EHR Implementation Checklist and Cost Breakdown

EHR Implementation Checklist and Cost Breakdown

Electronic Health Records (EHR) implementation is the process of integrating a software-based document service into a healthcare company’s workflow. 

Introducing a new system in any industry follows many similar processes. An EHR implementation plan adopts the same milestones as any new software adoption, but there are some aspects unique to healthcare. 

This article will cover what is involved in implementing EHR, as well as providing a checklist for success, and discussing the costs you can expect. 

The EHR implementation process sections will be as follows:

  • Benefits of EHR implementation 
  • Project steps
  • Recruiting the right team
  • Forecasting project costs
  • Scheduling an EHR implementation

Benefits of EHR Implementation

Electronic health records are a major step up from paper records. There is resistance to change in any workplace. The saying ‘if it’s not broken, don’t fix it’, is often used by staff members who are not willing to embrace a new way of working. 

That’s why it’s important to point out the benefits of trying to implement EHR in hospitals at the beginning of any change process. These are just some of the benefits: 

  • Simpler access to patient medical records 
  • Improved administrative efficiency
  • Records are easily transferable between different specialists and departments 
  • Improved safety, as records are protected from physical loss and destruction
  • Improved connection to pharmacies

Project steps 

It’s important for implementation teams to have a clear idea of what they are trying to achieve and how they will go about it. The following steps are key: 

1. Build an EHR Implementation Roadmap

Project owners should start with a crystal-clear outline of all the tasks and processes required to complete the implementation. One of the earliest decisions to make is whether to go for a “big-bang” all in one approach, or a phased approach. 

Team roles and responsibilities should be clearly assigned. Physicians, administrative managers, and IT staff will all have different, but important roles to play. Even patients have a job to do as they can take part in the testing and feedback phase. 

Beyond identifying the individuals, there needs to be an implementation committee created from key stakeholder groups. Part of the project plan involves assigning clear reporting and accountability lines. 

After defining the project plan, you can schedule the work with confidence. 

2. Adapt Workflows

This is a crucial step. Workflows within hospitals, especially rural hospitals, tend to be established over time and can outlive staff. 

It’s not uncommon for outdated workflows to remain the same for many years. Think of the design of a hospital, which defines a workflow. Patients arrive at the administration desk, are processed, and then sent to a waiting room. 

What if there is an online booking system for non-emergency cases that negates the need for a visit to the administration desk? Can the old workflow accommodate this? 

Implementing EHR could disrupt these workflows. That’s why it’s a good idea to adapt them before the implementation project starts.  

3. Install and Test the Hardware

Project teams should prepare all the physical hardware that the EHR system will depend on. Of course, it’s always best practice to test these beforehand. 

Servers, tablets, and desktop computers all need to be tested before go-live.  

4. Troubleshoot EHR Software

In the same way that the hardware needs to be tested, software needs to be tested too. Even if your EHR system is a bespoke system developed for your needs, it needs extra tuning to adapt to the workflow on the ground.  

5. Migrate Records 

This is typically a time-consuming and troublesome stage. Migrating records includes the transfer of clinical records like diagnosis notes and non-clinical records like billing data from a physical system to a new one. 

This is where information can be lost or miscategorized. This transfer process often brings home the reality of why EHR is so important in the first place. It’s very easy to misplace crucial physical records.  

6. Cater for Disruptions 

It’s rare that a massive EHR implementation takes place without disruptions. In fact, it’s so rare that you are advised to expect disruptions and outages and plan accordingly. 

Common problems can occur at the last minute like internet outages and software bugs. Sometimes human error causes delays, especially in the early stages of a new system.  

7. Perform EHR Training 

This is a vitally important step. It’s often the case that staff in a busy practice do not have time to attend training sessions, but it should be non-negotiable.  

Without proper training, an expensive and well-planned new software project can face heavy disruptions during go-live. The need for training should be stressed to all stakeholders from very early on in the project. 

Recruiting the right team 

Your project plan is a vital part of the process but be sure to reserve special attention to the makeup of the team. 

You will need change champions who will drive the adoption of the new system. You will also need senior-level input so the seriousness of the take-on is well-known. 

The team can be the difference between a new EHR being adopted on time and on budget, or not. The team should include medical professionals, administrators, compliance specialists, and technical specialists  

Here are some of the roles that an EHR implementation team normally contains: 

  • Project Manager 
  • Lead Physician
  • Lead Super User
  • Physician Advocate to represent physicians on training matters
  • Nurse Advocate to represent the nursing corps with their own concerns
  • Administrative Advocate to represent support departments such as billing

It might be hard to get someone as senior as a Hospital Director on the day-to-day team but try to get them to perform the role of implementation champion with their daily communication to section managers. 

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Forecasting project costs

Once you have a project plan and an implementation team, you can get serious about nailing down the EHR implementation cost breakdown. 

Setting up and maintaining an EHR system can be expensive. Physicians and practice managers are often discouraged by the upfront costs of EHR implementation. 

It’s common for many budgets to run over. A clear budget with the following elements should help you make sure no unexpected costs come up: 

  • Hardware and networking costs
  • Overtime costs for hospital staff and contractor staff
  • Customization costs from the EHR vendor
  • Training fees
  • Consultancy costs
  • Data conversion, backups, and storage costs

Be sure to request a detailed quote for your EHR System. Costs are highly variable as each site has its own challenges. Costs also vary between EHR providers.

Scheduling the EHR Implementation

How long does it take to implement EHR systems? That’s the million-dollar question. This is one of the hardest estimates to work out. Remember, a schedule can be impacted by one or all of the following: 

  • Project scope: how big is the job? 
  • Project teams: are they responsive and supportive? 
  • Project budgets: does it cover what’s required to keep the wheels turning? 

Predicting the duration of the project is often a challenge. What is easier is to break the implementation down into two of the most time-consuming parts: 

Migration of Clinical and Administrative Data 

We mentioned this is a troublesome task. It is true that patient data is the heartbeat of an EHR implementation. It's not an easy job either. Depending on the size of the practice, there could be vast amounts of patient files. 

Medical legislation like HIPAA and just common best practice dictate that healthcare organizations need to keep patient data for many years. Here are some of the key stages of EHR data migration: 

  • Converting paper records to electronic records. 
  • Data verification and cleansing. 
  • EHR database configuration. 
  • Matching old data to new database fields. 
  • Data transfer from the old system to the new one. 
  • Checking legacy data for accuracy vs new data inputs. 

As you can see, each of these tasks is laborious and time-consuming. Couple that with the fact that there is no room for sloppy work. 

The integrity of this data must remain intact. How long this process takes depends on how much resources you can devote to the job.

User Training

User training is not to be taken lightly. Getting your training right could lead to a 10% increase in productivity and $70,000 in annual savings.  

For training to be successful, you will need super-users and active change advocates. Your communication needs to be clear as you communicate with your teams about why training is so important. 

It’s important to insert feedback loops to keep users talking to your project management leaders. One of the most common causes of EHR implementation failure is poor user adoption. 

The timeline for training must be right. Too short and the users will not grasp the new material. Taking too long costs money and delays the whole project. 


EHR implementation is a challenging process, but it is manageable with a clear plan. Project teams should create a clear checklist in order to be successful with the implementation.  

By following a set of best-practice guidelines, you have the best chance of sticking to the budget and delivering the project on time.

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