FIRST, UNDERSTAND THE IMPLICATIONS OF THE CHOICE YOU’RE ABOUT TO MAKE
Over the years, I’ve observed that EHR system selection conversations often begin with questions about specific EHR vendors. Leaders want to know things like which product is the best, which system offers the strongest functionality for their organization’s specific workflows, and which platform is gaining market momentum. Those are all great questions that must be answered; they’re just not necessarily the most important ones.
Here’s what I’ve seen… The healthcare organizations that achieve the greatest long-term success typically spend some time during the EHR selection process focusing on software features, but more time first understanding the strategic implications of the decision they are about to make.
Let me explain…
Technology Is Rarely the Hardest Part
All major EHR platforms today offer extensive functionality. While it’s important to use structured demo scripts to enable apples-to-apples comparisons and highlight how each solution supports your organization’s unique workflows, that’s often the easiest part of the selection process. The real challenge is determining how each solution aligns with your organization’s strategic vision and needs.
Below are just a few examples of questions you’ll want to answer:
- How much operational independence does your organization want to maintain?
- How much standardization (i.e., system build outside of your organization’s control) are leadership and end-users willing to accept?
- What level of reliance on internal resources vs. external partners is appropriate for you?
- Do you have the internal resources required to support and optimize the chosen solution over time?
- Will you be able to freely access, extract, and use data without restrictions?
The answers to these and other questions often have a greater impact on long-term satisfaction than feature comparisons alone.
The Importance of Governance
One of the most crucial conversations during an EHR system selection has nothing to do with software at all. To succeed, you need to have a solid governance framework in place. As healthcare continues moving toward hosted platforms, shared-service models, and health system alignment strategies, you’ll want everyone in your organization to understand how decision-making authority will look before, during, and after your implementation.
For example:
- Which committee(s) / board(s) / executive sponsor(s) will own strategic direction, implementation, optimization, and prioritization?
- How will competing stakeholder priorities (internal and external) be resolved?
- What organizational problems must the new EHR solve, and who approves those priorities?
- How will customization vs. standardization decisions be governed, and how will change requests prioritized?
In our experience, these conversations often deserve as much attention as product functionality.
Cost Is More Than Just Software and Implementation Fees
Another common misconception is that EHR selection is primarily a capital budgeting exercise. It is not. The true total cost of ownership (TOC) financial picture often extends well beyond initial licensing or subscription costs.
Be prepared to ask and answer questions about these items during your selection process:
- Staffing costs (legacy support, productivity loss, training, ongoing support staff requirements, etc.)
- Data conversions, infrastructure, interfaces, archival costs, etc.
- Future optimization costs
- Contract exit costs
The most expensive decision is not always the EHR system with the highest price tag. Sometimes it is the option that appears affordable upfront but creates limitations later.
The Human Side of Every Selection
An EHR is ultimately used by people. Success depends on physicians, nurses, registration staff, revenue cycle teams, and operational leaders adopting new workflows and more efficient ways of working. But change is hard. That’s why some selections that look strong on paper struggle during and after implementation, while others exceed expectations.
The difference is often not technology. It is organizational readiness and change management. Be sure change management becomes a built-in facet of your EHR system selection and implementation.
A Final Thought
One of the most important lessons I’ve learned is this… The best EHR decision is rarely about choosing the “best” system. It is about choosing the system that best aligns with your organization’s strategy, governance model, workforce capabilities, and long-term goals.
Those conversations can be challenging, but they often determine whether an EHR becomes a strategic asset or an ongoing source of frustration. I hope you’ve taken a pearl or two of wisdom away from this episode of Keane Insights.
Blog Post Author
Mary Ann Keane, MS, RN
President
HealthNET Consulting
Mary Ann Keane brings decades of IT, healthcare operations, and nursing administrative experience to HealthNET. She was Director of Nursing at a major medical center, where she was responsible for Nursing Informatics, Medical/Surgical, and Maternal Child Health Nursing. Her background is augmented by notable accomplishments in IT strategic planning, IT assessments, system selections, EHR implementations and Promoting Interoperability planning and project management. Mary Ann is an outstanding facilitator, presenter, and thought leader. She earned her BS in Nursing from the University of Massachusetts in Boston and her MS in Management from Lesley University.
