Ideal Practices for Managing eClinicalWorks System Administration

An eClinicalWorks build is a production system. It deserves the same governance you would apply to any other system the practice cannot operate without, and it almost never gets it.

One named owner

Not a committee, not the vendor, not whoever answers first. One person with authority over configuration and responsibility for documenting it. The role can be part time and outsourced, but it cannot be diffuse.

Change control proportional to risk

Adding a preference list item does not need a committee. Changing a billing rule, a security role, or a template that feeds a quality measure does. Keep a dated change log for everything that touches production.

A security matrix you can actually produce

Every role, every permission, every user, current as of this month. Review it quarterly and at every departure. If producing that document would take two days, you have found your first project.

Dictionary discipline

Restrict who can create structured items, and require a search before creation. This is the least popular policy on this list and the highest return.

Test environment used as a test environment

A test instance two years out of sync with production is a decoration. Refresh it before any significant change and validate there first.

Documentation as a deliverable

A configuration runbook that explains what is set how, and why. The test is simple: if the administrator left tomorrow, could a competent replacement be productive in a week?