EHR implementation projects have a high failure rate and an even higher rate of implementations that technically succeed but functionally disappoint. Eric Cecava has been through one, and he has a clear view of why.
Electronic health record implementation is one of the most complex operational projects a hospital or health system can undertake. It touches every clinical workflow, every administrative process, every interface between departments. It requires training thousands of staff members, often under compressed timelines, on systems that are different from what they have used for years. It demands close coordination between IT, clinical leadership, finance, operations, and frontline staff. And it has to happen while the hospital keeps running — patients keep arriving, surgeries keep happening, and the emergency department does not close for the transition.
The Technical Problems Are Not the Hard Problems
Most EHR implementations that fail do not fail because the technology does not work. The technology works. The hard problems are organizational: physician adoption, workflow redesign, change management, training quality, and what happens after go-live when staff revert to workarounds because the system is slower than what they used before.
Health systems spend enormous amounts of time on vendor selection, contract negotiation, and technical configuration. These matter. But the implementation outcomes tend to be determined by how well the organization manages the human side of the transition — how clearly it communicates the reason for the change, how seriously it invests in frontline training, how well it listens to clinical staff who identify workflow problems before go-live, and how quickly it responds to issues in the immediate post-go-live period.
The organizations that do this well treat EHR implementation as an organizational change initiative that happens to involve a technology platform, rather than a technology project that involves some organizational change on the side. That reframing changes how leadership allocates attention, resources, and time.
Physician Engagement Is Not a Nice-to-Have
The single most important variable in EHR implementation success is physician engagement. Physicians who are involved in workflow design before go-live, who are trained adequately and supported after, and who trust that the organization will respond to their concerns are the difference between an implementation that improves care delivery and one that adds friction to every patient encounter for years.
Engaging physicians in EHR implementation is not easy. Physicians are busy, often skeptical of administrative initiatives, and protective of their time. Asking them to participate in design sessions, pilot testing, and training programs competes directly with clinical responsibilities and personal time. The organizations that get physician engagement right invest in it early — before the implementation timeline creates pressure — and they ask physicians what matters to them, not just what the implementation team has decided to build.
Go-Live Is Not the Finish Line
One of the most consistent patterns in EHR implementations that underperform is what happens after go-live. Organizations invest heavily in the run-up to the transition date and then exhaust their resources and attention at the moment the new system goes live. Staff are on their own to figure out workarounds, problems go unaddressed for weeks or months, and the system never reaches the level of adoption and optimization that would justify the investment.
The post-go-live period requires as much operational attention as the implementation itself. At-the-elbow support — trained staff available on the floor to answer questions and solve problems in real time — matters more in the first two weeks after go-live than almost any training program before it. Rapid response to reported issues, clear escalation pathways for clinical problems, and ongoing optimization of workflows based on real usage data are what determine whether the organization actually gets value from the system.
The organizations that treat go-live as a milestone rather than an endpoint — and plan and resource accordingly — get substantially better long-term results from their EHR investment.
Process Discipline Carries the Implementation
Cecava’s background in Lean Six Sigma shaped his approach to EHR implementation at McLaren Port Huron. Process mapping before the implementation — understanding current state workflows in detail — made it possible to identify where the new system would create problems and where it would create opportunities for improvement. It also made training more effective, because staff learned the new system in the context of workflows they understood rather than in abstraction.
EHR implementation is not a technology project. It is a process redesign initiative supported by technology. The organizations that understand that distinction going in are the ones that come out with a system that actually does what they needed it to do.