EMR Implementation: Procedures and Challenges

There are few people, if any, who would contest the long-term benefits of a quality electronic medical record (EMR) system. From acute care to long-term care, home care to hospice, EMRs are no longer a choice, but a necessity. With full utilization, a quality EMR system offers:

  • Increased productivity and efficiency
  • More complete and legible documentation of patient visits
  • More accurate and available medication profiles
  • Improved connectivity with labs, hospitals and specialists
  • Increased availability of data for QA analysis and reporting 
  • More accurate and timely billing and claims
  • More efficient and comprehensive care for patients, resulting in increased patient satisfaction 
  • Long term reduction in costs

Selecting the Best EMR for Your Agency

For home health and hospice providers looking for a quality EMR solution, the challenge can be daunting. The investment in a new EMR is huge, and with the ever-evolving regulatory requirements and literally hundreds of EMR systems and vendors to choose from, it can be hard to know how—and where—to start.  The decision-making doesn’t stop once the choice of a vendor is made, either. Agencies are continuously evaluating their EMR systems and may find that what looked like a solution was not. Especially in light of the PDGM regulations scheduled to become effective on January 1, 2020, many agencies are reevaluating their EMR systems and looking for better alternatives.  

According to Health Data Management’s Fred Bazzoli, “…the use of such systems does not remain static. New capabilities are added, or organizations decide to rip old ones out and replace them with new ones. For most providers, clinical system implementation is a concern that comes up regularly…” 

Include Your Clinicians and Staff

It is a good idea to involve your staff in the decision-making process as early as possible, certainly by the time you are making your selection of an EMR system. Clinical users and staff can offer varying perspectives and invaluable input. Many functionality and usability issues can be identified and addressed during the decision-making process, and end-user involvement at this stage can help avoid challenges down the road. 

In addition, when staff and clinical users have an active role in the selection process it can help foster a sense of ownership in the new system. Complaints of procedural disruption and distractions, time constraints, or usability issues are not uncommon with new EMR systems, but they can be mitigated or avoided altogether with the selection of the right solution for your agency.

On-Line Research and Word of Mouth

There is a lot to consider during the decision-making process, but checking user feedback and ratings on independent review sites can be a good place to start. When you’ve narrowed down your selection of vendors, check with other agencies who are using the systems to see what they have to say (keeping in mind that different agencies may opt for different functionalities within any given software system). 

Ask other HHAs:

  • Does the EMR integrate easily with other software solutions at your agency?
  • What do your system users (clinicians) think about the system?
  • Does it help your agency meet all regulatory requirements such as OASIS-D, HIS, and PDGM?
  • Can it be customized to your agency’s individual requirements?
  • What was the Implementation process like? 
  • Was your EMR vendor responsive to your needs?
  • Was EMR training sufficiently comprehensive?
  • Does your EMR vendor offer ongoing system support and training?


While there are many things to look for in EMR software, interoperability is one of the most crucial elements to consider when comparing healthcare software solutions. According to Bazzoli, “Systems need to be able to exchange information so that different providers can make use of it and get a complete picture of a patient’s health. While… vendors are making strides in improving interoperability, it can become a frustration for the implementing organization, particularly exchanging information across different systems used by multiple providers.”

Interoperability relates to the transfer of information or data from one healthcare provider or organization to another. Interoperability is of paramount importance in the home healthcare arena, since long-term and post-acute care (LTPAC) patients are more likely to have chronic conditions and co-morbidities that necessitate frequent transition between multiple care providers. Interoperability has become increasingly critical since the implementation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, a bipartisan bill passed in 2014. The IMPACT Act requires that assessment data be standardized in order to facilitate coordinated care and enable assessment data comparison across all four LTPAC settings: home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals.

An EMR system with limited and/or ineffective interoperability is not an EMR solution, because it does not enable a patient’s electronic medical record to become part of their broader electronic health record (EHR). Home health software vendors have been interfacing with partner vendors for years. NDoc® has been interfacing for over two decades with HIT systems such as hospitals, laboratories, medication management, DME and supplies, coding, telehealth, telephony, transcription, benchmarking, and patient satisfaction (CAHPS).

Vendor Training and Support

Selecting the right system for your agency is an investment in greater efficiency, effectiveness, and savings down the road, but the investment is more than monetary. Beyond hardware and software, the total cost of your EMR solution includes changes to infrastructure, clinical and staff training time, and clinical and IT support. These “extras” aren’t really extra; they are the difference between the success and failure of your new system. Invest too little in these areas and you risk the long-term return on investment (ROI) your system offers.

You should also consider your vendor relationship when making your EMR decision. It’s important to know what you can expect during and after EMR implementation. Indeed, training and support are two of the most crucial factors for the success of an EMR implementation, so make sure you know what you’ll be getting. Ask: 

  • Will the vendor be on-site during EMR implementation? When and for how long?
  • What kinds of training and support will the vendor offer pre- and post-Live?
    • On-site training of agency users… all users or just “super users”?
    • Ongoing education and training resources? (Ie., online implementation and training videos; blended learning materials; webinars and conference calls)
    • Online manuals for implementation, ongoing operation, system administration, and system customization?

A Thornberry Ltd project manager oversees the entire implementation process, from pre-server install through 2-3 months post-Live (through the 1st or 2nd agency billing closing), and an NDoc clinical trainer is onsite for 1-2 weeks pre-Live (dependent on number of staff to be trained) through 2-3 days post-Live. Altogether, Thornberry’s total on-site time averages several days for the smallest agencies, and can be as long as three weeks for larger agencies.

The Decision is Made… What’s Next?

Whether it’s your agency’s first clinical software solution or you are transitioning to a new vendor system, the keys to successful implementation are support, communication, and a comprehensive plan.  

Agency Support

Successful implementation and ongoing utilization of an EMR require the support of the entire Agency: top-down and bottom-up. A new EMR is a chance to change ingrained agency habits that aren’t working, but your agency must have an “all in” mindset. It’s never too early to involve all relevant agency departments—from clinical to clerical, IT to management. Ideally, this started at the EMR selection stage, but the sooner a shared vision of the new system can be established, the better.

Garnering agency-wide support is not a smooth and automatic process (and it would be surprising if it were). It’s important to remember that a new EMR system is just that: new. New means different; different means change; and we all know that change is never easy, even when it’s positive. “But we’ve always done it this way!” is a common complaint from staff at all levels during EMR installations, but developing a shared vision can help address this and other protests. 

Communication, Communication, Communication!

Open and efficient communication is critical to success—during vendor selection, through planning and analysis, to implementation and beyond. 

Communication between Agency and Vendor: What do you want and need your new EMR to accomplish? What issues are you hoping the system will help to resolve? Make sure you communicate your requirements and expectations to your vendor clearly, completely, and consistently. Make sure you’re talking “apples to apples.” That’s the only way you and your vendor can be sure the system is customized to your agency’s needs and maximized to your requirements.

“Effective communication between the healthcare provider and the IT vendor is essential to fine-tune the EHR system to yield the desired results,” says Bazzoli. “It is not a one-time activity but a continuous process to ensure that the expectations of both the parties are met.”

One challenge that many agencies face in the agency-vendor relationship is the vendor’s tendency toward a single-minded focus on implementation and Go Live. Focusing on the end-goal is necessary, but it can’t be the only focus. Your agency has to keep functioning, in all its complexity, throughout the EMR implementation. Make sure your vendor acknowledges that EMR implementation is not the only reality for your agency, and that accommodating the implementation process cannot be the top priority for every agency staff member or department. Your vendor must consider the greater impact of the implementation process, and the importance of the daily operations that will be ongoing throughout.

Communication with Staff: Even if your staff were involved and supportive early on in the decision-making process, it doesn’t mean they won’t be resistant to the reality of change. As previously mentioned, “but we’ve always done it this way” is a strong barrier to overcome.

Bazzoli warns: “Whether it’s implementing a new system from the ground up, or transitioning from an existing system, not everyone is open to the idea of making technological changes… In some cases, the staff lack awareness about the current technological advancements and the comprehensive benefits of it.”

Frequent and open communication throughout the implementation process can go a long way toward overcoming resistance. Agency-wide acceptance of and support for your new system is an ongoing process. You’ll need to continually anticipate, communicate, and accommodate. 

Consider the perceptions your staff may have and fears they may be experiencing: 

  • The new EMR will be difficult to use
    • Assure your staff that there will be ample training, and allow for additional training for those staff members who require it
  • I won’t remember what to do when I’m in the field
    • Allow for additional training for those staff members who require it
    • Make sure your vendor trainer will be available at Go Live to support your efforts 
  • It will take longer/too long to chart in the new system
    • Explain that a temporary reduction in productivity and efficiency is normal and expected
    • Assure your staff that the new system will help to streamline their documentation responsibilities, leading to greater productivity and efficiency once the learning curve is over
    • Explain and demonstrate the efficiency of the system, and the benefits it offers
  • It will take time away from patient care and interaction
    • Reassure your clinical staff that patient care will still come first, in both philosophy and practice
    • Explain the procedures involving in-home documentation: patient interaction and laptop placement
    • Explain how the system and its capabilities will benefit patients: accuracy and availability of documentation and records, quality assurance analysis and reporting, more efficient workflows and better outcomes.


Communication with Patients: Your staff members aren’t the only ones who may be resistant to change. Patients—particularly older, less tech-savvy patients—may be concerned about how your new EMR system will impact their care. Make sure agency patients know about the upcoming EMR implementation. They should be aware of what will be changing, when the changes will happen, and what the changes will mean to them. 

Planning and Analysis

Planning and analysis should begin before the start of your EMR implementation. Know what you want from your new system, and decide how you will evaluate your progress. If you clearly delineate your goals and objectives ahead of time, and identify your metrics of success, then you will be better able to support and accomplish your goals throughout the implementation process.

It is beneficial to make as many decisions as possible before implementation kickoff. You and your vendor began the necessary information-gathering at your first meeting, with a joint consideration of agency timeframes and vendor-recommended schedules. Through questionnaires and phone calls, documentation reviews and workflow analyses, the information-gathering by both vendor and agency should be comprehensive and continuous throughout the EMR implementation process. 

Launch Strategy: “Big Bang” vs. Incremental

One of the first decisions that needs to be made is how your agency will launch the new EMR system. This should be decided long before kickoff, as the launch strategy will dictate necessary implementation procedures and timelines.

Big Bang: All agency patients, departments, and product lines (ie, home health, hospice, private duty) go Live with the EMR at the same time. With this approach, the learning curve for users is much shorter and it reduces the potential for confusion between old vs new system (or paper vs EMR procedures). The downside: any procedural bugs or system issues are realized on a larger scale. The big bang launch requires dedicated agency support and a commitment of resources during the implementation process and post-Live adjustment period.

Incremental Roll-Out: The agency goes Live with the new EMR one patient (as they are admitted), department, or product line at a time. With this approach, the agency has the chance to work out any procedural bugs or system issues on a smaller scale; they have the opportunity to observe, analyze, and fine-tune best practices—one patient, department, or product line at a time. The downside: the learning curve for clinical and office users is gentler, but longer, and new users can lose energy and enthusiasm for the implementation process the longer it takes.

You’ve probably heard arguments on either side of the big bang vs incremental conversation, and there is no one right answer. Your vendor will have recommendations for what works best for their system and how your agency should proceed. Just make sure you’re in agreement before implementation kickoff.

At Thornberry Ltd, we recommend a thoughtfully phased preparation and a combined roll-out approach: all departments and product lines go Live together, with each new admission or recert entered into the NDoc system (exceptions to this approach are sometimes recommended in special or complex circumstances). By the end of 60 days, every agency patient is on NDoc. In support of this combined approach, the Thornberry project manager oversees every phase of the implementation process, from pre-server installation through the first or second month-end closing.

Identify and Install Hardware

Once you know your launch strategy, it’s time to choose the hardware. Hardware technology is ever-advancing, and your hardware selection should be primarily driven by your vendor’s requirements and recommendations. Remember that the right hardware can save your agency time and money up front and down the road. 

Strategic Implementation Plan

Benjamin Franklin said, “By failing to prepare, you are preparing to fail.” Knowing what you want and need, and knowing what to expect, are crucial to a successful EMR implementation. You’ll need to anticipate and address real and potential barriers to implementation within your agency.

“A detailed strategic plan is a key requirement for an effective implementation plan. Assign duties and responsibilities for team members… and create a space for mutual support and dependence,” Bazzoli advises. “Having a realistic expectation of all implementation requirements will result in a more accurate list of tasks to be completed and better scheduling.”

The implementation schedule should address hardware and software installation, agency workflow analysis, launch strategy, system configuration, data migration, training and support, and more. Your vendor should also offer a phased timeline and a multi-disciplinary detailed task list for all affected agency staff that clearly outline and define implementation roles and expectations. 

Your vendor should work with you to develop an implementation schedule that works for your agency, but it’s important to remember that vendors have vast experience with installations and implementations—experience that shouldn’t be discounted. What may seem inefficient or even undoable at first may actually be the most efficient and effective implementation strategy for your agency. 

Your implementation plan, timeline, and task lists will be multi-faceted, interdepartmental, and carefully customized to your agency. The implementation timelines run concurrently among agency staff and departments, with many tasks starting at the pre-implementation phase and continuing throughout the entire process. Following the timelines and task lists your vendor provides is critical to the success of your EMR implementation and roll-out.

Your Implementation Team

A strong, interdisciplinary agency Implementation Team is integral to the success of your EMR implementation. It’s important to have the right people on board, and your vendor should be actively involved in defining the necessary implementation roles and helping to select the team members. All Implementation Team members should be enthusiastic about the new EMR system and supportive of the necessary procedural changes and adjustments it will require.

Your first selection should be a project manager, who will oversee your implementation on the agency side, working closely with your vendor project manager to ensure a smooth transition to the new EMR. Your project manager will need dedicated time to help oversee and manage your EMR implementation. 

In addition to the project manager, your Implementation Team should include an IT (information technology) leader and a representative from each of the main clinical departments in your agency: RN, PT, OT, etc. These clinical team members—sometimes referred to as “super users”—will be the subject matter experts for your EMR and will serve as role-based mentors for other clinical users. Thornberry Ltd recommends at least one mentor per every 10 staff members to be trained. Depending on your agency, your Implementation Team may also include administrative, clerical, and/or compliance staff members. 

All Team members will function as mentors and morale builders, mediators and messengers. Team members will monitor and analyze system usage and agency workflow, and will help to mitigate and manage the impact of the new EMR—from implementation through the first months post-Live. 

Workflow Assessment and Analysis

One of the first tasks your Team should undertake is an honest assessment of agency workflows and procedures, and it should begin prior to kickoff. Remember that any issues you have with inefficiency or ineffectiveness prior to implementation can intensify during the implementation process, so workflows should be optimized, redesigned, and/or developed as soon as possible. 

Take an honest look at staff and system capabilities, keeping your defined goals and objectives in mind. Some things to consider as you assess each task or step:

  • Does this benefit the agency and/or the patient?
  • Does this fit in with our defined goals and objectives? 
  • Is this necessary?
  • Is this being accomplished efficiently?
  • How can efficiency be improved?
  • Is there a better way and/or person to do this?
  • Is this being done at the right time, or should tasks/steps be reordered?
  • Will this be necessary or obsolete with the new EMR system?
  • How will/can this be done differently with the new EMR?
  • How will efficiency and effectiveness be evaluated with the new EMR? 
  • What new steps will be necessary with the new EMR?

Troubleshooting and Risk Mitigation

We should never forget Murphy’s Law. Even the smoothest implementation can run into rough spots, so you should build troubleshooting time into your schedule and make it an ongoing priority. It’s important to anticipate what problems and issues might arise during implementation and beyond, and to plan ahead for how to deal with them. Identifying potential problem areas early can help to mitigate their effects and expedite their resolution. Make sure your risk mitigation plans consider:

  • Procedures and requirements for agency staff, both in the field and in the office
  • Procedures and requirements for your EMR system
  • Communication policies and channels for agency staff, patients, and providers

System Security: The security of patient records has been an ongoing concern in healthcare for a long time. While paper records presented their own privacy challenges, EMR systems raise issues of cybersecurity and system access. Security breaches can be harmful and expensive for both agencies and patients. 

According to Fred Bazzoli, “Data privacy issues often form a substrate to an entire implementation. Stakeholders may voice concerns over the risk of data leakage because of a natural disaster or a cyberattack. HIPAA rules require protection of the confidentiality of personal health data.”

Your EMR has the ability to control and limit access to data as required by law, but it is your agency that determines the access and authorization parameters within the system. Consider a HIPAA risk assessment, and make sure your agency’s security policies and procedures are updated to accommodate ever-expanding rules and regulations and your new system. Familiarize yourself with your EMR’s security features and requirements, and work with your vendor to ensure the system is compliant with all requirements and configured to your needs.

What Happens If Your EMR Is “Down”?  No technology is without the occasional glitch. Whether due to a power outage or a system malfunction, a glitch in your EMR can mean delays in clinical charting and agency billing. So make sure you have the policies and procedures in place to deal with the worst of your what-ifs, and make sure you have sufficient backup systems and procedures in place before you go Live.

Customizing Your EMR

Your hardware is ready and the system is installed…now it’s time to make your new EMR really yours. With your help, your vendor will identify necessary system interface and interoperability requirements. 

System Configuration

While your vendor works on the system-to-system interactions, you should be working on the system-to-user interactions. System configuration refers to the customization of your EMR software system. The more flexible your new EMR is, the more it can be adapted to meet the unique needs of your agency. At the same time, the more flexible and customizable your new EMR is, the more time and work that is required on your end to ensure you’re taking maximum advantage of all it has to offer.

System tables define what you do and who you are as an agency; they set the parameters for how your new system will look and function. Thornberry starts working with agencies to define and build their NDoc tables starting in the third week of implementation. Table building and customization continues for two to six weeks (depending on agency size) and will be completed prior to Training. (Table customization will be ongoing after Live, based on feedback from agency users and the changing needs of your agency.)

A few members of the Implementation Team will be in charge of custom table set-up. It is not just busy work. Table building helps familiarize Team members with the new system prior to Training, affording a deeper understanding of the system’s utility, functionality, and capabilities. Team members will work on a multitude of prioritized clinical user selection tables, and on billing tables such as: 

  • Facilities/Providers
  • Referral Sources
  • Physicians
  • Pharmacies
  • Insurance Companies 
  • Employees
  • Services Provided
  • Billing and Charge Codes

Thornberry’s expanded table building guide will show agency table builders exactly what clinical users in the field will see. 

Data Transfer

In addition to table building, agencies need to decide what existing patient data, if any, should be transferred into the new EMR system. This decision may depend in large part on your agency’s launch strategy, and whether existing patients will be moved over to the new system. 

Data transfer—also known as data migration—can be a time-consuming and potentially costly process. The more data you transfer, the more time and resources you’ll need, so take a close look at clinical requirements in the field and make a comprehensive list of patient data categories to ensure that no critical information is missed. Remember that the purpose is to have critical patient data accessible in your system, not to archive your paper charts. Consider and prioritize such patient data as:  

  • Medical history
  • Allergies
  • Medications
  • Immunizations
  • Recent visit notes
  • Recent test results
  • Family and social history

Whatever you decide, you should transfer the most recent data first, and work back from there. For field clinicians, it will be more important to know what happened with a patient last week than last month. You’ll want to complete as much of this data migration as possible before Live; after Live, all new data will be entered into your new EMR.


EMR Training

Training is one of the factors most crucial to the success of your new EMR. The better the training, the shorter the learning curve, which means users will be more comfortable with the new system more quickly. Conversely, insufficient or ineffective training can leave users uncomfortable and dissatisfied with the new system. The investment in the time and resources necessary for effective, comprehensive EMR training is an investment in your agency and in the sustainability of your new EMR.

An effective training plan should include:

  • General overview of why the new system is needed
    • to mitigate staff resistance
    • to maximize compliance
  • General education on the benefits and overall operation of the new EMR
    • to reduce misuse of the system
    • to maximize productivity
    • to increase understanding of how system use is integrated throughout all disciplines and departments
  • Detailed instruction on basic system functionality and related policies
  • Detailed instruction on discipline-specific documentation procedures and policies

Your vendor will most likely take a phased approach, from pre-Live remote training, to on-site training, through Live and beyond. Every training phase is critical and builds on the one before.

Training Roles

Your vendor’s clinical trainer will be the primary training contact, but there will be several other people involved in the training process; their roles should be clearly identified and explained prior to implementation. 

“Mentors” vs “Super Users”: Some vendors will train agency “super users” in each department or discipline, who will in turn train all of the other users in that department. The rationale: nurses learn best from nurses; office staff learn best from office staff; etc. While this approach can save money up front (because the vendor only needs to train a handful of users), it can cost an agency in the long run—in efficiency, effectiveness, and satisfaction.  

At Thornberry Ltd. we’ve found that staff training staff is not the most efficient or effective training method. No matter how thoroughly super users are trained, they are new users, and those who are still finding their way around the system are not the best people to be training others. While they can be extremely helpful—even indispensable—in supportive “mentor” roles, super users cannot know or understand the system well enough to be effective teachers.

Role-based mentors are selected by the agency, and Thornberry recommends at least one mentor from every department or discipline (intake, clerical, RN, PT, OT, supervisor/QA, etc.), and at least one mentor per every 10 staff members within that department. 

We train ALL of your staff, not just a few key players, but your mentors will be the subject matter experts for your EMR and will be an immediate and ongoing resource for departmental colleagues.

Remote Training

At Thornberry, the first phase in your EMR Training is Remote Training. Agency mentors are trained first, about two weeks prior to on-site training, so that they’ll have time to practice and get comfortable with NDoc before they need to mentor and assist agency staff. 

In addition to mentor training, all system users are required or encouraged to complete on-line video training prior to their scheduled on-site training. The blended learning videos provide a general overview of the system and include initial instruction on basic system functionality. Completion of the video training has been found to increase the effectiveness of on-site training and decrease the learning curve on the system.

On-Site Training

On-site training is the make or break step in your implementation plan. If it’s done too early, users will forget what they’ve learned; if it’s done too quickly, users won’t have the knowledge or skills necessary to use the system efficiently, effectively, or comfortably.

“Training is best done within a couple weeks of the Go Live date,” says Adam Siegel, an EHR consultant. “This ensures that new workflow and process will be fresh in the minds of the staff.”

Thornberry takes a “Just In Time” approach, training all staff users on the basic processes of NDoc right before the scheduled Go Live date. Pre-Live training begins after installation and customization: system configuration (table building) and remote training have been completed by this time, but some interfaces may still be underway. Your NDoc clinical trainer is on-site for one-to-two weeks pre-Live (dependent on number of staff to be trained), and will remain on-site for about three days post-Live.

On-site training combines lectures with hands-on training in a three-tiered approach:

  1. The first training session will be a general overview of the system and functionality for ALL users
  2. Subsequent session(s) will be department- or role-specific for clerical users, supervisors/QA users, and RN/PT field staff users. These may consist of one 2-hr training session (for Intake users) or up to three longer training sessions for clinical field staff
    • There should be at least one role-based mentor per every 10 trainees in any given session 
    • Thornberry recommends no more than 15 trainees per session, plus the relevant mentor(s)
    • The agency project manager (or a designated overseer) should attend all sessions
  3. The clinical trainer meets daily with the agency project manager and mentors to discuss training issues and identify users who may require extra training or assistance. Mentors are available to assist new users during and after all training sessions. 

Go Live!

With Thornberry, your agency will go Live directly after on-site training is complete. This means that new users have immediate, real-life, hands-on reinforcement of their training. Your NDoc clinical trainer remains on-site for two or three days post-Live and is available during this time for one-on-one training. They can walk through a new admission with a field clinician and answer any questions that may have arisen during real-time charting—in the field or in the office. 

While your clinical trainer is on-site, your agency will be introduced and transitioned to the Thornberry Help Center. But your clinical trainer won’t disappear; they will be part of your ongoing Thornberry Support Team.

What Happens Post-Live?

Your Thornberry Go Live visit concludes with a wrap-up meeting with your agency Implementation Team and your NDoc clinical trainer. After this meeting, your agency project manager will officially assume the responsibility for system management and oversight. This will include the coordination of ongoing agency customization, user training, and IT support. 

Your project manager should not feel deserted, however. Your vendor should be available and accessible to help you through your post-Live transition. With Thornberry Ltd, you can expect weekly phone calls for at least three weeks post-Live, and your Thornberry Support Team is always available whenever you need them. In fact, at Thornberry we don’t consider your implementation completed until 60-90 days post-Live. 

Audit and Maximization Visit

Between 60 and 90 days post-Live, after the learning curve has smoothed out and the new user “frustration hump” has been cleared, Thornberry will conduct a two-to-three day on-site Audit and Maximization visit with your Implementation Team and agency management. (Depending on agency location, this visit may be accomplished through a series of remote video conferences.) 

During this visit you, together with your Thornberry project manager and NDoc clinical trainer, will look at how the system is being used and how it has functioned throughout an entire revenue cycle. You will also explore how NDoc can be better utilized by your agency for maximum efficiency, effectiveness, productivity, compliance, and quality assurance. The visit can include remedial training to address problems or utilizations that didn’t quite “stick,” or it can include new training on NDoc functionalities in order to maximize agency systems and processes.

Training and Support

Training can’t stop when the system goes Live, so make sure you have a comprehensive post-Live training plan in place. There will always be new hires to train, and system users may find new functionalities or ways of utilizing the system that they can share with other agency users. In addition, your EMR system will be constantly evolving in order to comply with new regulations and meet new agency needs. Training must be an ongoing priority and commitment within your agency.

Feedback, Evaluation, Enhancement… The Ongoing Cycle

Once your implementation is complete, you are only beginning to reap the benefits of your new system. You should have a plan for the ongoing, continual monitoring and evaluation of system usage in order to maximize benefits and mitigate risks.

User feedback will be crucial to this process, so the communication channels should be open and clearly defined before implementation is complete. Your clinical and staff users should feel comfortable sharing their experiences, insights, and suggestions for the system. Indeed, they should be encouraged to do so: it is the user experience that defines the success of your new EMR, and it is your users who can help to fine-tune and optimize the system for your agency. 

Your project manager should pay close attention to feedback regarding workflow efficiency and effectiveness, and they will need a plan for prioritizing user feedback. Some minor system tweaks can make a major difference, while some major system enhancements might have limited benefit in the long-run. 

The process of continual feedback, evaluation, and enhancement will ensure that your agency is getting the optimal ROI on your EMR system.

Words of Wisdom

If you are considering or undertaking an EMR implementation, there are a few things you should keep in mind as you move forward through the process. Call them “Words of Wisdom” or “Keys to Success,” the following offers a brief summary of some of the most crucial points to remember.



  1. Communicate, communicate, communicate!
    • Establish open lines of communication as early in the process as possible: with your vendor, your staff, and your patients 
  2. Evaluate and understand your agency processes and workflows
    • Be honest about what’s not working with your current system/processes
  3. Be explicit about what you need, want, and expect from your new EMR
    • Communicate your needs and expectations to your vendor to avoid misconceptions
    • Make sure you’re talking “apples to apples”
  4. Select a vendor you’re comfortable with, and make sure they have a proven record of success with:
    • Customer satisfaction
    • Quality training
    • Ongoing support
    • Interoperability
  5. Strive for agency-wide support for and commitment to your new EMR
    • Top-down and bottom-up support: from clinicians to clerical staff, IT to Intake, QA to management
  6. Make sure you fully understand the capabilities and limitations of your new EMR
    • Be aware that your new EMR system has its own innate processes, which may be very different from your agency’s current processes
    • Keep expectations realistic: Remember that EMR software can’t automate everything
    • Acknowledge that sometimes the best solution is changing agency policies and procedures, not changing the system
  7. Make sure you have a strategic plan, with clearly defined goals, prior to implementation
    • Build troubleshooting and risk mitigation into your plan 
  8. Acknowledge that ALL change, even the best, is difficult and stressful
  9. Select a strong project manager and Implementation Team
    • Allow them to dedicate the time and resources required for efficient, effective, and optimal system implementation and management
  10. Make a commitment to ongoing system management, monitoring, and enhancement
    • Solicit and encourage feedback from all agency users
    • Evaluate and prioritize system modifications and enhancements