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EMR Implementation: "I've Selected an EMR. Now What?"

Selecting an EMR: Ready, Set......Go Compare!

A comprehensive and disciplined ambulatory electronic medical record (EMR) selection process not only leads to the selection of a suitable EMR for a physician office, but also creates the blueprint for a successful implementation. Procuring an EMR is important, but unfortunately the poor implementation of even the most suitable EMR will lead to a failed EMR implementation. Modern Healthcare reported that 19% of ambulatory EMR implementations had failed and the EMRs de-installed among 800 respondents to a 2007 Medical Records Institute survey. This number did not include ambulatory EMR implementation projects abandoned before being completed. These unfortunate situations are avoidable and are more typically related to poor implementations rather than poor EMR selections. Preparation and execution of a comprehensive EMR selection process will not only lead to the selection of a suitable EMR, but also illuminate the passageway to a successful implementation.

Over the next 5 years the physician incentives in the ARRA/Stimulus Package will help pay for the purchase and meaningful use of office EMRs and will subsequently lead to record numbers of physicians seeking and implementing EMRs. This has raised the concern that physicians may hurry into the EMR selection and implementation quagmire without adequate preparation. Educating physicians on health information technology (HIT) issues, including the selection and implementation of EMRs, is perhaps the most important way to help physicians avoid failed implementations. These developments and concerns are the impetus for a new series of Digitized Medicine medblogs called, “EMR Selection: Ready, Set……Go Compare!”.  A second series, "EMR Implementations: I’ve Selected an EMR. Now What?”, will be developed concurrently. The goal is to create a physician resource of best practices for the selection and implementation of office EMRs.

The EMR Selection Guide (miniaturized below) is a one-page conceptual overview of this process:

Selecting EMR

The time frames in blue boxes on the left side are relevant for small physician offices with a dedicated project manager who facilitates the efforts. The time frame will be longer for larger offices, for offices lacking a dedicated project resource or for offices with more time constraints. The time frame can be shortened by adding more project resources and/or providing more resource time to the effort.

The Action Items in the middle column are the specific tasks for office physicians and staff to work through during the selection process.  Although an office physician may choose to lead the EMR selection project himself or to assign one of his staff to lead the effort, the amount of effort and time involved should be carefully considered. One blog will delineate the effort involved and make a reasonable case for hiring an outside consultant, project manager or advisor to manage the EMR selection and implementation. It is very easy for internally managed selection and implementation efforts to take a lower priority to daily office activities and result in a suffering effort that may languish.

The Objectives column on the right identifies the purpose and goals of each phase of the EMR selection. In Month 1 the office is getting ready not only for the EMR selection, but also for the implementation. In Month 2 the office is continuing preparation activities and getting set up for the successful evaluation and comparison of an EMR that meets their needs. The results of these activities will later play important roles during contract negotiations and the implementation process as well. In Months 3-4 the active comparison of EMR vendors and products takes place along with continued preparation for an EMR. At the end of Month 4 an EMR is selected and contract negotiations begin.

This guide and the medblogs to follow are derived from ongoing personal research on the best practices for EMR implementations. Relevant references and websites are listed below and will be added to as appropriate. I hope physicians will find the information useful and I look forward to your comments.

Relevant references:

1. Arnold S. Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid. HIMSS. 2007.

2. DOQ-IT (Doctor’s Office Quality- Information Technology). Electronic Health Record Implementation in Physician Offices: Critical Success Factors

3. Forrester Research. Electronic Medical Records: A Buyer’s Guide for Small Physician Practices. California Health Foundation, October 2003.

4. HIMSS Ambulatory Paperless Clinics Work Group. EHR Implementation in Ambulatory Care. 2007.

5. Holbrook A, et al. A Critical Pathway for Electronic Medical Record Selection. Proc AMIA Symp. 2001;264-268.

6. Keshavjee K, et al. Best Practices in EMR Implementation: A Systematic Review. Proc 11th International Symposium on Health Information Management Research- iSHIMR 2006.

7. Larkin, H. How to do an RFP for an EHR. Medical Economics. Jan. 19, 2007.

8. Marcus, David D., Lubrano, John. Electronic Medical Record Implementation Guide. Texas Medical Association. 2007.

9. McDowell SW, Wahl R, Michelson J. Herding Cats: The Challenges of EMR Vendor Selection. Journal of Healthcare Information Management. 2003; 17(3):17.

10. Miller J. Implementing the Electronic Health Record: Case Studies and Strategies for Success. HIMSS. 2005.

11. Smith D, Mancini MN. A Physician’s Perspective: Deploying the EMR. Journal of Healthcare Information Management. 2003; 16(2):71.


1. American Medical Directors of Information Systems (AMDIS)

2. Center for HIT

3. Certification Commission for Health Information Technology

4. College of Healthcare Information Management Executives


6. Office of the National Coordinator for HIT

7. Texas Medical Association


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Thanks for the informative article and post...

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