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 office) or remotely. Remote EHR systems are described as “cloud-based” or “internet-based.”

With over 75% of office-based clinicians and 96% of hospitals in the United States using an EHR system, nearly all practices have an immediate, practical interest in improving the efficiency and use of their EHRs. Some practices may be considering a replacement acquisition of an EHR to better care for their patients and reduce the burden on clinicians who need to use the EHR.

As part of the 21st Century Cures Act, ONC is helping healthcare practices improve the quality of care for patients, which includes optimizing EHRs and increasing data interoperability.

This Playbook is a source for clinicians 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 experience more efficient, less burdensome, and more effective.

The EHR journey

Most clinicians agree that implementing an EHR is an ongoing journey. There is no single destination or end, as there’s always the opportunity to optimize workflows or improve the use of data. This section provides resources to guide you through the many stops along the road to 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 use your workflows to improve and optimize the way you use your EHR. This part of the ongoing EHR journey starts each time you adopt additional health IT solutions, such as:

• Adding a patient portal
• Connecting to a health information exchange
• 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. Navigate the Playbook and select the tools appropriate for your EHR adoption journey.

EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print

Selecting an EHR and then negotiating its purchase is a challenge for any healthcare clinician. ONC's downloadable electronic health records contract guide can help you, your business managers, and your advisors select the right technologies for your practice, and then navigate the acquisition process. It will also help you negotiate contract terms to minimize potential problems and to 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.

The EHR contract guide in 2 parts

Part A highlights critical planning steps to help you understand the EHR acquisition process. A thorough understanding will help you communicate your specific requirements to potential vendors. Topics include:

• Types of EHR products and service models
• Researching and comparing EHR products and vendors
• Identifying and prioritizing your EHR’s technical and operational requirements
• Due diligence — finding the best EHR for your needs
• Understanding certification and regulatory requirements
• 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 illustrate 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

The decision to move to an electronic health record (EHR) system requires a lot of time and effort. Before you begin your implementation project, it’s important to understand the benefits that an EHR brings to your practice. It’s also important to set realistic expectations. Common roadblocks to successful adoption include:

• Difficulty understanding your organization’s information needs
• Uncertain costs
• The intense effort required to identify and implement a system

How can you overcome implementation roadblocks? Gather as many of these success factors as possible:

• Readiness
• Eager personnel
• Someone to champion the cause
• Stakeholders who perceive EHRs as useful
• Teamwork

Remember: Your planning must address both the initial and the 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:

• Reduces upfront hardware and software costs
• Reduces ongoing maintenance costs
• Lets you start small and increase IT allocations as needed
• Provides higher levels of IT service availability than in-house IT services
• Reduces run-time failures

Common challenges:

• Data security — you and your cloud clinician share responsibility
• You have a lower level of data access and control compared to an on-site EHR system

Locally hosted EHRs

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

Common benefits:

• If your practice doesn't already have reliable, high-speed internet access, a locally hosted option will require less investment in internet connection upgrades
• You won't have to trust an outside organization with the security of your patients' data

Common challenges:

• Making sure the servers are physically secure is your responsibility
• You'll be in charge of performing regular data backups

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.

A successful EHR adoption consists of 2 steps: pre-implementation and implementation. Following these guidelines will help you get the most out of your system.

During the pre-implementation phase, you:

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

Establishing a governance process means creating guidance and a stewardship plan focused on data integrity. This helps ensure that your EHR system is implemented in an effective and sustainable manner and that your practice manages data appropriately.

During the implementation phase, you:

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

It’s time to evaluate the implementation process and its effect on your practice. This is where you learn what worked — and what didn’t — so you can either avoid repeating mistakes or follow a similar path to success.

Issues to consider 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?

You’ve met a significant milestone on your electronic health record (EHR) journey. A thorough evaluation provides a solid foundation, and it will help you continue to improve the value of your EHR system.

Plan for 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. Once you have your EHR up and running, it's helpful to:

• Take a continuous optimization approach — meaning the system can always be improved
• Establish a process to gather feedback from clinicians, patients, and other EHR users
• Make improvements based on user feedback and best practices

 

Migrating from paper-based documentation to an electronic health record (EHR) system requires careful planning, and so does migrating from one electronic environment to another. Reasons you may want to replace your EHR include:

• Outgrowing your first EHR’s capabilities
• Expanding your practice
• 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.