EMR implementation: Getting it right the first time

With the need for increasing productivity and efficiency in healthcare and the growing role of digital care, the need for a strongly performing electronic medical record (EMR) is pivotal. However, it’s not often an easy journey to get it right the first time. The implementation of an EMR system typically underpins a major organisational transformation that touches nearly every function in a healthcare enterprise. In this article, the value of strategic planning, program and change management when implementing an EMR system are discussed. Practical advice on avoiding common pitfalls in EMR projects and a structured approach to managing risks are also showcased.

Electronic medical records support the entire healthcare delivery value chain, from patient registration and appointment scheduling to management and transitions of care to discharge and billing. Having an EMR is also crucial to be ready for the current and forthcoming digitalisation of care delivery. Organisational activity in this area has been spurred on by the COVID-19 pandemic. A global survey of 200 healthcare CEOs¹ in 2021 found that almost 50 percent of healthcare leaders were fundamentally revising their approaches to electronic health records (EHRs).

Given the complexity and cost associated with EMR implementations, it may be tempting for a healthcare organisation to rush an implementation with the intention of making iterative changes down the line. However, shortcuts may not be the best route to choose. Based on KPMG’s experience in supporting these projects worldwide, shortcutting an EMR project can negatively impact benefits realisation and lead to broader organisational disruption. In our view, using a robust implementation strategy is key to getting things right the first time and essential in helping to facilitate success, minimise delays, and increase health care worker satisfaction, as well as help decrease the chances of system usability being compromised.²

With the deep experience of KPMG firms in helping organisations around the globe navigate the complexities of EMR implementations, we aim to help healthcare organisations get things right the first time. Below we offer insights on the most common pitfalls for organizations embarking on an EMR implementation and our practical guidance on how you can avoid them.

• Underestimating the scale of change: Introducing a new EMR is as much a change management project as it is a software project. A new EMR can affect the work processes of nearly everyone who works in the health system. Each design decision about how to configure and use the EMR can have both upstream and downstream impacts on other systems, processes and workflows. Not recognising the substantial end-to-end process impact of the implementation risks can create further stress on staff, who are often already struggling with existing workloads. It is important to help staff embrace, rather than reject, the change. These projects provide an opportunity to engage clinicians and staff to redesign core business functions to improve their workflow. But mismanaging the scale of change could result in major disruption and organisational risk.
• Thinking in silos: Approaching an EMR implementation as a department-by-department software configuration project will likely result in significant complications to processes upstream and downstream. These risks are real, as they can impact the speed and quality of care to patients.
  An EMR implementation is an opportunity to radically improve value streams that bind the organisation. Organisations should maintain a customer-focused lens when thinking about the end-to-end patient journey and how information needs to flow among clinicians and staff, and across, as well as within, departments, applications and external partner organisations.
• Insufficient training: Many healthcare organisations do not pay adequate attention to planning for, delivering and reinforcing training of the EMR in the context of “day-in-the-life” workflows, which can result in diminished adoption results. Ideally, didactic training sessions should be reinforced with one-to-one follow up and strong “at-the-elbow” support at go-live. However, since the pandemic, we have seen an over-reliance on virtual training methods with minimal at-the-elbow support, and sometimes not even making the training mandatory. In our view, training should be treated as a priority and be mandatory – no training, no login. Other important training-related considerations include replacement coverage when clinicians are in training, having a sufficient number of trainers, accommodating all work shifts, and having a mix of training channels and facilities to accommodate the different needs of clinicians and staff.
• Misjudging the technology and data uplift: Healthcare organisations should not underestimate the application modernisation, data management, reporting and data governance implications of these changes. A new EMR may need to interface with hundreds of other legacy systems both internally and externally to the organisation. If it isn’t set up to share data with other systems both within the healthcare system and with trusted partners, the value of the EMR-enabled transformation can be reduced. Another shortcut that many organisations take is to “lift and shift” existing reports into the new system. Just as clinical workflows need redesign, so too do the (typically) thousands of legacy reports and the data architecture underpinning them. When an EMR becomes the new single source of truth for an enterprise, it provides an opportunity to rationalise reports and redefine the operational metrics by which leaders and departments are held accountable. Data governance policies and processes, particularly focused on data quality and integrity, should also be examined as they can create a foundation to accelerate advanced analytics later. 

Given the high stakes and costs involved in these transformational initiatives, KPMG recommends taking a structured approach to preparing for and monitoring risks throughout the EMR implementation. KPMG professionals use an extensive EMR risk and readiness framework to identify the top nine major domains of risk that healthcare organisations should consider in advance of and during their projects. 

Further defining “what good looks like” in each domain provides a concrete reference point for healthcare organisations to compare themselves for an honest assessment of their readiness. When taken together, these nine domains form the basis of a comprehensive project plan to help guide and prepare your organisation for a successful implementation. 

New EMR systems provide a valuable opportunity to reimagine the way care is delivered in healthcare organisations. In our experience, getting implementations right the first time is achievable with strong planning and management. This upfront effort can help prevent many headaches down the road and ensure that organisations gain maximum benefit from the process.

• An EMR implementation can underpin a generational level transformation, affecting many aspects across healthcare organisations. Healthcare organisations require a clear focus on what they are trying to achieve and the risks they need to mitigate during their EMR implementations. Putting in the effort to get it right the first time through careful planning and strong program management may be more work up front but can help accelerate time-to-value over the short and long run.
  
• When preparing for an implementation, organisations should apply a customer lens and think about the end-to-end patient journey to consider how best to improve their experience through the transformation. It is equally important to consider how information needs to flow between, as well as within, departments to support clinician and staff and partner organisations. Thoroughly mapping out integrations, applications, and infrastructure are important foundational activities that can allow the organisation to get more value from the data over time.
• Minimising risks during implementation is not only important to get to a smooth go-live, but it is also crucial to helping staff adjust to the new EMR and workflows to help maximise adoption. Effective change and risk management are at the heart of successful EMR-enabled transformations, where leadership teams and workforces feel engaged, empowered and confident in their abilities to provide the best care possible for their patients.

Electronic medical record implementations are complex and challenging undertakings. At KPMG, we assist healthcare organisations and systems around the world to navigate the complexities related to EHR systems and work with many EHR system vendors to deliver successful and sustainable implementations. KPMG professionals can support planning, designing, building, testing and implementation services, and monitoring risks throughout implementations (including using the risk and readiness framework referenced above).

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The views and opinions of external contributors expressed herein are those of the interviewees and do not necessarily represent the views and opinions of KPMG International Limited or any KPMG member firm.