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Rural Implementation Steps

Step 2: Plan Your Approach

Organize Your Project Infrastructure

A major investment in Health IT (HIT), especially focusing on clinical information systems such as electronic health records (EHRs), requires engaging representatives from all key stakeholders.  To represent these stakeholders and get expert oversight of your EHR project, you should plan for the appropriate governance of your project and develop a HIT Steering Committee.

Steps in the Planning Phase

Here are some steps that typically occur during the EHR implementation planning phase.

  • Establish roles and job descriptions for project leaders.
  • Create a project plan for transitions from paper to electronic (current state to future state).
  • Identify the executive sponsor and project manager.
    • The executive sponsor should have formal and informal authority to make guiding decisions and define parameters regarding staffing, budget, resource allocation, and workflow redesign.
    • Your project manager should be process oriented, understand workflow redesign, be literate in technology, and understand the requirements of the care delivered in the facility.
  • Establish a formal change management process.
  • Establish a communication plan to help you plan and track your ongoing communication needs to stakeholder groups and staff.
  • Estimate total cost of ownership and return on investment (ROI) potential over a time span of 1, 5, and 7 years.
    • Application acquisition
    • Implementation services
    • Capitalization of staff time
    • Ongoing service & maintenance expense
    • Upgrade expense (i.e. services, hardware, etc.)
  • Determine potential funding sources to assist with EHR implementation.
  • Map out your organization’s current workflow and processes of how your organization currently gets work done (the current state) and map out the desired workflows and processes after an EHR is implemented (the future state).
  • Understand what data elements will be migrated from your old system to your new system, such as patient demographics, problem lists, diagnoses, etc.  Carefully deciding which data elements and how much data to migrate can ease the transition process.
  • Identify concerns and obstacles regarding privacy and security and create a plan to address them.  Privacy and security are critically important when transitioning to EHRs. Get started using this Health Information Privacy and Security: 10 Step Plan.


The following resources are examples of tools that are used in the field today, and are recommended by subject matter experts for the use by others who have made the commitment to implement or upgrade to certified EHR systems.

Namesort descending Details
Legal Health Record Policy Template View
Medicare Incentive Payment Calculator for Providers View
Workflow Redesign for EHRs View

The material in these guides and tools represents the collective EHR implementation experiences and knowledge gained directly from the field of ONC’s outreach programs (REC, Beacon, State HIE) and through the Health Information Technology Research Center (HITRC) Communities of Practice (CoPs) in their performance of technical support and EHR implementation assistance to primary care providers. The information contained in these resources is not intended to serve as legal advice nor should it substitute for legal counsel. The resource list is not exhaustive, and readers are encouraged to seek additional detailed technical guidance to supplement the information contained herein.

Reference in this web site to any specific resources, tools, products, process, service, manufacturer, or company does not constitute its endorsement or recommendation by the U.S. Government or the U.S. Department of Health and Human Services.

Financial Resources

HRSA Financing and Sustainability Resource

Insights on searching for and securing funding and budgeting for a HIT project, especially for rural providers.

HealthIT.gov Grant Program Information

Websites of organizations with grant programs and funding opportunities available to healthcare providers in rural settings.

HealthIT is an Opportunity for Job Creation in Rural Communities

Blog post will direct you to rural health funding resources from rural health stakeholders collaboration with HHS and the USDA to identify funding and financing opportunities.

Stratis Health Toolkit

Stratis Health developed a health IT tool kit providing resources and guidance to Critical Access and Small Hospitals. The following tools have been identified to help you with this step of EHR implementation:

Establish a HIT Steering Committee

Project Management

Project Manager Job Description

Clinical IT Leadership

Communication Plan

Change Management

Total Cost of Ownership and ROI

HIT Project Governance

Goal Setting

Workflow and Process Redesign Webinar

Workflow and Process Redesign Presentation

Chart Conversion Planning

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