5 EHR implementation challenges and how to overcome them

1. Resistance to change

Since EHR implementation impacts virtually every workflow within a healthcare organization, staff might resist adoption of a new EHR due to fear of change or comfort with existing processes.

Identifying fears staff might have about an EHR implementation early can help leaders target educational efforts to gain employee buy-in, according to the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC).

Leaders should also ensure all staff members are part of the EHR decision-making process so the new system meets end users' needs.

Additionally, organizations should reinforce the value of each team member and provide additional support to individuals resisting the EHR implementation.

"Schedule regular meetings or daily staff huddles," ASTP/ONC noted on its website. "These meetings will help to engage everyone in your organization and allow everyone to share their opinions."

Organizations can also assuage end-user worries about adopting a new EHR by providing EHR training before, during and after implementation. Best practices for EHR training include specialty-specific training, ongoing EHR education and eLearning modules.

2. Data migration issues

Data migration is a critical aspect of EHR implementation to ensure accurate patient health records. According to ASTP/ONC, an organization's outgoing EHR vendor should assist with transitioning data to a new EHR vendor's system.

However, in the absence of a contractual obligation that specifies the vendor's data transfer requirements, an outgoing EHR vendor might provide data in an inconvenient or impractical format. In these cases, organizations incur the time and costs associated with data conversion.

ASTP/ONC noted that negotiating contract terms with EHR vendors prior to implementation can simplify the data migration process should an organization change vendors in the future.

"Contract terms that support an orderly transition from your current EHR will structure, speed up, and simplify what can be a very time-consuming, expensive and difficult process," ASTP/ONC explained.

However, if an organization does not have EHR transition terms in place with its legacy vendor, it can employ experts or consultants to help oversee the migration process.

EHR data migration requires detailed data mapping and cleaning to ensure accurate and relevant data is transferred.

According to the Texas Medicine Association, organizations might consider limiting their EHR data migration to active patients only. For inactive patients, organizations can archive data as a PDF to maintain access to patient records for periods required by state medical boards and payers.

3. Cost overruns

The economic burden of an EHR system extends beyond the cost of the new software and its implementation. Careful planning is critical to maintain within budget.

According to a 2020 study published in Applied Clinical Informatics, organizations incur costs from additional hardware, consulting fees, operational expenses, hiring personnel skilled in configuration and build, testing, training and retrofitting existing equipment.

Transitioning EHR systems involves transferring vast amounts of sensitive patient data. The complexity and volume of this information can introduce vulnerabilities, making it easier for cybercriminals to exploit weaknesses.

Additionally, organizations must invest in connecting the new EHR to in-house and external laboratories, suppliers and inventory systems.

Further, stakeholders must invest in ongoing costs associated with the legacy EHR to maintain data access until the transition is complete. However, an organization's EHR implementation approach impacts the cost of maintaining the legacy EHRs significantly.

A "big bang" rollout deploys the new system to all departments at once, which means organizations can spend less time and money on maintaining legacy EHR systems.

On the other hand, a phased rollout uses one department, clinic or smaller hospital as a test case for the health system. While this approach can help identify challenges early in the transition process, it requires the cost of maintaining two EHR systems during a longer transition period.

Overall, EHR project expenses can total hundreds of millions of dollars initially and often continue with each subsequent upgrade. The study authors indicated that the total price tag can exceed $1 to $2 billion for larger systems.

"Make sure to budget appropriately for both the rollout and for the expense of operating two systems simultaneously when using a phased rollout," the authors advised. "Examine whether internal personnel could reduce the need to pay for outside consultations."

4. Heightened cybersecurity risks

Transitioning EHR systems involves transferring vast amounts of sensitive patient data. The complexity and volume of this information can introduce vulnerabilities, making it easier for cybercriminals to exploit weaknesses.

CIOs and leaders must recognize and address heightened dangers of data breaches, ransomware and other cybersecurity threats during times of transition.

To safeguard against these risks, organizations must establish a dedicated cybersecurity task force to manage and mitigate emerging threats. The task force should focus on both new and ongoing cybersecurity needs and ensure compliance with ONC regulations that mandate enhanced cybersecurity for EHRs.

Additionally, the task force should include ethical hackers to regularly test and secure the systems, according to the Applied Clinical Informatics authors.

Organizations should allocate funds for IT personnel, continuous staff training, ongoing data backups and monitoring emerging threats to maintain data security.

5. Patient engagement

Patients are often overlooked as an end-user group during EHR transitions. However, according to a 2024 study, organizations must keep patients informed about EHR implementations to support patient engagement.

"Failure to communicate about the EHR transition can leave patients unaware of changes that affect their interactions with the healthcare system, such as changes to the medication refill request processes through a patient portal, scheduling appointments, or the flow and length of their clinical encounters," the study authors underscored.

Getting patients to use the new patient portal can be difficult. However, educating patients on the benefits of the new EHR system can help improve engagement.

According to a 2021 data brief, patients who were encouraged by their provider to use the patient portal were much more likely to access personal health information, view clinical notes and exchange direct secure messages with their provider than those who were not encouraged.

Despite its challenges, EHR implementation can be successful with the right strategies. By addressing resistance to change, ensuring smooth data migration, managing costs, strengthening cybersecurity and engaging patients, healthcare organizations can achieve a seamless transition.

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.