Choosing and Implementing a New Electronic Health Record: A Project Manager's Recommendation for a Composite Community Hospital
Student Name
Master of Science in Nursing Program, Aspen University
N537: Health Care Informatics
Instructor Name
Month Day, Year
Slide 2: Objectives
Explain usability, configurability, and interoperability
Compare two candidate systems and recommend one
Select the phase one implementation team
Plan for culture, resistance, and common pitfalls
Speaker notes: As project manager for Lakeview Community Hospital's move to a new electronic health record, I will explain the three qualities that matter most in choosing a system, compare two finalists, and recommend one. I will then describe how I would build the first implementation team, lead with culture, respond to physician resistance, and avoid the pitfalls that derail many implementations.
Slide 3: The Situation
Composite 120-bed hospital with two outpatient clinics
Current EHR: vendor ending support in 30 months
Separate systems for the ED, pharmacy, and clinics
Nurses report double documentation and poor handoffs between systems
Speaker notes: Lakeview's current record will lose vendor support in 30 months. The hospital also runs separate systems in the emergency department, pharmacy, and clinics, which forces nurses to document in more than one place and makes information hard to follow across settings. The new system must solve these problems, not simply replace the old software.
Slide 4: Usability
Can clinicians complete tasks efficiently and accurately?
Poor usability drives workarounds and errors
Tested with real users performing real tasks
Directly affects documentation burden and safety
Speaker notes: Usability is how easily clinicians can complete their work in the system. A system that requires many clicks or hides key information encourages workarounds, such as copying notes forward or documenting later from memory, which lead to errors. Informatics research has long shown that poorly designed systems can foster errors rather than prevent them (Ash et al., 2004). Usability must be tested with our own nurses and physicians doing real tasks, not judged from a sales demonstration.
Slide 5: Configurability
Can the system be adapted to local workflows?
Order sets, flowsheets, alerts, and screens
Too little: forced workarounds
Too much: costly customization and upgrade problems
Speaker notes: Configurability is the ability to adapt the system to our workflows through built-in tools rather than custom programming. Some flexibility is essential, since our clinics and inpatient units work differently. But heavy customization raises costs and complicates upgrades, so the goal is a system configurable enough to fit our work while keeping to vendor standards where possible.
Slide 6: Interoperability
Can the system exchange data with others and use it meaningfully?
Standards: HL7, FHIR interfaces, standard terminologies
Connections to labs, pharmacies, the state exchange, and post-acute facilities
Replacing our separate ED, pharmacy, and clinic systems
Speaker notes: Interoperability is the ability to exchange data with other systems and use it without retyping. For Lakeview, it means one record across the hospital and clinics, and standards-based connections to outside laboratories, pharmacies, the regional health information exchange, and nursing homes. Without it, the new system would recreate the fragmentation we are trying to end.
Slide 7: Should These Outweigh Cost?
License cost is only part of total cost of ownership
Poor usability costs nurse and physician time every shift
Poor interoperability costs duplicate tests and errors
Recommendation: weigh them heavily, within a sustainable budget
Speaker notes: Cost matters, and the hospital cannot choose a system it cannot afford. But purchase price is only part of the total cost of ownership. A cheaper system with poor usability costs time on every shift for years, and poor interoperability produces duplicate tests and handoff errors. These qualities should carry more weight than a modest difference in price, within a budget the hospital can sustain.
Slide 8: Comparing the Finalists
System A: lower cost, strong inpatient modules, separate clinic product, limited FHIR support
System B: 18 percent higher five-year cost, single integrated record, better usability test scores, mature FHIR interfaces
Both certified; both offer standard terminologies
Speaker notes: Two systems reached the final round. System A costs less and has strong inpatient modules, but its clinic product is separate and its standards-based interfaces are limited. System B costs about 18 percent more over five years, but provides a single record across settings, scored higher in our usability testing with nurses and physicians, and has mature interfaces for data exchange.
Slide 9: Recommendation
Recommend System B
Solves fragmentation with one record across settings
Better usability in local testing
Higher cost offset by fewer interfaces and less duplicate work
Speaker notes: I recommend System B. It directly addresses Lakeview's main problem, fragmented records, by providing one integrated system. It performed better when our own clinicians tested it. Its higher price is partly offset by eliminating the costs of maintaining separate systems and interfaces, and by the time nurses and physicians will save by documenting once.
Slide 10: Selecting the Phase One Team
Executive sponsor: chief nursing officer and chief medical officer
Clinical leads: respected nurses, physicians, pharmacist
Informatics nurse and IT analysts
Frontline super users from each unit and clinic
Speaker notes: The phase one team needs authority, credibility, and technical skill. Executive sponsors from nursing and medicine signal that this is a clinical project, not an IT project. Clinical leads should be respected by their peers, not only enthusiastic about technology. An informatics nurse bridges clinical and technical work, and frontline super users from each area will test workflows and later support colleagues at go-live. Strong clinical leadership and early user involvement are consistently associated with successful large-scale implementations (Cresswell et al., 2013).
Slide 11: Lead With Culture
Assess readiness and find where resistance lies
Listen to fears: time, competence, loss of control
Engage all levels: frontline staff, managers, physicians, support staff
Communicate early, often, and honestly
Speaker notes: Sipes (2019) advises project managers to lead with culture, first determining where the resistance is, and then to engage all levels of employees. At Lakeview, I would begin with listening sessions on each unit to hear concerns, which often center on time, fear of appearing incompetent, and loss of control over familiar routines. Engaging frontline staff in design decisions turns potential resisters into owners of the change.
Slide 12: Physician and Key Professional Resistance
Common concerns: productivity loss, more clicks, less patient time
Involve physician champions in design and testing
Provide specialty-specific training and at-the-elbow support
Share data on time and safety after go-live
Speaker notes: Physicians and other key professionals often resist because they fear lost productivity and more time at the computer. Lorenzi and Riley (2000) describe resistance as a normal response to change that should be understood rather than simply overcome. I would recruit physician champions to help configure order sets, provide training tailored to each specialty, offer at-the-elbow support during go-live, and share data showing how the system affects their time.
Slide 13: Pitfalls and How to Avoid Them
Treating it as an IT project: keep clinical leadership
Underestimating training: schedule and backfill staff
Customizing too much: follow vendor standards where possible
Declaring victory at go-live: plan for optimization
Speaker notes: Common pitfalls include treating implementation as a technology project, underestimating the time needed for training, over-customizing the system, and ending support at go-live. I would keep clinicians in leadership, budget for training time with backfill so staff are not trained on their days off, limit customization, and plan a year of optimization after go-live, when most usability problems become visible.
Slide 14: My Experience With a New System
Lived through a medication administration system change as a staff nurse
Training was two hours, a week before go-live
Workarounds appeared within days
Lesson: design with users and support them after go-live
Speaker notes: As a staff nurse, I lived through the implementation of a barcode medication administration system. Training was brief and scheduled a week before go-live, and within days nurses were scanning medications at the station instead of the bedside because the scanners did not reach. That experience taught me that systems succeed only when they are designed with the people who use them and supported well after the launch.
Slide 15: Conclusion
Usability, configurability, and interoperability deserve heavy weight
Recommend System B for its integrated record and usability
Build a clinically led team and lead with culture
Plan for resistance, training, and optimization
Speaker notes: Choosing a new electronic health record is a clinical decision as much as a financial one. System B best meets Lakeview's needs. Its success will depend on a clinically led team, attention to culture and resistance, adequate training, and continued optimization after go-live. The recorded presentation closes with the references on the next slide.
References
Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112. https://doi.org/10.1197/jamia.M1471
Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, 20(e1), e9-e13. https://doi.org/10.1136/amiajnl-2013-001684
Lorenzi, N. M., & Riley, R. T. (2000). Managing change: An overview. Journal of the American Medical Informatics Association, 7(2), 116-124. https://doi.org/10.1136/jamia.2000.0070116
Sipes, C. (2019). Project management for the advanced practice nurse (2nd ed.). Springer Publishing.
How this N 537 Module 5 example is structured
N537 Module 5 typically asks for a 7 to 12 minute recorded presentation, as project manager for a new system, on usability, configurability and interoperability and whether they outweigh cost, your system recommendation, phase one team selection, leading with culture, physician resistance, pitfalls and your own experience, with at least three scholarly sources. The recording is your own work. Aspen revises courses, so follow your classroom's prompt. This example answers each question on its own slide with notes you can speak from.
N537 Module 5 questions, answered
What does N537 Module 5 usually ask for?
A 7 to 12 minute recorded presentation with slides, as project manager for a new clinical system, covering usability, configurability and interoperability versus cost, your recommendation, phase one team, leading with culture, handling physician resistance, pitfalls and your own experience, with at least three scholarly sources.
What is the difference between configurability and customization?
Configurability means adapting the system with built-in tools such as order sets and flowsheets. Customization means changing the software itself, which raises costs and complicates upgrades, so most organizations configure as much and customize as little as possible.
Who belongs on a phase one implementation team?
Executive sponsors from nursing and medicine, respected clinical leads, an informatics nurse, IT analysts and frontline super users from each area, so that the project has authority, credibility and technical skill.
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