implementing an EHR, the first few questions that loom large are:

  • “Where do I start?”
  • ”What resources will I need?”
  • “How long will this take?”


Electronic Health Records (EHR)  can transform the way data is captured and reported, but the landscape is vast, and it can be easy to get lost in the sales/advertising mix.  Choosing the right EHR for your agency is imperative for long-term success.  Starting strong, with a core team and solid plan, is the first step towards selecting the right EHR for your business.

EHR Selection Steps:

Step 1: Identify your Core Team

First, identify your core team.  Include both internal and external resources.  What do we lack internally that we could use help with?  Where are we strong?  By engaging a diverse team of forward thinkers from the start, you will ensure an integrated approach to evaluating the unique needs of your business.

In selection, choose thinkers that represent all functional areas of your business; this will help uncover the specific clinical, billing, and quality needs to consider in the EHR selection process.

Remember, internal capacity often dictates success; be sure to include an external project manager to drive the process with you, and to add experience and objectivity.  Thinking you can go it alone can be costly in the long run.

Your core team should include representatives from the following internal teams:

  • Management/Operations
  • Financial/Billing
  • Clinical
  • Quality/Compliance
  • IT
  • Medical

Step 2: Develop your Project Plan and Timeline  

Once your core team has been identified, begin development of your estimated project plan and timeline.  This should include your steps for execution, the timeline for selection and implementation, and any other considerations that may impact your decisions. Need more assistance? Hire EHR consultants who know their way around the industry.

For instance, are there other major development or rollout projects occurring that could impact your plan?

Don’t underestimate the value of tracking your progress each step of the way.   A Gantt Chart is a great way to manage time spent and activity deadlines.  The example below shows some basic steps in EHR selection mapped for a period of time.

Step 3: Define Agency Needs and System Requirements

With a project timeline developed, the core team should then work to identify and prioritize required components for the EHR.  Some questions to answer include:

  • What are our critical components?
  • What are the requirements for each component?
  • Did we include requirements to meet strategic goals?
  • What can’t we live without/deal breakers?


Next, develop a rating scale to objectively evaluate and compare different systems.  This will assure consistent rating during vendor evaluations and help you to prioritize critical components, assuring appropriate value and rating in your vendor assessment.

Include feedback from your direct care team.  EHR functionality is critical to your frontline workers, direct care providers and clinical staff.  Staff want to be able to do their work ethically, efficiently, and without technical difficulties.

These members will provide the best feedback on their workflow and documentation needs, including critical process elements that operations may not be aware of.  Detailed analysis of this workflow is a vital step to review in preparing for your EHR selection.

Should you work with a Project Manager?

Driving the EHR selection and implementation process requires organization and oversight that is often difficult to manage without external guidance.

Project Managers can see the broader picture, provide independent workflow analysis, enhance staff skillset through engagement and teaching, and use their experience to help your business avoid pitfalls.

Utilizing the expertise and experience of a Project Manager for your EHR selection and implementation will provide the objective partner you need on your team.

How do I know which Vendors to look at?

In Part One of this series, we talked about the importance of establishing a core team, developing your project plan and timeline, and identifying your specific agency needs.  As you gather  your resources and develop your project plan, you might be wondering how to narrow the field.

EHR’s, EMR’s, hosting packages, contract negotiations – Sales pitches that say they can do it all!

It may still seem like there are an overwhelming number of options on the market, and there are, but with the correct tools at your disposal, identifying a Vendor and EHR platform that is right for you is next on the horizon.

Step 4: Identify Select Vendors 

Now that you learned what you need  from our last posting, it is time to determine which vendors to look at more closely.  We know you don’t want a flood of sales-y emails hitting your inbox from the world of electronic health records.  So how do you figure out which vendors to get more information from?

Determining which EHR to look at can be tackled IN a few ways:

  • Research, references, and recommendations. Use your core team to help gather information.
  • Ask around; you’ve got friends in the field. Which EHRs are used by similar providers?
  • Discuss your internal experience with EHRs. What have members of your team used previously with success?
  • Hire a consultant to help you collect information and narrow the search. Don’t assume you have all the answers.
  • Use your Vendor Evaluation Matrix! How can you narrow the search based on this criteria?


After compiling a list of potential vendors, you can now weed out any that don’t meet your baseline criteria.  Remember, those deal-breakers are important to your team.

As you are researching vendors, look into the owner and management structure.  How long have they been around?  Is there a risk of ownership change?  Is this software going to be viable in 5, 10, 15 years?  What does their support structure look like?  Does the vendor have long term strategic goals that are aligned with your agency’s needs?

Recommendations from trusted partners are invaluable.  Consider reaching out to see what agencies with similar funding sources and service delivery systems are using.  They will also let you know what they did right, and wrong, in their selection process.

Step 5: Write A Request for Information (RFI)

Once you know which vendors you are interested in learning more about, you will want to reach out for more information.  What do these vendors have to offer your agency?  What are the implementation and on-going costs?  Do they have current clients with like business practices?  Are there other users in the same state?

Writing a detailed Request for Information, commonly known as an RFI, will start you on the right track.  Your RFI should include a full project background and timeline for selection and implementation and any relevant history, like current and prior systems used for data collection.  Give them everything you are looking for in an EHR system.

Include your deal-breakers.

Be sure to refer back to the critical components previously identified.  What did your team establish as their ‘must haves’ in your next EHR?  This is where feedback from your core team on their workflow is critical.

Request information on the implementation processes, the cost to implement, annual support fees, and hosting.  Let’s make sure you know exactly what you would be paying for now, and in the future.

And don’t forget to provide a deadline for responses.  You’ve got a plan and a timeline.  Stick with it.  This attitude will continue to drive the importance of creating and meeting tangible deadlines for your project and your team.  EHR selection and implementation takes time and perseverance.  Tracking your progress is critical to success.

Step 6: Evaluate Vendor Responses

You’re almost there.  Based on the vendor responses, which vendors should be asked to provide full system demonstrations?

With your core team, complete further analysis of each EHR system based on vendor response.  Compare these responses to your RFI by using your previously developed Vendor Evaluation Matrix.  You can evaluate, prioritize, and re-prioritize as needed to determine which systems will fall on your short list.

Vendor Evaluation Matrix      
Functional Area System Requirement Importance (1-4) Score (1-4)
Financial Send client statements … 4 3
Clinical Capture live signatures … 3 4
Medical e-MAR and e-Prescribing … 3 0
Security Vendor hosting package … 3 4
Client Portal Consumer virtual record … 4 4
Reporting Client daily census report … 3 3
State Reporting State quarterly reporting … 4  
System Setup Ability to configure setup … 3  
Support Structure 24/7 access to support …    
Add-on Features To be determined …    


Once your short list of preferred vendors is established, start scheduling more in-depth system demonstrations.  Determine the length of time needed for this review and the availability of your core team to participate in the process.

Things to consider:

  • Do you have the expertise needed to ask critical questions?
  • Do you have the internal resources to take the next steps?
  • Is staff trained on how to complete the objective vendor evaluation?
  • Have you asked the vendor to demonstrate how the system will handle your ‘must have’ scenarios?
  • Who will compile the vendor evaluations for review?

How do I pick the right EHR?

We covered a lot in the first two episodes of this series.  You should feel confident taking the next steps towards selecting the right EHR for you.

Vendors have a format to follow in their sales demonstrations that may not touch on all system functions.  For example, you might see the end result of some report functionality, like a fancy dashboard, but chances are you also want to drill down on this data for your own independent analysis, or custom reporting.  Ask to see it.  The proof is in the pudding.

Really, don’t be afraid to ask that all components of the EHR’s functionality be explained in detail when scheduling your vendor demos.  Implementing a new EHR is a huge investment of your time and resources, you want to be comfortable that you’ve made the right decision.

Request to see system functionality that is important to you and your core team.  Provide specific scenarios to the vendor.  For example, 837 processing and month end reconciliation reports will be important to your finance team; what are other significant functions you need to see performed in your EHR demos?

Does the system allow for e-scripts and e-labs?  How does that actually work in system?  What does configuration entail?

Shows us how this works and how we set it up, soup to nuts.  

Step 7: See those Demos

Once your list of vendors has been vetted, you can now schedule more in-depth demonstrations.  Vendor demonstrations can take place on-site and/or remotely.  To fully experience all that an EHR has to offer, make sure that vendors provide you with enough time to complete your review to your satisfaction.  A thorough system demonstration usually does not take less than two business days.

Include your core team and other critical staff in the full vendor demonstrations.  Although time-consuming, having representation from all functional areas of your business will ensure that all aspects of your workflow are being considered.

Use your Vendor Evaluation Matrix to weigh the critical components previously identified by your core team.  This work will establish the foundation for your final selection.

Step 8: Compare your Finalists  

After a flurry of demonstrations, it’s time to complete your analysis of each finalist with your internal core team.  Evaluate each by aggregating the findings from your Vendor Evaluation Matrix.  Once each vendor is scored, you can properly compare the results using the same objective rating system.

Out of the demonstrations provided, who did you like the best and why?  How did each Vendor score in your evaluation?

When the list is narrowed to 2-3 vendors it is time to check references and resolve any unanswered questions.  Do you have all the information needed to make your final decision?  Don’t hesitate to reach back out to a Vendor and ask for clarification on any system functionality.  The more information you have, the better prepared you will be to select the EHR that is right for you.

Step 9: Select your EHR and begin Negotiations

Select the Vendor.  Really, it’s time!

Once you have reviewed the functionality of the EHR finalists to your satisfaction and looked at the final numbers, it is time to select your EHR and notify your vendor to begin contract negotiations.

Negotiating your contract can be tedious.  Be sure to have a clear understanding of what is included, and what isn’t.  This requires some time and attention, and it can be beneficial to utilize additional resources to provide an independent eye.  Make sure your legal team reviews the contract before signing.

Things to consider:

  • Implementation Process and Go-Live Rollout Schedule
  • Overall Cost and Annual Support Fees
  • Additional Training and System Configuration/Reporting Development Costs
  • Cost of Add-on programs, like enhanced reporting, e-prescribing, etc.


Questions on the next steps in EHR selection?  Please reach out to us at [email protected].

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