Health Information Management

How to test the effectiveness of your EHR system

HIM-HIPAA Insider, January 23, 2007

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Electronic health records (EHR) testing is difficult and has high stakes. This testing must validate that a very expensive system will perform as expected. Once the EHR passes all forms of testing and you convert it to live status, two important cultural and economic events occur. First, the system will create a huge (and with hope, positive) impact on the organization. A positive impact can ensure achievement of many benefits. A negative impact can be catastrophic to the organization and the implementation team. Second, your vendor probably will have received final payment (unless you are able to withhold a significant portion until sometime after go-live). With that last payment, you lose leverage in having the vendor fix problems, especially because it was up to your organization to find them earlier and failed to do so.

Because of the enormous impact of the EHR, it is important to establish appropriate accountability, keep good records, and use formal issues management structure.

A simple method to establish accountability is to require testers/departments/users to sign a form acknowledging that they have conducted a thorough test and certify that the system has passed, perhaps noting any specific concerns or failures as appropriate. Some organizations require such sign off for each testing level, others only after final integrated system testing. But assuming accountability in this formal matter puts the onus on the individuals to do the very best they can on the testing process.

It is very important to keep written records that demonstrates you have conducted testing, describes how well the system performed during the tests, and identifies any detected errors. These records need to be easily recoverable in case you need documentary evidence of your efforts. There may be government or regulatory agencies asking for evidence of your testing, perhaps as far in the future as 10 years after you implement the system.

More likely, however, is the internal need for them. Internal needs include the ability to deal with questions arising in later testing or after go-live. Such questions might include: problems that were identified, but were not fixed; problems that occurred later that you should have discovered but didn't; or problems that arise due to subsequent changes or updates. Documentary evidence can be very powerful in building or protecting your case for fixing such problems. The lack of documentary evidence will create an easy area for potential adversaries to exploit.

Issues management
It is good to find errors during the testing process. You want your tests to be tough and thorough so you will find whatever problems exist at this point and not during normal use.

Equally important to finding errors and problems is having a process in place to track them. This includes describing the problem, giving evidence and documentation that vendors can use to diagnose and resolve, assign accountability to fix the problem, and track it through resolution. Once you correct a problem, you need to retest it.

Besides error correction, changes in the EHR you implement can be many and frequent. Track these changes to ensure that their impact is understood and to determine whether you need to retest the system with those changes.

Editor's note: The above article was adapted from the book Electronic Health Records: Strategies for Implementation, written by Margret Amatayakul, MBA, RHIA, CHPS, FHIMSS and Michael R. Cohen, MM, FHIMSS. For more information or to order, call 877/727-1728, or go to

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