Best practices for a successful EMR conversion

Key points:

  • New EMR platforms, upgrades, and transitions present a host of potential benefits for hospital systems’ long-term financial health, patient care quality, and workflow efficiency.  
  • However, EMR conversion is also a difficult process that can lead to catastrophe if not handled appropriately. 
  • It is imperative that hospital systems proactively incorporate best practices in order to ensure their expected return on investment. 


Electronic medical record spending (including implementation, switching vendors, upgrades, etc.) is projected to increase by 19% every year until 2024. The increased investment is largely a result of hospitals turning to EMRs to help facilitate long-term financial stability. As Morris (Ill.) Hospital & Healthcare Centers explained, “unreliable digital health information can lead to clinical documentation errors and ultimately billing and collection problems downstream.”   

Of the 96% of hospitals that use an EMR, it is predicted that in any given year, 5-12% will invest in upgrading or switching EMR platforms, vendor tools, or other components. The transition from outdated electronic medical records and paper records to a single, enterprise-level medical records system is a challenging task. However, proper EMR conversion can help hospitals reap workflow efficiency benefits, greater data integrity, and downstream financial gains.  

What challenges impact EMR conversion?

When EMR conversion is done correctly, the process benefits many aspects of a healthcare organization. Patient data is more accurate and available immediately after conversion; providers trust the new system; patients feel well supported; and administrative teams can optimize reimbursements.  

However, when the EMR conversion is not properly planned or executed, every aspect of an organization’s operations is impacted dramatically. Covenant Health, a Tewksbury, Mass.-based health system, cited its $83 million Epic EHR implementation in 2017 for a $60.9 million operating loss in 2018. The hospital reported a 30% decrease in productivity after the implementation, as well as physician turnover, which contributed to further financial issues.  

Not only does the organization’s reputation suffer from poorly planned EMR conversion, but gaps in patient history can lead to care delivery errors that compound these challenges. The most common and obstinate challenges facing healthcare organizations include: 

Technology literacy and security

  • Staff unfamiliarity with the new EMR, its functionality, and capabilities leads to workflow inefficiencies. 
  • Transferring files from the old EMR to the new EMR presents digital security risks. 

Technology compatibility

  • Systems often downloaded records and files in a previously generic format and have found that the previous format is not backwards compatible with the new EMR format. 

Clinical feedback

  • Clinical needs, expertise, or point of view are often overlooked leading to a less than user-friendly and efficient EMR interface on their end. 

Disparities between multi-site systems

  • Hospital systems with multiple sites often have different capabilities, initial EMR platforms, and data present on their EMRs. 
  • This differentiation frequently leads to slower and costlier implementations than predicted. 
  • Different sites may have different rollout capabilities that may not be documented or tested prior to new EMR implementation. 


  • Hospital systems that have never transitioned EMRs before can lack internal expertise of the process and best practices. 

6 best practice solutions for a successful EMR conversion

Effective education, security measures, pre-transfer testing, clinical team feedback, and template review can all factor into a successful transition.

1. Proactive education

As the new EMR is built out and implemented, train necessary staff in the new technology early.

2. Establish a security protocol

  • Before starting the transition process, take potential security issues into consideration. 
  • If a third-party vendor is helping to handle the transition, consider their certifications. 
  • SOC 2 + HITRUST is the highest tier of cybersecurity available. Organizations with this distinction demonstrate the ability to fully protect patients and other sensitive, personally identifiable information in accordance with HIPAA.

3. Gradient roll-out plan

  • For multi-site systems, consider a tiered roll-out plan based on the capabilities of each site, region, facility, etc. 
  • Take into consideration measures for sites that will transition into the new EMR system slower than other sites. 
  • Potential reasons some sites may transition slower: site size, bandwidth of staff, age of previous EMR technology, technology literacy of site, region, etc. 

4. Proactive testing

  • Test and retest file transfers. 
  • A common oversight in EMR transitions is assuming that a file from the old EMR will transfer easily into the new EMR. 
  • Files that do not transfer into the new EMR will have to be reformatted or adjusted before the transition is complete to maximize workflow efficiency. 

5. Proactive feedback

  • Ask clinical teams what fields or tabs might benefit their workflow. 
  • Map required workflows and respective EMR involvement. 
    • Learn and reverse-engineer order sets to accommodate a seamless workflow.

6. Reincorporate effective strategies

Request forms from previous implementations that have resulted in positive outcomes. 

Benefits of a successful transition

Smooth and seamless transition

Despite different site capabilities, the overall transition into a new EMR will be timely, relatively free of complication during the rollout itself, and will be done with cybersecurity in mind. 

Improved financial performance

Upfront costs may be large, but improved clinical documentation means optimized billings and collections in the long term. 

Workflow efficiency

  • Proactive staff education means shorter downtime and learning curves with the new EMR. 
  • Clinical feedback on preferred record or data locations, fields or tabs help with workflow and concurrent review. 
  • Well templated forms with previously tested optimal outcomes reduces upfront work and ensures continued positive outcomes. 

Continued innovation

Continued partnership with outside experts and internal analysis prompt continuous opportunities to improve, upgrade, and innovate. 

The sum and substance for healthcare leaders rolling out an EMR conversion strategy

New EMR platforms, upgrades, and transitions present a host of potential benefits for hospital systems. This is representative of the trend within hospital systems for technology innovation to improve long-term financial health, patient care quality, and workflow efficiency.  

Like most changes, EMR transitions and upgrades can be complex, hampered by inexperience and capacity issues. Further considerations such as staff affinity for the new technology and cybersecurity are often overlooked and can cause unforeseen inefficiencies.  

Hospital systems that proactively tackle staff education, multisite rollouts, and potential partnerships can expect a smooth and relatively seamless transition with little downtime to a new or upgraded EMR. The incorporation of feedback on fields, location of documentation and optimize the experience and provide benefits for concurrent review. With EMR investment projected to increase in the next five years, it is imperative that hospital systems proactively incorporate best practices in order to ensure their expected return on investment.