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Implementation Methodology Matters

July 1, 2007
by Rich Rutherford
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Successful electronic health record RFPs must include malleable methodologies that change over time.

How many electronic health record (EHR) requests for proposals (RFP) include implementation methodology requirements? While functional requirements are critical to selecting the right software, the implementation methodology is the process by which those functional requirements will come to fruition.

EHR implementation service fees are based on the vendor's effort required to execute the implementation methodology from beginning to end. Since you are paying implementation service fees, you will want to inquire about the latest methodology during the RFP process. The implementation methodology is the process that is responsible for delivering the application features to meet the project objectives and ultimately project success.

Rich Rutherford

One of my best grilling recipes is barbeque chicken. The sauce is a key component and I continue to refine it by slightly changing ingredients. Implementation methodologies, as with my barbeque chicken recipe, will have varying results when the processes are changed.

EHR implementation methodologies will change over time as vendors refine their processes in order to reduce effort and schedule duration. Since the process is responsible for meeting the project objectives, changes in the process should be closely evaluated. Implementations that occur over several months are at risk for these types of methodology changes. The question is how will those changes impact the project and will you be aware of process changes if a baseline of the implementation methodology was not set at the beginning of the project.

I have established the reasons why implementation methodology is important and identified that changes to the process will change the project results; so let us look at a few ways in which we can reduce the risk of negative methodology changes on our EHR projects.

Every methodology is made up of a set of deliverables. The deliverables should be defined within a work breakdown structure or some type of documentation. Having a list of these deliverables is key to understanding the process as well as establishing a baseline for monitoring changes. As W. Edwards Deming stated "If you can't describe what you are doing as a process, you don't know what you're doing."

Do not underestimate the value of having expert resources on site to facilitate the implementation. Site visits typically increase project cost due to travel expenses and having a resource dedicated for eight hours. Site visits are typically defined by the implementation methodology. An organization is not likely to increase the number of site visits but rather reduce the number of visits, as the methodology is refined and repeatable.

Deliverables should include a project plan that defines both vendor and customer implementation tasks, application workflow design and configuration tools, training process, testing plans as well as project management deliverables such as risk and change management plans.

I suggest defining a list of deliverables that you would expect to find within the vendor's implementation methodology and including those items in your RFP. This enables you to evaluate the implementation methodology process as well as the features and functional requirements for your EHR project. This will give you insight into the organization's business operations, project management maturity and provide a methodology baseline, which you can monitor for changes.

I also suggest asking reference sites about the implementation methodology utilized and key deliverables the organization feels that made its EHR project successful. You may find a gap between the deliverables you have received in the RFP and what the reference organization believes was critical for success. This will provide insight into additional services you may want to include in the contracting process.

The implementation methodology is the process that will deliver the project objectives. Changes that occur in the implementation methodology increase risk to the project objectives. By understanding and documenting methodology deliverables, you will be able to monitor the risk and ensure your EHR project is successful.

Rich Rutherford ( is president of Glenmoore, Pa.-based Project Navigation LLC