We are in the beginning stages of organizing an EHR implementation project for our rehabilitation clinic. We are finding that we are using much more time than was originally allotted for this, and I'd like to get other people's takes on how theirs is going. What are your expectations? How quickly or slowly do you plan to move through this process?

There is no "standard" timeline for implementing an EHR, though it can easily take from 3 months to a year or more depending on several factors:

1. Did you go through all your documents, forms, and communication flows and standardize them before starting the implementation or is that part of the implementation time?
2. Are you going to accept standard forms and screens from a supplier or will you need customization?  How much customization?
3. Are your records already in some electronic form?
4. Are you going to convert all existing records or start everything new?
5. How do you plan to get current demographic client data into the system?
6. Have you set realistic expectations for your staff or are you going to experience resistance during training?
7. How many staff will use the system intially?
8. Do you have dedicated personnel for the project?
9. There are many more items that need to be covered during your discovery efforts before even selecting an EHR system.

Sometimes, a pause and revisit of the project baseline or a rededication for the effort is in order.

Charles

Before going any further, ask yourself some key questions:

• Have you involved your end-users with decisions about presentation, easy of use, pro/con on modifications to current workflow, privacy and security, and usefulness of EHR data to healthcare consumers?  In other words, will they enthusiastically use it?
• What about ensuring that CMS's meaningful use criteria can be supported?
• Does the current project plan and schedule support affirmative answers to the above two questions?
• Does the project staff concur with the schedule and do they have meaningful incentives to realize it and consequences if they don't?
• Does the project manager have the authority and strength of character to deflect disruptive tampering with project objectives and resources from people who are not direct project stakeholders? 
• If you have vendors or consultants on the project team, do they have iincentives for on-time on-budget performance and penalties for failures? 

These are all great tips. The involvement of end-users seems like it could be a challenge in and of itself. Do you - or anyone - have any tips on how to prepare an organization for this change? What reasons for resistance should I expect?

The tip that comes readily to mind is forming an end-user advisory panel.  This group will stay with the project through implementation and is charged to bring honest advice and feedback as the project moves forward.  It is good to do a Myers-Briggs test, or similar, for the end-user advisory panel members and then openly discuss each others' results and what they mean in the context of working together.  A lot of resistance arises from people not understanding where each-other is coming from.

Outside of the team, the key reason for resistance is that many people dislike change, and much of that is irrational.  Your primary tactics are friendly communication and seminar-style education as the project progresses.  You will also need some formal classroom instruction for the users who must use the system day-to-day plus thorough online help and FAQs for users to use as they start using the system.