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Top 3 electronic health record implementation risks and how to manage them

Article-Top 3 electronic health record implementation risks and how to manage them

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Even though electronic health records have become commonplace, EHR implementation projects still face risks that can make them challenging to implement.

EHRs have finally gained widespread adoption. According to 2021 data, 96% of non-federal acute hospitals in the U.S. deployed an EHR system. Nevertheless, the EHR market faces numerous challenges. In fact, about a quarter of EHR system installations fail.  

That often happens due to a poor understanding of potential implementation risks and missing risk management. So, what are the top EHR implementation risks, and how to manage them? We look into the matter. 

Top EHR implementation risks 

The risks connected with EHR implementation fall into three large groups: 


Estimating the EHR project budget is a tricky matter. According to the 2022 EHR Software Report by Software Path, the average EHR budget is $1,2K per user annually. However, the actual cost can vary due to several factors – the available funds, the size of your practice, the features you need, and the implementation method. 

As for the latter, on-premises EHR solutions require system hosting on hospital servers, which may require buying additional computers and other hardware. On the other hand, in this case, you own your data with no concerns about vendor ownership of the system, as happens with cloud solutions. 

At the same time, a cloud EHR solution does not require hefty upfront investments. That is about affordable monthly subscriptions. However, there is still a point to keep in mind. The cost of a cloud-based EHR may significantly grow. With such a system, scaling up is easy but could become less affordable.  


This risk refers to your employees dealing with the EHR system daily. For medical personnel, a new digital tool brings a lot of stress – they need to work and learn the key functions of the new solution simultaneously. That builds up the workload on clinicians and nurses.  

An increased workload and the lack of experience with the new tool increase resistance to change. People knew how to work with the previous solution and got used to the hurdles it offered, and now with the new tool, they are back to adjusting to new processes, training, and overwork.  

EHR Technology 

Though today EHRs are ubiquitous, hospitals concentrate on one aspect of the system – digital data storage. However, another important function is medical data exchange among providers, patients, and their doctors. When insured properly, health data exchange prevents health data losses and helps to ensure care continuity across different locations. 

EHRs work as a cornerstone of any hospital. Doctors from any hospital department should have seamless access to the system from any location. Besides, the ability to connect from anywhere appeals to patients. These two features require integrations with all hospital systems and patient-centric solutions: mHealth apps, patient portals, and tools for remote patient monitoring. 

Additionally, to improve care delivery and patient experience, electronic health records should support clinical workflows. It may require mapping and subsequent redesign. 

Effective risk management strategy 

How to overcome all the risks while implementing an effective EHR solution? Below we provide an EHR risk management strategy that helps run the project smoothly. 

Smart preparation 

Remember that EHR implementation is a long-term investment, not a one-time effort. First of all, you need to draft your total EHR cost. To do so, you need to identify the core features the team needs in the system. You can also assign priorities to those features to see which functions are critical and which can wait for the optimization round.  

Сonsider different add-ons your practice already has (a patient portal, lab software, etc.) These efforts will help you visualize the scale of the project, its cost, and the required integrations. 

Then ensure productive communication with your stakeholders – clinicians, administrative staff, board members, and the marketing department. Prepare the ground by openly discussing the current EHR solution and its deficiencies for all stakeholders. A new EHR project should not be unexpected to them.   

Productive dialogue 

At this point, the new EHR benefits should come under the spotlight. Your hospital leader needs to discuss the problems with the current system and promote the need for a new solution citing its benefits for each group of stakeholders. This approach helps mitigate the resistance to change, as the change comes as the solution to the key pain points. As a result, employees will welcome a new EHR more willingly. 

Besides, it helps pave the way for another important effort – attracting doctors to electronic records implementation. 

Multi-faceted team 

Hospitals differ in size, scale, and the range of services they provide. Logically, software engineers, however qualified, often have no idea how a hospital works. Hence, the team needs to use the clinicians’ expertise to ensure the project's success.  

And here comes another question: which clinicians are a better fit for participating in the project? It makes sense to test your doctors’ computer skills, select those with mid to high levels of computer literacy, and assign them to the development process as consultants.  

Working as project consultants, doctors can: 

  • Map the selected workflows so that they fully reflect clinical processes. 
  • Foster the integration of existing digital solutions. Clinicians can outline the necessary integrations in advance and submit them to developers to plan the needed services. 
  • Test the solution’s usability and detect potentially detrimental issues to patients, like incorrect dosage or units of measurement. 
  • Become supervisors during the training. Tech-savvy doctors can help beginners master the top workflows and features relevant to their position. 

The doctors’ participation in the project can drive a better understanding of the system and its place in your practice and make the implementation smoother and swifter. 

Closing thoughts 

Even though electronic health records have become commonplace, EHR implementation projects still face risks that can make them challenging to implement. Those risks include: 

  • Swelling project costs; 
  • Staff resistance slowing down the implementation; 
  • Lack of understanding of the system and its role in a hospital. 

Fortunately, with a well-designed risk management strategy, those risks are manageable. That strategy comprises three measures: 

  • The preparation stage. This stage helps take the project cost under control and address staff resistance to the new system. 
  • Effective communication. This stage helps bring all project participants on the same page and prove the new system is required. 
  • Doctors in the team. This stage helps create EHR systems with your practice specifics in mind and without lengthy rework. 

That strategy helps address EHR implementation risks and prevent the hurdles they may cause. 

Inga Shugalo.JPEG

Inga Shugalo is a US-based Healthcare Industry Analyst at Itransition: Software Development Company. 
This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.
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