Critical Factors Influencing International EHR Implementation Timelines

Perspective from David Fraser, Head of Implementation Planning, Medix Technology

No matter where they take place, technology implementation projects are massive undertakings requiring the efforts of multiple teams and significant organizational investment. Generally speaking, international electronic health record (EHR) installs take a bit longer than similarly sized U.S. implementation projects. There are several reasons for these discrepancies, including experience, working culture, the time-tested blueprint for success in that country or region and organizational timeline decisions. Please note: While development and/or translation are also key factors here, these tend to be install-specific aspects that require due diligence with an EHR vendor.


First, one of the most critical aspects of any EHR pre-implementation period is project staff recruitment. While the project at hand may be today’s top priority, leadership must always be looking ahead to the future. It is critical that the healthcare organization cultivates and develops talent as part of their organization for the ability to maintain their EHR long-term. This can be somewhat supported by EHR vendor partnerships and leveraging experienced, certified resources to supplement the in-house team. 

The challenges that international groups often face with this approach are twofold. One is the lack of EHR-experienced talent in their market that understands their local healthcare and culture. The second challenge is that, in order to achieve sustained success, they need to build a strong internal team as most organizations cannot afford to keep consultants on forever or to lose that knowledge when they roll off. Hiring such a team can be a challenge that slows health systems down, despite the strength of their recruiting team. 

In recent years, organizations have become more creative in solving this challenge. For example, it is now possible to engage with workforce solutions partners who are willing to take on the risk of recruiting, training and certifying local talent. This sort of support can help to accelerate in-house recruiting efforts. Once integrated within a team for a period of time, these skilled talent can then be brought onto the team in full-time roles, extending their impact beyond the implementation project alone. 

Working Culture

To be honest, I’m often jealous when I learn about the time off and holidays offered internationally! It probably won’t come as a surprise that the perception abroad is often that Americans can be obsessed with work and don’t take enough time to enjoy themselves; after all, 50-60 hour work weeks are not uncommon across a variety of roles and industries in the U.S. While some countries may have similar working practices, this pace of work is much more uncommon. It’s important that healthcare organizations embarking on their EHR journey spend time with their vendor understanding how their working cultures and practices compare to what the vendor has seen elsewhere. Then, use this information to adjust their implementation timeline accordingly. 

Regional/Country Blueprint

Next, there is a blueprint for large EHR implementations in the US given the volume of installs of one EHR across a health system in contrast to what has been done to date internationally. When entering a new country there are considerations (i.e. regulations, development, culture, different service lines and ways of delivering healthcare) that influence timelines until repeatability is established. Once that repeatability is established, speed can start to increase. Consulting with teams that have experience with what has worked on similar projects can go a long way. Healthcare organizations in the pre-implementation stage that do well modeling this for their organization speak with the EHR vendor, experts, and international health system peers to leverage their experience and understandings to blend that with the understanding of their delivery model.

Organizational Timeline

Finally, many organizations have apprehension about the speed of their install. There’s a healthy balance to strike here between allowing the right amount of time for the considerations noted previously, while not extending the implementation too long that it allows for decisions to go in circles. 

Personally, I’ve seen this happen firsthand, as work often expands to the amount of time that’s allowed for it. Counterintuitively, if a project is instead constrained by tighter deadlines or an impending legacy system end-of-life, there’s often an equal likelihood of meeting them at a high quality. Organizations will sometimes assume that after deploying an objectively long install timeline and missing the mark that the issue was that they simply needed more time. However, there are blueprints of organizations with similar considerations moving much faster. 

What I’ve seen with these successful organizations is time spent up front on leveraging the lessons discussed to strike the right balance on timeline and putting in the work early to establish the model and best practices that sets them up with an implementation governance structure, team, decision-making process and guiding principles to succeed.

Do you need help maintaining your EHR implementation project timeline? Talk to a Medix Technology expert to learn how we can deliver solutions and specialists to keep your project on track.

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