One question that we have come across with clients time and time again is “How should we implement an EMR?” (or in our case a DMR - Digital Medical Record). This usually refers to whether a hospital should take a Big Bang approach to the implementation of Electronic Medical Records or phase it in over time. One of the largest concerns with hospital management during the implementation of an EMR are the change management and business continuity aspects. Logistics around existing inpatient records and new patients with historical records within the hospital are among the many challenges considered when making implementation decisions. 

Factors such as size, complexity and type of hospital, will influence the EMR implementation approach that best suits their needs. So what are the advantages and disadvantages between a phased approach and a big bang implementation?

Big Bang EMR Implementations

The advantages of a big bang approach, that takes a hospital fully live on an EMR all in one go, albeit with maybe a department by department approach spread over a few weeks, are that:

• From an end user engagement perspective, you are bringing everyone on the same journey at the same time.
• From a patient and business continuity perspective, patients can continue to move throughout the hospital between different departments and both the patients and clinicians can be guaranteed that their records are all centralised in one location from the beginning.

There are several choices open to hospitals in terms of how to approach the existing paper records for inpatients, they can be scanned into the EMR from the point of Go-Live to ensure a full patient record is always in the one location, with a policy being put in place by the hospital in terms of historical legacy or “closed” files. Depending on the legislation in each region, the retention periods for those files still needs to be adhered to. Alternatively another approach that works well is where the existing paper record remains on paper with all staff knowing that previous to a certain date the record is not electronic. This primarily only works for new patients into the hospital even if they had previous admissions, rather than existing inpatients.

Disadvantages with the big bang approach is that it can put significant pressures on the organisation as a whole to ensure continuity of care, while also introducing a largescale change in day to day operations. A watertight business continuity plan needs to be in place and a significant communication project undertaken to ensure all clinicians and end users are prepared for the date of change. 

The Phased Approach to EMR Implementations

In our experience, the phased approach is becoming more and more popular and by a phased approach this doesn’t necessarily mean bringing department by department live over a few weeks, but rather converting different areas and workflows to an electronic format over different phases and stages.

With this approach the advantages are that:

• The risk of change management is lower, as each phase is targeting one particular speciality or area (for instance end of bed nursing or oncology only etc).
• This approach also lends itself to allowing the hospital and the end users to “bed down” the system before exposing it to further areas with more end users.
• With this approach implementation is achieved in a much quicker time frame bringing the first area live much earlier than with the big bang approach; this keeps up the momentum of the project and engages people earlier to allow for a smoother transition. 

The disadvantage is that more focus needs to be put into the transfer of patients throughout the hospital and how operating a hybrid approach for a patient record in both paper and electronic form is managed from an accessibility point of view and a complete clinical record view.

While we have outlined some of the advantages and disadvantages of the two approaches mentioned, the decision of which approach best suits an individual hospital should be made based on the individual requirements and looking at the project and stakeholders as a whole. Luckily for all organisations considering an EMR implementation, Vitro is so flexible that it can operate within both implementation approaches quite seamlessly, allowing the focus on continuity of clinical care during the transition to be the hospitals top priority.

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