Clinical Process Review Before an EMR Implementation

In a recent EMR vendor demo I did, they talked about strongly encouraging purchasers of their EMR software to do what they called a “clinical process review” before implementing their EMR. They had a contract with a third party group that would do the analysis and give the organization an idea of their current processes and what the future processes would be with an EMR. It highlighted things that would need to change, additional processes that would be added and processes that would be removed.

I’ve talked about this a lot in the past and I think it’s essential to a successful EMR implementation. I called it mapping your workflows, but clinical process review sounds prettier.

Certainly if you’re a large organization it can sometimes pay off to get someone else to do this for you. However, if you’re a small organization you can often do this yourself. Many EMR vendors will work with you on your current workflow and help you work that into their EMR software. I believe it’s absolutely essential.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • In order to efficiently implement any automation, it is recommended to understand the current process and put in place a new process to support the current “work flow”. This is done in every IT project with very good results.

  • I think you could have more aptly phrased it that “In every IT project with very good results, this is done.”

    Sadly, too many clinics miss these important details and their EMR implementation fails.

  • You know I agree. The work flow and clinical review MUST be taken in to consideration when looking to replace the current with the new.

  • I like the phrase “Clinical Process Review” as well.

    We go at this problem by conducting a needs analysis as part of an implementation. We need to figure out who’s doing what, and how, when, and why there doing it, before we can tell the practice’s management how implementing an EMR is going to impact their workflow, and what steps they can take in preparation in order to smooth the transition. (This is also how we figure out how to customize the software to suit the needs of any particular office.)

  • Bill,
    I’d be interested to hear more about what customizations you offer to your customers. How far will you customize the system? Honestly, the best EMR software I’ve found has customization of the EMR as a major part of their EMR.

  • We’ve customized the software in a variety of ways in the past to suit the needs of particular clients, from adding buttons to the Control Panel for accessing unique functions or items, to providing a treatment protocol catalog feature for an oncology group that shows up in several places in the system. Another frequent request is hooking up to lab equipment so the data can be directly imported into charts, which is something I’m sure most EMR vendors can provide.

    (FYI, a side benefit of customizing the software for each client is that we don’t have to charge sales tax. Sweet.)

    Not to get too technical, but one of the nice benefits of loosely coupling the software components and making heavy use of interfaces is that it’s easy to substitute modules on an individual-client basis.

  • The point about not having to charge sales tax if you’ve customized the software is really interesting. That’s why a good accountant is worth the money.

    Interfaces are great when they work well. It was one of the happiest days of our EMR implementation when our lab interface was complete and we no longer had to pass around paper lab results which then needed to be signed and scanned. Electronic lab results is 100 times better.

  • be careful with the sales tax angle here; remember you’re guilty until proven innocent; ask anybody that has fought the installation vs. fabrication issue

    if this angle worked, software vendors would charge a buck for the product and call everything else, the custom templates, and setup, etc tax free “installation” type labor

  • re: sales tax

    John, you might want to follow-up this thread and add it to your inventory. Not a big issue in the greater scheme of things but nonetheless, can be a big gotcha.

    For example, in some states …

    “The vendor of the custom computer software program must pay sales or use tax on the cost of all materials used to produce the custom software.”

    Lots of pitfalls. Could even get through to the provider as a Sales AND Use Tax issue.

  • Axeo,
    I think I’ll leave this discussion to the accountants. Each state is different and so too much to consider.

    My recommendation is to get a great accountant and do what they say.

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