Imaging Management, Volume 1 / Issue 1 Spring 2006

New Technologies Accelerate EHR Growth

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What to Consider Before Using a Specific EHR System

In most healthcare settings, two types of users of the EHRs can be identified - primary and secondary. Each group has specific needs that should be reflected in EHR features and functions. Primary users are those who provide direct patient care. This group uses the EHR for record-keeping and they are interested in features that reflect information found in paper charts, rapid response times, ease of use, and quick access to patient data.


Secondary users, on other hand, are those who use information in the EHR for research, education or management purposes. For this group, reporting and querying capability are the most important features. Understanding the differences between these two groups is critical as EHR products are rarely optimised for both. It is therefore important to be very sure for whom the intended uses are for prior to selecting a system.


Implementing an EHR Requires More than the Actual Cost

A sound EHR selection process will result in a product that meets key needs and does not break the budget. Be aware: bells and whistles can be very expensive and rarely provide significant benefit to the organisation. Also, keep in mind that the cost of implementing an EHR is much more than the actual cost of the product. Successful implementations require extensive changes within the organisation. This often means hiring new personnel, extensive job retraining, implementing new security and disaster recovery measures, and upgrades of existing hardware and networks. With this in mind, the EHR selection criteria should focus on functions and features that will be used immediately and meet the most important objectives of the organisation.


Finally, the budgeting requirements for an EHR project should focus on the total cost of a complete implementation; not solely on the cost of the software plus hardware required. Finally, the budgeting requirements for an EHR project should focus on the total cost of a complete implementation; not solely on the cost of the software plus hardware required.


EHR Selection Must Include Clearly Matched Requirements and Features

The actual process of selecting an EHR can be divided into two phases. The first is problembased and focuses onmatching the organisation's stated goals and objectives directly to product features and functions. The second phase is feature-based and emphasizes a side-by-side comparison of competing EHR products.


Problem-based selection ideally begins with a review of the organisation's stated goals and objectives. Using this information, a formal systems analysis should be conducted to review information flows, job functions and the overall efficiency of the clinical operation. Once this systems analysis has been completed, a formal list of requirements can be generated - usually referred to as a “requirements document” or “requirements specification”.


The requirements specification serves three purposes. First, it provides a listing of the required features and functions that any product must have in order to meet the needs of the organisation. Secondly, it provides an objective set of criteria for comparing products. Its final use is for creating a formal request for proposal (RFP) which is then sent to vendors that may wish to bid for the project. The requirement specification is also very important to the implementation phase of the project because it provides, in one document, cross-referenced goals, objectives, features, and functions which can be quite handy when used as a metric to track project progress during an implementation.


Feature-based selection is straightforward - assuming that a requirement specification has been created. This is simply a side-byside comparison of two or more products to determine which offers the greatest number of required features and functions. When doing the feature-based comparison, required features and functions should be prioritized from essential to wish list. Using this method, all key objectives and goals are sure to be addressed with any product selected. Many organisations use a point-based, numerical system to calculate a final score for each product, with the highest scoring product winning the competition.



A successful EHR implementation requires the selection of a product that meets all the needs of the organisation. Therefore, the selection process begins with a thorough review of the goals and objectives of the organisation followed by a detailed analysis of current functioning along multiple axes. This information is then used to create a requirements document that allows the organisation to realistically select the ideal EHR product. Inmost organisations the entire process, from the statement of goals to the selection of the final product, requires six to nine months.


There are no shortcuts.

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