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Rural Implementation Steps

Step 4: Conduct Training and Implement an EHR System

Electronic health record (EHR) Implementation involves installing an EHR system and associated activities, such as training, mock “go-live,” and pilot testing. The EHR implementation plan and schedule (developed during the planning phase) should be followed and executed during this phase.

Consider the following when planning your EHR “go-live” step:

  • Set a date with your EHR vendor for “go-live” during a time that is the least busy
  • Use the “go-live” date to plan all aspects of the EHR implementation and be sure to allow for contingencies
  • Determine your rollout strategy with the realization that resources may be limited during EHR implementation (you will always need more resources than you expect!). Some hospitals “go-live” with a portion of physicians at a time or all physicians using limited functionality.
  • Plan to notify other key individuals, third parties, and other vendors (e.g. physicians, labs, billing company) of your “go-live” date when it appears certain and request their support and patience.

Building an EHR implementation checklisr [DOC - 1.1 MB]  for planning your EHR system “go-live” event will help you identify issues that you may need to address beforehand.

Additional process steps during EHR implementation include:

  • Align your organization’s project plan with your EHR vendor’s implementation methodology and final data conversion plan
  • Develop your EHR implementation project team
  • Establish a formal change management process
  • Consider all hardware and software implementation needs
  • Test your systems and interfaces with your EHR vendor and ensure your EHR vendor understands your environment (e.g., Critical Access Hospital (CAH) or other rural health care setting).
  • Train your leadership team and all staff
  • Develop policy and procedures to include privacy and security requirements
  • Schedule mock “go-live” to test back-up plans
  • Develop optimization strategies to maximize goal achievement and staff satisfaction
  • Plan for additional resources needed for EHR system “go-live”
  • Incorporate the change management process into the implementation process


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 ascending Details
Vendor Management for Critical Access Hospitals View
Project Management for Critical Access Hospitals View
Monitoring Health IT and EHR Goal Achievement View
Legal Health Record Policy Template View
Guide to Privacy and Security of Health Information 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.

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