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The Power of Strong Implementations The Power of Strong Implementations
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The Power of Strong Implementations
How HIT Vendors and Customers Can Lay a Foundation for Success

author - Ryan Oliver
Ryan Oliver
author - Jeremy Goff
Jeremy Goff
author - Chloe Jensen
Chloe Jensen
December 21, 2022 | Read Time: 6  minutes

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Health systems are increasingly working to get the most out of their IT investments. Focusing on a strong implementation can have a huge impact. Analysis of KLAS data gathered from 2018–2022 suggests that the quality of an implementation may be more important than the technology selected. This white paper offers early insights on how the quality of an implementation impacts outcomes and user satisfaction. The data primarily focuses on solutions that require complex, large-scale implementations (e.g., acute care EMRs, ERP solutions, patient accounting systems, and PACS solutions). This study is part of KLAS’ new Landmark Insights initiative—aimed at helping health systems currently implementing an HIT solution determine whether their project is on track for success.

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High-Quality Implementation Is One of the Strongest Predictors of Market-Leading Performance

In 2022, 81% of Best in KLAS winners were also the highest rated in their market segment for quality of implementation; in market segments that require complex, enterprise-scale deployments, that number was 100%. This highlights the effects of a strong implementation on all other customer experience factors. Additionally, interviewed customers are unlikely to report high satisfaction with outcomes without an implementation rating of at least 7 out of 9. On the flip side, 85% of customers satisfied with outcomes report a good implementation.

quality of implementation by best in klas rating

Many Implementations Aren’t Making the Grade, and Success after a Poor Implementation Is Rare

49% of interviewed individuals report that their implementation needed improvement (i.e., they rated its quality 7 or below on a 1–9 scale). Improving the customer experience overall is difficult after a poor initial implementation—among organizations that start out with a poor implementation and low satisfaction, 76% continue to struggle years after the implementation. This echoes a key finding from KLAS’ Arch Collaborative (an initiative that directly measures end users’ EMR experience): poor initial training can continue to negatively impact end users for up to six years.

almost half of implementations need improvement
lingering effects of poor implementations

Keys to a Successful Implementation—Best Practices for Vendors and Healthcare Organizations

Both HIT vendors and healthcare organizations have a role to play in driving successful IT implementations. One CIO described the need for collaboration between all parties: “An implementation is owned by all the groups involved. Projects are about ownership, attention, and commitment. Every leader needs to be at the table with a full understanding of the options. . . . We need to communicate in a clear and concise fashion. The client needs to truly understand what they are getting themselves into. The vendors need to be honest and forthright with their clients. We are paying a lot of money to get the system implemented correctly.”


Vendors are particularly responsible for setting proper expectations around the time and resources needed for a strong implementation. This includes resources dedicated to governance, change management, training, testing, project management, and communication with the vendor and within the organization. Additionally, vendor sales teams should accurately promote product functionality and ensure clients understand what they will get from their solution. KLAS data shows 85% of customers experience a good implementation when the vendor establishes proper expectations up front by promoting the product accurately.

icon1Make Realistic Promises to Clients, and Ensure Commitments Are Met

quality of implementation by whether vendor keeps all promises

icon2Accurately Promote Solution Capabilities and Required Implementation Lift

quality of implementation by product works as promoted

Healthcare Organizations

For healthcare organizations, one of the most important principles is visibility. In the Landmark Insights engagements KLAS has had with implementing organizations, the primary barrier to solving issues is not knowing about or understanding those issues. One CIO said, “I feel like my steering committee meetings are just about the positives. I know there are issues that I am not hearing about.” Problems go unresolved when everyone who sees them assumes another person will fix them in the next phase of implementation. Organizations should pay particular attention to promoting a safe environment to raise issues without concern for political ramifications (a common barrier to catching and resolving problems early).

The following best practices can help healthcare organizations avoid visibility problems, as well as other common issues, and set them up for a successful implementation.

Before the Implementation

icon3Start Planning Early
Implementation planning begins in the sales process. Set clear expectations and realistic timelines. Vendors need to be honest and forthright about what is required from the organization. All stakeholders should consider the number of integrations they need and the data conversion necessary. Everyone should be bought in to timelines.

icon4Consider Risk-Based Contracting
Budget issues are typically caused by delayed projects and the additional time and resources needed to move forward. Consider risk-based contracts and assume there will be unexpected delays.

icon5Over-Invest in the Right Resources
If possible, properly vet external resources and ensure they have experience with the product. Backfill roles to allow internal resources to dedicate time and attention to the implementation. This will facilitate knowledge transfer and better post-go-live support.

During the Implementation

icon6Utilize Governance Structures
Clearly define governance ownership from the start with clear roles and responsibilities. Dedicate the right leadership teams to the project from the start.

icon7Don’t Skimp on Change Management
Outcomes like efficiency and cost savings are strongly tied to effective change management. Vendors and consultants should have the right expertise to make strong recommendations for change management, and organizational executives should own the execution.

icon8Create a Communication Plan
All stakeholders should understand who is doing what and why. Set up effective program management. Maintain strong executive sponsorship.

icon9Ensure Stakeholders Are Aligned
Make sure the organization, software vendor, and (if applicable) services firm work closely together. Every leader needs to be at the table, with a full understanding of the project status and the issues to be solved. Leaders should be asking questions and demanding transparency. Avoid handing problems off to third parties and letting them run with the solution without coordinating with the organization.

icon10Invest in Training
Training is closely tied to end user satisfaction and adoption. Various types of training can be effective as long as good trainers are involved who know the workflows of those they’re training. Define early who is responsible for developing and delivering training content. Efforts to deliver quality training up front will likely yield better user satisfaction and efficiency.

How We Can Help: KLAS’ Efforts to Provide Implementation Transparency

landmark insights logo

Landmark Insights

KLAS’ new Landmark Insights initiative focuses on helping organizations successfully navigate large HIT implementations. At strategic points in the implementation process, KLAS conducts in-depth interviews with health system stakeholders in multiple departments, vendor implementation leaders, and third-party implementation resources. Data from these interviews is analyzed to identify any stakeholder misalignment and to detect problems early so they can be addressed before the go-live. To learn more about how to participate in this initiative, visit the KLAS website or contact the Landmark Insights team at

Upcoming Research: Implementation Benchmarking and Best Practices Report

KLAS is collecting data from over 120 health systems on a broad range of implementations. In early to mid 2023, we will publish our initial benchmark report, which will share insights into which areas have the biggest impact on HIT implementations and the most common challenges organizations face. This report will also provide the industry with best practices so healthcare organizations, software vendors, and third-party implementation partners can strengthen future implementations.

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. KLAS’ standard quantitative evaluation for healthcare software is composed of 16 numeric ratings questions and 4 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.

This report draws on KLAS’ standard data across a broad set of IT solutions to explain industry-wide trends around implementations and the subsequent customer experience. Additional insights on specific solutions can be found on the KLAS website.

customer experience pillars software
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author - Amanda Wind Smith
Amanda Wind Smith
author - Jess Wallace-Simpson
Jess Wallace-Simpson
author - Joel Sanchez
Project Manager
Joel Sanchez
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2023 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.