C816 Task 1 EHR Implementation Plan Example

Retiring the Paper Half: An EHR Implementation Plan for a Composite Critical Access Hospital of 25 Beds Still Running a Hybrid Record, Phase by Phase With the HIM Roles Defined

Student Name

Leavitt School of Health, Western Governors University

C816: Healthcare System Applications, Task 1

Course Instructor

Month Day, Year

Retiring the Paper Half: An EHR Implementation Plan for a Composite Critical Access Hospital of 25 Beds Still Running a Hybrid Record, Phase by Phase With the HIM Roles Defined

The Hospital and Its Hybrid Record

Aspen Valley Hospital is a composite critical access hospital, licensed for 25 beds, with an emergency department, a small surgical suite, a rural health clinic and a swing-bed program. It bought an electronic health record (EHR) module for the clinic and emergency department six years ago, but nursing documentation on the inpatient unit, consent forms, anesthesia records and outside records still arrive on paper. The result is a hybrid record: each patient's information is split between the EHR and a paper chart that the health information management (HIM) department scans after discharge.

The hospital's board has approved moving to a single, fully electronic record within 18 months. This plan explains what the hybrid record is costing, sets out the implementation through the phases of the system development life cycle (SDLC), defines the roles of two HIM professionals, and addresses legacy records, data conversion and downtime.

What the Hybrid Record Costs

The hybrid record creates problems for patient care, operations and revenue. At the bedside, a clinician reviewing the EHR during a readmission cannot see the nursing assessments or medication administration records from the previous stay until they are scanned, which currently takes an average of six days after discharge. In the HIM department, three staff spend most of their time retrieving, prepping and scanning paper, and coders wait for scanned documents before they can code inpatient accounts, which delays billing. Release of information requests require staff to search two places and assemble one copy, which slows responses and raises the risk that part of the record is missed. The paper chart can also be misfiled, and a scanned page indexed to the wrong patient is an error that may not be discovered for months.

Critical access hospitals face these problems with fewer resources than larger hospitals. A systematic review of health information technology in critical access hospitals found recurring challenges of limited finances, staffing shortages and interoperability failures (Pai, 2025). Aspen Valley's plan must therefore be realistic about staff time and must include support from its EHR vendor and its regional health network.

Implementation Through the System Development Life Cycle

The plan follows five SDLC phases. Because the hospital is extending an existing vendor system rather than building one, the design work is configuration rather than programming, but each phase still has concrete tasks.

Two decisions in the analysis phase shape everything after them. First, the hospital must define its legal health record: which documents, in which systems, make up the official record the hospital will produce for patient care, billing and legal requests. Without that definition, staff cannot know whether a document still on paper is part of the record. Second, the forms inventory sorts every paper form into one of three groups: replaced by an electronic template, captured by scanning at the point of care because it originates outside the hospital, or retired. Only when the scanned group is small and managed at the time of care does the hybrid record truly end.

Roles of Two HIM Professionals

The HIM director serves on the steering committee and is responsible for the integrity of the record through the project. In planning, the director helps set scope and budget for HIM work such as scanning and conversion. In analysis, the director leads the legal health record definition with the compliance officer and medical staff, sets retention rules for legacy paper, and approves the forms inventory. In design, the director reviews templates to ensure they meet documentation, coding and regulatory requirements, and defines how amendments, late entries and corrections will work electronically. After go-live, the director monitors record completion, runs documentation audits and approves changes that affect the record.

The HIM data integrity analyst is responsible for the data the new system will depend on. In analysis, the analyst reviews the master patient index for duplicate and overlaid records and resolves them before conversion, since duplicates carried into a new workflow multiply errors. Research on a multisite set of confirmed duplicate records found misspelled names and mismatched Social Security numbers among the most common discrepancies (Just et al., 2016), so the analyst will also rewrite registration search and naming standards. During design and testing, the analyst tests scanning and indexing at the point of care and validates interface data. After go-live, the analyst tracks unindexed documents, merges new duplicates and reports data quality measures monthly.

Legacy Records and Data Conversion

The hospital holds about 11 years of inpatient paper charts in storage. Scanning all of them would be costly and of little value, so the plan scans charts for patients seen in the last three years on demand when they return, abstracts key data such as allergies, problem lists and advance directives into the EHR for active patients, and keeps older paper charts in storage until their retention periods expire under state law. A retrieval process will remain in place for legal and release of information requests that involve older records.

Downtime and Business Continuity

A fully electronic hospital depends on its system being available. In a study of reported EHR downtime events in one hospital over more than four years, 96.1% of 204 events were unplanned, medication-related events were the most common, and most disrupted patient care (Fang et al., 2025). Aspen Valley's plan therefore includes downtime procedures before go-live: a read-only downtime computer on each unit that prints current medication administration records and active orders every four hours, paper downtime forms that match the electronic templates, a communication tree, and a recovery process in which HIM staff scan or enter downtime documentation within 24 hours after the system returns. The procedures will be tested in a planned downtime drill during the implementation phase.

Conclusion

Aspen Valley's hybrid record slows care, billing and requests and creates risks for patients. Moving to a fully electronic record through a phased SDLC plan, with a defined legal health record, a clean master patient index, clear HIM responsibilities and tested downtime procedures, gives a small hospital a realistic way to retire its paper half without losing the integrity of its record.

References

Fang, Q., Liang, J., Xiang, P., Zhao, M., He, Y., Zhang, Z., Wan, H., Hu, Y., Wang, T., & Lei, J. (2025). Electronic health record downtime events of a hospital: A retrospective analysis from adverse event reports. Applied Clinical Informatics, 16(5), 1419-1429. https://doi.org/10.1055/a-2701-5819

Just, B. H., Marc, D., Munns, M., & Sandefer, R. (2016). Why patient matching is a challenge: Research on master patient index (MPI) data discrepancies in key identifying fields. Perspectives in Health Information Management, 13(Spring), 1e.

Pai, D. R. (2025). Health information technology in rural health care: A systematic review of its impact on critical access hospitals. The Journal of Rural Health, 41(3), e70052. https://doi.org/10.1111/jrh.70052