EHR Replacement: Get It Right the Second Time

If your organization has completed a thoughtful analysis and determined that your incumbent system cannot be optimized, the next challenge is to plan and execute a successful replacement EHR implementation strategy.

The Game Plan

Replacing an EHR system is often more complex than implementing the original one.  It’s critical to invest in up-front planning to define the business and end-user needs, implementation approach, data migration method, and technology integration strategy.  To vet these areas, organizations should consider four components:


As with any complex project, the involvement and support of the individuals who are affected can ultimately dictate whether the outcome is successful.

  • Organizational Buy-In – All users must understand how the new system will enable them to be more successful in their jobs.
  • Executive Leadership – Implementation cannot truly succeed if it is managed as an IT project and/or lacks clinical and operational leaders willing to hold people accountable for the success of the system.
  • Change Management – Acknowledge and leverage the valuable input experienced users may have while setting realistic expectations about what users will and will not have an opportunity to influence.


One of the most common mistakes made when implementing a replacement EHR is trying to recreate work flows optimized for the original system.  Organizations need to:

  • Perform thorough current-state work flow analysis of clinical processes.
  • Involve clinical staff and system application analysts in designing future work flows.
  • Thoroughly test work flows by a variety of users with quality initiatives and population health in mind.
  • Launch mock go-lives that simulate common processes from beginning to end.
  • Devise a strategy to transition staff from one system to the other.


IT staff will most likely focus on the obvious technology impacts of the replacement system, including the often overlooked area of interfaces.  Because a new system will involve new work flows and data mappings, the interfaces between systems should be reviewed in detail.

  • Include an in-depth testing process that accesses each data element being passed between systems, any translation rules that may be applied to data, and triggers to pass off data at appropriate times.
  • Develop a data migration strategy to determine when data will stop flowing to the old system and start flowing to the new one.  For example, if you perform your system cutover on January 1, does a lab result from a December 20 visit go into the new system or the old system?Data_Graphic_13M11D15


The replacement poses a new problem – there’s already a wealth of discrete data in the old EHR, and an organization may be tempted to move it all over.  Treat the existing EHR as you did paper charts and ask the same question:  What do you really need?

  • Consider converting:
    • Active problem lists, allergies, medications, immunizations, and possibly patient history, last visit note, and lab results.
    • Long-term meaningful use, Physician Quality Reporting System (PQRS), or population reporting data required by your organization.
  • Consider archiving:
    • Data that is unlikely to be needed in routine patient care.
    • Data elements 3 years or older, including acute conditions and scanned documents.

To learn more about successful EHR replacement, read the Executive Briefing on our Web site.

This entry was posted in EHR/EMR, Healthcare IT and tagged , , , , , by Michelle Holmes. Bookmark the permalink.

About Michelle Holmes

Michelle is a leading industry expert on the application of IT strategies in physician practices and ambulatory care settings. As a leader of ECG’s Healthcare IT practice, she directs the development of IT plans and other key services. Michelle’s deep background with implementation and management allows her to craft strategies that prioritize actions with the greatest short- and long-term impact on patients, staff, physicians, and leadership, rather than tasks that may be the quickest and easiest. She is known for leading focused engagements that create value for her clients, apply innovation to complex tasks, and ensure clarity at the task level so that action plans are successfully executed. With expertise in many major IT platforms, including NextGen, eClinicalWorks, Epic, and MEDITECH, Michelle frequently shares her insights in articles and educational presentations for national audiences. Healthcare executives, IT vendors, professional associations, and industry publications, such as The Wall Street Journal’s MarketWatch, rely upon her insights for using IT to enhance and streamline patient care delivery and ensure that IT investments deliver their expected returns and benefits. Michelle has master’s degrees in business administration and health services administration from the University of Washington, a bachelor of arts degree in health services administration from Eastern Washington University, and a bachelor of science degree in business management from The University of Utah.

One thought on “EHR Replacement: Get It Right the Second Time

  1. Pingback: Smooth Transitions: Integrating Into a Multispecialty EHR | ECG Management Consultants, Inc.

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