Key Factors Behind IT Implementation Failures in Mid-Sized Healthcare Settings

May 5, 2025 admin HealthIT

Healthcare technology projects (EHRs, telehealth platforms, patient-management systems, etc.) promise big gains, but about half of the implementations fail to meet goals. Mid-sized hospitals and practices, with limited budgets and lean staff, are especially vulnerable.

Common failure points include poor planning, Inadequate change management, underestimated costs, and interoperability gaps. We examine the challenges below, drawing on U.S. case studies and authoritative sources.

Common Implementation Challenges in Adopting EHR.

Lack of Clear Planning and Leadership

Many projects never form a dedicated IT governance team or roadmap.
An industry review notes that the top failure causes are “no implementation team or plan exists” and the absence of executive/clinician leadership.
Without defined goals, timelines, and ownership, projects drift or stall.

Insufficient Staff Engagement/Training

Clinicians and nurses may feel ignored or undertrained. When users revert to familiar paper routines, the system’s benefits vanish.
One account observes that staff often “continue documenting on paper…leading to twice the work” if training is inadequate.
Resistance to change is common; studies emphasize communicating benefits early, providing “hands-on training,” and creating super-user champions to build confidence.

Underestimated Costs

Mid-sized practices frequently cite funding as a barrier. Budgets often omit hidden costs (IT support, hardware upgrades, maintenance, and lost productivity during training).
Smaller clinics report financial concerns and fear of rapid obsolescence more than larger systems.
Unplanned overruns can derail projects – a reminder to build thorough ROI analyses and contingency funding.

Technical Integration and Data Issues

Migrating legacy data and linking systems is error-prone.
Accurate data migration requires careful validation, or patient records may be incomplete.
Likewise, many EHRs and ancillary systems use proprietary formats, so “hundreds of …EHR products” each with unique terminologies make standard data exchange difficult.
If labs, pharmacies, or imaging systems won’t interface smoothly, clinicians lose trust in the new system. Incomplete interfaces and duplicate records are common side effects of poor integration.

Security and Downtime Risks

Unforeseen technical events can cripple operations.
For instance, a 2024 global software glitch (via a faulty CrowdStrike update) caused a nationwide outage: many hospitals postponed surgeries and lost EHR access until it was fixed.
Without robust downtime procedures (e.g., pre-printed charts, backup systems), such outages halt patient care.
One hospital system prepared for exactly this by maintaining continuously updated paper records and training staff on them; when their EHR went down, they continued seeing patients (albeit at reduced capacity).

Telehealth-Specific Challenges

Launching telemedicine and remote-care platforms brings unique hurdles.
A major barrier is reimbursement: Medicare and many payers still only cover limited telehealth codes.
Complex state licensing rules (often requiring an in-person visit before telemedicine) also frustrate providers.
In some cases, providers even resist telehealth to avoid new competitors in their market.
Technical issues (uneven broadband access, user-unfriendly software) and inflated expectations (“hype” without evidence) further risk failure.

These pitfalls underscore that technology alone isn’t enough: successful projects need good project management, realistic scope, and user buy-in from day one.

Related: Build vs. Buy? Why Custom EHR Systems Are the New Competitive Edge in Healthcare IT

Organizational, Financial, and Technical Constraints for Mid-Sized Practices

Mid-sized healthcare organizations (tens to a few hundred staff) face challenges distinct from large systems or tiny clinics:

Organizational

These practices often lack full-time IT leadership or a formal change office. Responsibility may fall to a busy physician or administrator with little project management training.

Competing priorities (e.g., clinical productivity vs. IT deployment) can cause delays. Industry guidance stresses forming a clear project team with executive and clinician representation. A physician champion on the team, who actively shapes workflows and encourages colleagues, greatly increases the chance of success.

Financial

Budgets are tight. Larger hospitals benefit from economies of scale in vendor pricing and can absorb contingencies; mid-sized groups cannot.

As noted above, cost is a common concern: one study found smaller practices report financial barriers and worry about technology obsolescence much more often than large ones.

This means budget plans must be especially detailed. Also note that federal incentive payments have mostly ended, so ROI must rely on efficiency gains and billing improvements rather than subsidies.

Technical Infrastructure

Mid-sized organizations may have aging networks, limited server capacity, or no in-house IT team. Upgrades (to Wi-Fi, devices, security) are often needed before implementing a modern EHR or telehealth platform. Integration is also a hurdle: since EHRs and ancillary systems (labs, imaging, billing) often come from different vendors, data exchange can be weak.

“Hundreds of … EHR products” in the U.S. means no universal interface – each site’s setup is unique. Without careful technical planning (using standards like HL7/FHIR and assigning IT resources), these interfaces can fail, preventing information flow and defeating the purpose of digitization.

Staff Training and Change Management

Even with a good product, human factors often determine success. Staff will resist changes to familiar routines unless the benefits and training are clear. Common issues and remedies include:

Resistance to Change

People naturally resist workflow changes. As one EHR guide notes, “there will likely be resistance” from clinicians and administrators..

To combat this, communicate openly about why the system helps patient care and clarify how it will ease (not hinder) daily work. Involve staff early – let nurses, doctors, and techs give input on system choices and process redesign. This builds ownership.

Comprehensive Training

Half-day demos aren’t enough. Practices should budget extensive, hands-on training sessions before go-live, and refresher courses afterward. Super-user “champions” (often tech-savvy nurses or billers) can be trained extra-well to support peers on the floor.

Training plans should address all roles (front desk, clinical staff, billing, etc.) at appropriate skill levels. As one EHR planner advises, make completion of training a requirement before using the new system – optional go-live usage leads to haphazard adoption.

Managing Productivity Dips

It’s normal for appointments-per-day to drop temporarily during an EHR switchover. Staff should be warned that “patient flow and workflow efficiency” will slow down at first. Practices can offset this by staggering training (not training everyone at once), allowing extra staffing, or scheduling longer visits initially.

One source suggests setting clear expectations about reduced productivity and even authorizing overtime or float nurses during the go-live phase. Without this anticipation, clinics panic and may abandon the system mid-launch.

Ongoing Support

After launch, assign an in-house point person (or team) for questions and issues. Encourage feedback loops: hold brief daily huddles in week 1 to gather user problems and rapidly fix workarounds.

Tracking metrics (error rates, incomplete notes, or patient wait times) can highlight areas needing retraining or process tweaks.

Interoperability Challenges

“Interoperability” – seamless data exchange among systems – remains a major barrier. Key issues include:

Lack of Standards Compliance

Despite national efforts, many systems still use proprietary formats.
According to one analysis, after billions invested, only 6% of providers could share records with a different EHR by 2015.
This is partly because early incentive programs focused on getting systems in place, not on making them talk.
By later stages, many providers balked at the extra cost of interfaces.

Data “Translation” Problems

Even if two systems connect, the receiving system must interpret the data.
A recent review points out that true interoperability means “standardized coded data” that any system can use.
In reality, a lack of uniform coding (e.g., using different lab nomenclatures or free-text notes) can cause mismatches or unreadable fields.
Mid-size practices should insist on certified interfaces and verify data flows end-to-end during testing.

Cultural “Information Blocking”

It’s not always technical – sometimes organizations intentionally restrict data sharing.
In one survey, 25% of HIE leaders said hospitals pressure providers to use only certain EHRs, and 50% said vendors themselves “limit interoperability” or charge exorbitant fees (e.g. $5,000–$50,000) for each interface.
The 21st Century Cures Act now makes such information-blocking illegal, but it persists in practice.
Mid-sized organizations should demand reasonable interface fees and may need to escalate disputes through legal or regulatory channels.

External Exchange

Beyond internal systems, sharing data with external partners (referring doctors, labs, pharmacies) is vital.
Health Information Exchanges (HIEs) or Direct protocols can help, but smaller practices often don’t join regional HIEs due to fees or complexity.
Without that, lab results or medication lists still come by fax/mail.
This defeats much of the purpose of digital systems.
Remedy: Participate in community efforts for data exchange and choose software vendors who support HIE connectors or FHIR APIs.

Best Practices to Prevent Failure in Health IT Implementation

Based on the above, mid-sized providers can adopt several best practices:

Strong Governance

Create a multidisciplinary steering committee with executive sponsorship.

Assign a project manager (often a clinician or operations lead) who coordinates IT, finance, and clinical input. Define clear milestones, metrics, and accountability from the outset.

Stakeholder Engagement

Engage doctors, nurses, and office staff early.

Hold workflow-mapping sessions so the new system matches real processes. Capturing user feedback during vendor selection and build phases greatly improves acceptance.

Comprehensive Training Plan

Roll out extensive, role-based training before go-live. Train all users to competency – make EHR use non-optional by launch.

Plan ongoing “refresher” sessions and easily accessible help (e.g., a hotline or on-call super-user). One guide recommends ensuring every end user achieves required competency levels.

Realistic Timeline and Phased Rollout

Avoid “big implementation” if possible. Pilot key functions (like scheduling or lab interfaces) in one department, refine them, then scale up.

Factor in extra time for unexpected fixes. As one case showed, pushing a deadline without readiness can provoke a leadership crisis. Build flexibility into your plan – allow buffer weeks to address issues.

Budget Carefully

Include line items for hardware upgrades, network bandwidth, annual software licenses, and at least 15-25% overhead for unforeseen costs.

During the learning curve, account for temporary productivity losses (e.g., shorter clinic schedules).

Contingency Planning

Develop and test formal downtime procedures. For example, keep key patient information printed or on a secure local server, and establish paper order and charting protocols.

The AHA urges providers to “test cyber incident response and emergency preparedness plans” and regularly update backup systems.

Vendor Management

Choose vendors with experience in mid-sized settings and strong support services. Verify that interfaces with labs, pharmacies, imaging, and state registries are feasible and included.

Review the vendor’s interoperability certifications and ask for references. Some experts suggest budgeting for vendor on-site assistance during go-live to relieve your IT staff.

Interoperability by Design

Wherever possible, adopt systems and standards (e.g., HL7/CDA, FHIR, CCD formats) that facilitate data exchange. Join local HIEs or use secure messaging networks.

Test interfaces thoroughly before launch. Incorporate tools like Master Patient Indexes or standardized code sets to minimize mismatches.

Continuous Monitoring

Set up metrics to track the project’s progress (e.g., percent of staff trained, number of modules implemented, patient wait times, documentation completeness).

After go-live, monitor for issues (e.g., increased errors, throughput drops) and be prepared to iterate. Collect user feedback regularly – early correction of minor problems prevents major failures.

By learning from past mistakes and following these guidelines, mid-sized healthcare organizations can greatly improve their odds of a successful IT implementation. The goal is to ensure new technology enhances care delivery, not hinders it.

Related: Healthcare IT Budgeting: What You Should Spend On in 2025 (And What to Avoid)

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