Case Management and EHR Implementation


Electronic health record (EHR) implementation may seem like a daunting task. Bringing in any new agency-wide technology tool can be complicated. It requires a fresh look at how your agency works, as you want to realize the best possible outcomes without taking time away from the people you support.

Through decades of experience, Foothold Technology has developed a robust plan to make EHR implementation as smooth as possible for the agencies we work with. Here, we’ll demystify the process by highlighting how successful EHR implementation can transform your agency and guiding you through our proven EHR implementation plan.

people working on profile icon

What Is EHR Implementation?

EHR implementation is the process of integrating electronic health records within an agency, whether you are moving from paper records or migrating from a different platform. With electronic health records, the members of your organization and the programs you work with all have access to clients’ records, linking everyone to a shared source of information. Fully implemented EHR systems help to keep everyone current about important details like client notes, service plans, and medical information. 

For behavioral health organizations, the advantages of EHR implementation are numerous. Our customers have spoken of improved communication between programs, the ease of viewing information across agencies, and the ability to generate reports for the purposes of quality assurance, quality improvement, and supervising. Altogether, these advantages, and others, allow agencies to realize greater outcomes for their clients. 

EHR implementation is an agency-wide venture. Everyone, from senior leaders to junior staff, must understand the value of the new system and buy into it to ensure success. 

EHR Implementation Timeline

The National Center for Biotechnology Information estimates that hospital EHR implementations usually take around six to eight months. But with the right team members and processes in place, we’ve seen that most EHR implementations for human services agencies take about four to six months.

That being said, the time it takes to fully implement your EHR system depends largely on the complexity of your agency and your team’s project plan. If you’re a smaller agency initiating a new system, it would probably be quicker than it would be for a large organization replacing its existing EHR.

EHR Implementation Challenges

Working with our customers, we’ve found that change resistance is one of the biggest challenges that agencies face during implementation. By that, we mean that internal members are reluctant to adapt to the new system. Maybe they’re suspicious of the new technology, or perhaps they don’t want to abandon familiar methods. This is normal. Any new tool or process change is bound to lead to some anxiety about adapting to it and transitioning to different workflows.

We’ve seen that our customers have found the most success in change management by following a few key principles:

  • Involve staff as early in the process as possible.
  • Communicate how the change will positively impact the staff’s work and their clients.
  • Partner with program managers to configure the EHR to current workflows, or take this as a chance to make workflow improvements based on staff recommendations.
  • Be patient with training and understand that staff will naturally hit roadblocks along the way.

Aside from change resistance, other common EHR implementation challenges include:

  • Infrastructure: Some agencies, particularly those in rural areas, may have to build up the technical means to support EHR capabilities. 
  • Workflow Disruption: As the members of an agency get accustomed to the new EHR system, they may experience slowdowns in their workflows. To resolve this issue, it’s important to receive thorough demonstrations and training.
  • Training Time: Speaking of training, some agencies might experience additional disruptions related to the time allotted for training. A clear understanding of how much training you need is crucial for a smooth implementation.

What Are the Steps of EHR Implementation?

Having a well-defined plan is so important when you’re initiating a new system. After many years working with large numbers of agencies, we’ve honed our EHR implementation plan to maximize success.

Step 1: Assembling Your Implementation Team

To carry your implementation forward, you’ll need the right team. This team will become your internal EHR experts. They’ll lead ongoing tasks, like creating new forms, assigning permissions for new staff members, and changing access to client records for staff entering new roles at your agency.

Based on our vast experience with supporting implementations across the country, we have a few recommendations on how to strategically share knowledge within your agency and create your own database management team.

One is to streamline your entire implementation process by giving your team members specific roles. Here are our recommendations for implementation team roles:

  • Team Lead: The team lead is the main point of contact between your agency and your EHR vendor. Think of them as the internal project manager of your implementation process. They are ultimately responsible for bringing your implementation process to completion. Their responsibilities include delegating tasks, scheduling calls, and communicating with program staff. They will communicate the full database management plan to your agency so that everyone knows whom to see about questions or troubleshooting.
  • Quality Assurance Team: Include your quality assurance staff to ensure you are meeting documentation requirements when configuring your EHR.
  • Training Team: The training team will learn the ins and outs of your EHR software so they can start training other members of your agency. They will plan out the onboarding process for new hires and establish processes for creating internal training materials and deciding who will attend future trainings.
  • Internal Help Desk: Your internal help desk team will learn the specifics of your EHR’s functionality so they can troubleshoot problems and answer questions.
  • Permissions and Staff Logins Lead: This individual will set up your staff logins and manage permissions.
  • Form Creation Lead: This team member will help create and configure the forms that your agency needs to collect data.
  • Report Creation Lead: This staff member will lead the creation of report templates most commonly used at your agency.

Aside from the above, there are a couple of other roles you might consider, depending on how relevant they are to your agency. One is the provider/referral module lead, who works with your implementation consultant to set up a module that houses your referral sources. The other is a lead for each program you want to set up within your software. For that, we suggest choosing a representative who will ensure your EHR is set up appropriately for that program’s data collection and workflow needs.

Keep in mind, if your agency doesn’t have enough members to fill every role, certain members can work in dual capacities.

Step 2: Deciding Which Programs Will Use The EHR

Since most agencies run a variety of programs, think about which programs you want to implement in your EHR and in what order. To simplify this process, try to group your programs according to similarities in service planning, funding, and staffing.

Before you roll out the EHR system to the whole agency, first try a limited rollout to a couple of programs. This gives you a chance to learn more about what processes work best for your agency.

Step 3: Matching Your EHR to Your Workflow

Each of our client agencies partners with a dedicated Implementation Consultant who has extensive experience in human services. The Implementation Consultant is their guide through the EHR implementation process. Beyond making sure the software captures the information their programs need, the Implementation Consultant matches the software to the agency’s unique daily operations.

Here are a few questions to consider at this stage:

  • Are your intakes centralized for the entire agency, or does each program have its own intake process?
  • Do you have a vetting process for referrals?
  • Do you need your assessments to repeat on a particular schedule?
  • What kind of post-discharge follow-up do you do for your clients?
  • Are there restrictions on which agency staff members can see which client records?
  • What reports do you need for your funders and internal auditing?

Structuring modules and forms so that staff can work efficiently through their daily workflows is crucial for helping your agency operate more efficiently, from your frontline clinicians to your executive directors.

After the initial configuration, your team will check to make sure the software supports your typical data collection process. You can do this by walking through the life cycle of:

  • Admitting clients.
  • Planning and documenting their services.
  • Completing assessments.
  • Discharging clients.

The goal of this exercise is to ensure the database is ready for both staff training and daily use. The initial configuration is also a great time to take a look at your agency’s current workflows and make sure they are still fully optimized for your staff and clients.

Step 4: Entering Your Data

At this point in the EHR implementation process, your agency is ready to enter real client data into your fully configured EHR. For successful EHR implementation, you’ll need to make some key decisions concerning:

  • How You Will Enter the Data (Manual Entry vs. Upload): While our software has the ability to batch-upload thousands of records at a time, this may not be the best solution depending on the current state of your data. If your agency is using paper documentation or your data quality isn’t up to snuff, you might consider manual entry. It would provide you with a fresh slate and could save you time and resources down the line.
  • Who Will Enter the Data (Implementation Team vs. Clinicians): Some smaller agencies keep the work within the implementation team or clear some time on their administrative staff’s schedules to complete this step. For other agencies, clinicians may enter their own records by setting aside a certain amount of time per week. Either way, we recommend setting clear objectives and timelines for your entire agency to keep this project on track.

What Data You Should Enter During EHR Implementation (Demographic Data Only vs. Demographic Data and Service Plans): Often, it’s best to bring both your demographic records and your service plans into your new EHR before you go live. However, since service plans need to be manually entered, agencies with tight work schedules may choose to enter service plans on a rolling basis as their due dates come up.

"We started clean [with our data] . . . and kept an archive of our old data for compliance purposes. Starting clean assured we knew exactly what data was entered. If we had wanted to import, however, I feel certain Foothold would have walked us through the process to ensure a clean transition."
Foothold Client Agency

Step 5: Training Your Team

We help every customer create a custom training agenda for their agency so they can maximize their learning on the modules their staff will use the most.

We use the Train-The-Trainer model, in which we train key staff members at the agency who can then train and support other users. We find this model empowers agency staff to manage their own EHR system while having the support of their EHR vendor when they need it. Not to mention, having internal agency experts makes it much easier to train new hires.


Step 6: Going Live With Your EHR

With any transition, a smooth go-live day helps maintain staff morale through a time of significant change.

Here are a few tips to make your go-live day a huge success:

  • Make Sure Your Equipment Is Ready To Go. If you’ve purchased new hardware for your EHR, such as tablets or touch-screen laptops, test the devices at the location where they’ll be used. An easy way to perform a full hardware test is to walk through a complete chart workflow on a test client.
  • Double-Check Your Logins and Permissions. One week before your official go-live date, we recommend that you confirm all users have successfully logged in to the EHR at least once and have filled out their security questions.
  • Have the Implementation Team on Deck. Even the most prepared agencies may run into a few unanticipated snags on day one. We recommend that agencies clear their implementation team’s calendar on go-live day so they’re available to resolve unexpected concerns from your staff.

EHR Implementation Is an Ongoing Journey

Implementing an EHR system is a big undertaking. It can be disruptive, but the improved outcomes for your clients certainly make it worthwhile. Remember, you’ll need a strong implementation team, buy-in from senior leadership, a clear understanding of your processes, and support from your program staff. With the right team and a world of experience from your software vendor, any agency can make a seamless transition to a new EHR.

Our team has decades of experience in helping agencies of all kinds transition to a new EHR.