As the old saying goes – “Fail to Plan – Plan to Fail.” With the numbers of small physician practices adopting EHRs slowly increasing, Health IT experts agree that the biggest roadblock to a successful Electronic Health Record implementation is still not setting clear goals.

In a recent report, published by the American College of Physicians, Jerome H. Carter, M.D., said “You have to plan.” Dr. Carter is also the Founder and CEO of NTM Informatics in Atlanta, GA and is currently the Chair of the HIMSS EHR Adoption Task Force. Dr. Carter says despite overall increased interest in adoption of EHRs, improved products, and vendor relations – many EHR implementations today are still dismal failures – and often for the same reasons; unclear objectives and expectations and poor management and lack of staff involvement.

In a video on EHR vendor selection, available on – Dr. Eric Fishman with EHRScope, reiterated much the same thoughts. In the video Fishman says to viewers: “Ask yourself these questions: Are you trying to make more money, provide better medical care, make your worklife easier, get home earlier, get a better reputation in your community? I can’t tell you what is important to you and your practice, but I can tell you from experience that you had better figure it out prior to implementing an EHR, because having a mis-matched technology solution is no solution at all.” You can see the complete video right now at:

Both Doctors agree that an EHR implementation does not start at the point where you sit down with your chosen vendor, but the moment that you make the decision to switch over from paper.

Once the decision to go paperless has been made, now is the time to rely on your staff for feedback and input. The staff and senior management who will be most impacted by the EHR implementation need to be heavily consulted with about their problems, concerns, and what they ultimately hope to accomplish with an EHR. Understand that job responsibilities are likely to change after EHR implementation, so now is the time to make sure staff members understand, and will be comfortable with these changes. Health IT professionals say this process can take several weeks before any actual EHR solution is considered.  

The next step now that you have clear goals and reasonable expectations is to start the vendor selection process. There are hundreds of vendors to choose from. Dr. Fishman says, “Even if you have already narrowed the field by just looking at solutions that are CCHIT Certified for example. Or, you’ve decided that you’re going to discontinue using your existing billing or practice management system and therefore that you want an integrated EHR and practice management system. You will still have a universe of 100 or so companies to review.”

At this time you need to consider hardware issues and any other recourses or additional staff your EHR implementation may require. Fail to estimate these potential costs at the outset could be disastrous.

Besides having clear objectives and a practical budgetary estimate, if your practice deals with a lot of Medicare patients, you should be aware of the incentives available to physicians who adopt “certified” and “meaningful use” EHRs prior to 2014. However, just exactly what those parameters are has yet to be determined.   

Also understand that ongoing success with an EHR implementation does not start and end with a successful launch – anticipate the need for additional training as physicians and staff get more familiar with the EHR and its features.