The implementation of Electronic Health Records (EHR) can be broken into the five broad phases:  initiate, plan, execute and control. 

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Each of these phases are further explained using an outline provided by Claudine Beron:

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Initiate
 

    This phase marks the beginning of the project or phase and formally authorizes the project. For a successful project, the objectives and requirements should be well defined at the start of the project.
        Educate Your Organization on EHR
        Identify Owners & Stakeholders and get buy-in
        Identify Subject Matter Experts in each area considered
        Understand the Environment Today (high level only)
        Description of organization by Bed#, Acute / Long Term / etc and types of patients
        Services provided today (note difference if more than one environment)
        Legacy Systems in place?
            Which one’s Interfaces (HL-7 ver 2.0?, NCPDP, etc)
            Quality of Data, if any # of
        Clinical and IT Staff
        Outside of the Project Team Skills that will be needed
        Develop Business Case that include preliminary scope requirements
        Understand Budget Cycle and Politics
        Understand Procurement Process (if vendors are used)
   

Plan
    The Planning Process Group is considered the most important Process Group in project management. Time spent up front identifying the proper needs and structure for organizing and managing a project saves countless hours of confusion and rework during the Executing and Monitoring and Controlling Process Groups. Project planning defines project activities that will be performed, the products that will be produced, and describes how these activities will be accomplished and managed. Project planning defines each major task, estimates the time, resources and cost required, and provides a framework for management review and control. Planning involves identifying and documenting scope, tasks, schedules, cost, risk, quality, and staffing needs. This planning process includes the following:
        On Site Assessment of the Environment
        Detail questions/interviews for each clinical area to implemented modules based on preliminary scope
        Develop Gap analysis of actual systems and resources
        Build Draft Project Plan/WBS & Schedule
        Confirm Scope requirements
        Prepare Budget and Resource needs assessment
        Develop Request for Proposal (RFP) for Vendor Services, if applicable
        Evaluate Proposals for winning bid with lead clinical staff included Validate start date and terms and conditions
        Select Vendor and approve start date
        Update Schedule and Project Plan/WBS
        Verify Staffing by Organization and Assignments
        Verify Training by Organization and Assignment
        Order Hardware/Software for Test/Development and Production Site(s)
        Start up meeting to bring all stakeholders together
   

Execute
    The Project Team and all necessary resources should be in place and ready to perform project activities. The Project Management Plan is completed and baselined by this time as well. The Project Team’s and specifically the Project Manager’s focus now shifts from planning the project efforts to participating in, observing, and analyzing the work being done. In this phase the work activities of the Project Management Plan are executed, resulting in the completion of the project deliverables and achievement of the project objectives. This Process Group brings together all of the project management disciplines, resulting in a product or service that will meet the project deliverable requirements and the customers need. In this Process Group, elements completed in the Planning Process Group are implemented, time is expended, and money is spent. This Process Group requires the Project Manager and Project Team to:
    
        Conduct, coordinate and manage the ongoing work activities
        Perform quality assurance activities continuously to ensure project objectives are being met or achieved
        Monitor identified risks for triggering events and implement containment or contingency strategies as necessary
        Distribute information to project stakeholders
        Manage change.

    In short, it means coordinating and managing the project resources while executing the Project Management Plan, performing the planned project activities, and ensuring they are completed efficiently.  These activities include:
    
        Build Test/Development System
        Include staff responsible for ongoing maintenance for training
        Document System (Build Guide, Configuration Guide)
        Test System prior to implementing EHR
        Load EHR and Configure Modules mapped to current services Foundation (Foundation, FileMan, HL7, Kernel, all mandatory) Basic (Lab, Pharmacy, Scheduling, etc)
        Standard (CPRS, Problem List, etc) Extended (Hepatitis C, Medical Clinical Services, etc)
        Include staff identified as subject matter experts to validate configuration of modules and training
        Test System prior to ghosting to Production System
        Provide 1st Round training while system is Test/Development
        Verify configuration and usability by end users at Pilot Site
        Deploy Pilot Site (Production Site)
        Train SMEs and End-Users at Pilot Site
        Evaluation of course material essential
        Obtain Site Completion Sign off by owner
        Deploy Disaster Recovery Site
        Include staff responsible for ongoing maintenance Deploy and Test at Additional Sites
        Validate any differences in site by site services
        Train SMEs and End-Users
        Obtain Site Completion
        Sign off by owner Implement and Support.
        
   

Control
    Project performance must be monitored and measured regularly to identify variances from the project plan. Occasionally, current projects of the on-line era, also demand a change in an objective or a deliverable. Hence the methodology is equipped with a flexible yet well-defined process to control and manage the changes being requested to the project scope and objectives, and allows revisiting of the above phases anytime during the project life cycle.  Some of the main processes that can occur during this phase are:
        Scope Change
        Control Risk Monitoring and control
        Cost control
        Performance Reporting

    Specific activities may include:
    
        Control Validate throughout the project that scope is aligned with deliverables
        Changes documented in Change Request with owners signature
        Risk Monitoring and Control
        Develop Risk and Issue logs
        Meet on weekly basis with team/owners to document and discuss mitigation strategies
        Engage now owners if mitigation strategies aren’t working – don’t wait
        Cost control Review and document with team hours allotted and scope of work to be done
        Manage weekly/bi-weekly/monthly timesheet reporting
        Manage subcontractors, if any to their contracts
        Manage weekly/bi-weekly/monthly timesheet reporting
        Manage ODC’s and document any discrepancies in estimated .vs. actual cost
        Report to owner when 75% of project is complete
        Performance Reporting
        Provide monthly reports on financials and milestone/deliverables completed based on schedule and project plan.
        
   

Close
    The last major Process Group of a project’s life cycle is the project Closing Process Group. Project closeout is performed after all defined project objectives have been met and the customer has formally accepted the project’s deliverables and end product or, in some instances, when a project has been cancelled or terminated early. Project closeout is fairly routine, but it is an important process. By properly completing the project closeout, organizations can benefit from lessons learned and information compiled at closure.  Activities include:
    
        Complete closeout of any contracts subcontractors/product vendors
        Document licensing and warrantee for systems
        Sign off of customer acceptance
        Attach site completion sign off’s
        Closeout of any financial matters
        Prepare final reports
        Conduct a project review with all stakeholders
        Document lessons learned
        Complete, collect and archive project records
        Celebrate!