Why Most Custom EHR Projects Fail & How to Avoid the Top 10 Pitfalls
Custom EHR solutions are frequently sought after by healthcare organizations in order to better suit their particular workflows. However, many of these ventures falter or fail completely; estimates suggest that up to 50% never deliver on their claims. Common mistakes include technical faults, as well as inadequate planning and governance. The top 10 custom EHR project hazards are given below, along with tips on how to avoid them. Executives and IT directors can drive their initiatives to success by learning from past missteps.
1. Lack of Clear Leadership and Governance
A common reason custom EHR projects falter is weak project governance. Without an empowered steering committee or clear decision‐making structure, priorities drift and problems go unresolved. As one industry guide notes, successful implementations hinge on defining “who has ultimate authority” over the system and data. According to studies, choosing capable leadership and creating an EHR strategy are crucial success elements.
- Avoidance: Before development begins, organize an executive steering group comprised of executives from the clinical, administrative, and information technology divisions. In a governance charter, clearly define each stakeholder’s roles, such as decision-making authority, data stewardship, compliance supervision, and so on. Get the C-suite to actively support the initiative so that any financing or policy issues may be addressed quickly. As requirements change, regular leadership evaluations guarantee alignment.
2. Poor Stakeholder Engagement and Buy-In
Even the best-engineered EHR will fail if end users refuse to use it. Custom projects often falter when doctors, nurses or administrators feel excluded. In fact, experts warn that “stakeholder buy-in is critical for any enterprise-wide project,” especially securing support from a physician champion or clinical manager. Another review highlights clinician engagement as a top issue: “effective communication between clinicians and administrators” and ongoing training are key to success.
- Avoidance: Involve front-line personnel immediately. To review requirements and prototypes, form a cross-functional team of end users, including nurses, doctors, lab technicians, billers, and so on. Choose “champions” among professionals who can support the system and help to resolve peer grievances. Keep all stakeholders informed about developments by providing frequent updates and feedback sessions. Being open to user feedback increases confidence and ensures that the product meets clinical criteria.
3. Inadequate Planning and Undefined Objectives
Skipping detailed planning sets up projects to fail. Custom EHR implementations require a clear roadmap: vague goals or shifting priorities invite scope creep and missed deadlines.
One analysis of failed implementations found frequent breakdowns occur when “no implementation team or plan exists” or there are “no measurable goals (no milestones or dates set)”. Leaders frequently emphasize the need of having clear goals and metrics since it is difficult to tell whether a project is adding value without them.
- Avoidance: Before writing a single line of code, prepare a comprehensive project strategy. Determine and document the project’s scope, timeframe, and success criteria (for example, lowered charting time, user adoption rates). To track progress, divide the job into sprints or phases. Make decisions based on well-defined KPIs (reconsider a feature if it does not help you accomplish your objectives). Regularly update the plan and notify everyone when milestones will be met.
4. Over-Customization and Scope Creep
When too many features are added, custom EHR projects may become unmanageable. Every extra module or form introduces complexity, cost and risk. One vendor cautions against “over-engineering”: adding every possible feature can make the system bloated and hard to use. In fact, most EHR functions are standard – only a small fraction (e.g. unique specialty workflows) truly differentiate one provider.
- Avoidance: Prioritize requirements severely. Use the MoSCoW approach to identify features as Must/Should/Could/Won’t, then prioritize the must-haves. Avoid adding inexpensive tweaks “just because we can.” Use plug-ins or configurable templates instead of custom coding whenever possible. Adopt an iterative development method, releasing important features first and adding upgrades later, ensuring that each addition is thoroughly tested and truly necessary.
5. Misaligned Clinical Workflows
A custom EHR will fail if it doesn’t fit how clinicians actually work. Too often projects neglect to map existing workflows before building the system. If order entry screens or documentation templates don’t match real practices, staff resort to error-prone workarounds. Reviews of EHR failures repeatedly call out “no road map, or electronic workflows not defined in advance” as a critical mistake. Even off-the-shelf EHRs suffer when workflows are ignored, leading to clinician dissatisfaction.
- Avoidance: Conduct thorough workflow analysis with end users. Document how data flows today and how it should flow in the new system. In design reviews, walk through typical patient cases step by step with clinical staff. Customize forms, checklists and order sets to mirror their mental models. Perform usability testing (or pilot deployments) with actual clinicians to uncover mismatches early. Addressing workflow needs upfront prevents ad-hoc fixes after go-live.
6. Data Migration and Integration Failures
A tailored EHR should be compatible with imaging, billing, labs, and other systems. Another major challenge is the migration of legacy data. If old patient records are transferred with errors or omissions, clinicians lose trust in the system. As one analysis notes, “migrating incorrect, outdated, or unusable data can lead to poorly-informed decision-making”. Similarly, lack of integration standards causes silos – without HL7/FHIR interfaces, key information may not be shared.
- Avoidance: Inventory all data sources and interfaces before development. To ensure that only accurate, de-duplicated records proceed, clean up and reconcile legacy data. Test data migration procedures thoroughly; for instance, the new EHR should get sample patient records with known values undamaged. Adhere to industry standards (FHIR APIs, HL7 messages) and establish interaction points early on to ensure compatibility. To ensure that data flows seamlessly throughout the company, IT and doctors should participate in interface acceptability testing.
7. Insufficient Training and Change Management
Underestimating the human side of implementation dooms many projects. Even a well-built EHR will fail if staff aren’t prepared to use it. Research consistently highlights “poor/insufficient training and a lack of technical/educational support” as barriers to EHR adoption. Similarly, experts stress the need for a robust Change Management plan covering communication, training and resistance management.
- Avoidance: Create a thorough plan for training and change. Before going live, give practical training that is specific to each function (doctors, nurses, clerks, etc.). Use “superusers” or peer trainers to give additional support on the floor. Discuss the upcoming changes as soon as feasible, including the reasons for them, the benefits they will bring, and how workflows will be impacted. After the launch, offer refresher training and further assistance (help desks, office hours, quick reference guides).Monitor user comfort and system usage and respond quickly to any gaps.
8. Technical Shortcomings and Poor Usability
Custom EHR teams often focus on features and forget the technical foundation. If the hardware or network can’t support the software, or if the UI is clunky, the project will “fail the test of fire.” For example, one consultant reports that projects fail when “the system… wasn’t compatible with existing practice management systems”. Usability is equally critical: clinicians routinely flag slow response times, confusing screens, and extra clicks as major frustrations.
- Avoidance: Validate technical requirements up front. Ensure sufficient network bandwidth, server capacity and device coverage (especially Wi-Fi on the wards) before deployment. Conduct load and failover testing to avoid crashes. Invest in user interface design: minimize clicks and clutter, use clear screens tailored to each role, and follow healthcare UX best practices. Involve actual end-users in usability testing – have clinicians “think aloud” as they complete common tasks, and iterate on the design based on their feedback.
9. Vendor and Resource Mismanagement
Custom EHR projects often involve third-party partners (consultants, developers, integrators). Problems arise when vendors are poorly managed or lack healthcare IT expertise. One industry guide warns that vendor management is often overlooked, stressing that expectations and timelines must be clearly defined up front. Likewise, healthcare CTOs note that in-house IT teams may lack real software engineering skills; building an EHR is like “building a product,” not just configuring one.
- Avoidance: Examine your partners carefully. Choose a vendor or development team that has experience with EHRs and health IT and is familiar with healthcare laws. Contracts should include deadlines, deliverables, and penalties for failing to meet goals. Include the vendor in governance meetings to keep them aligned with the company’s objectives. Ensure that your internal team has the necessary competences (data architecture, project management, and informatics) at the same time. If you’re building internally, hire or contract experienced healthcare developers who understand agile and product development approaches. Maintain rigorous project oversight by reviewing code, developments, and impediments on a regular basis in order to discover problems early on.
10. Ignoring Security, Privacy and Compliance
Lastly, when security and compliance are neglected, custom systems frequently fail. Data security and patient privacy must be “baked in” from the start. Adoption may be hampered by physicians’ concerns about privacy and illegal access, according to numerous studies on EHR installations. Strong security and compliance checks are always key components of successful installations.
- Avoidance: Consider HIPAA and other relevant regulations from the start. Encrypt data in transit and at rest, and apply strong access controls (role-based permissions, two-factor authentication where required). Incorporate detailed audit logs into the system to track all record access. Test the system’s security on a regular basis (e.g., penetration testing) and correct any holes. During development, involve your compliance and privacy officials and ask them to examine consent processing, data flows, and storage. As the guidance notes, “standards of confidentiality and security of data… must be observed”. By embedding these controls up front, you avoid costly rework and protect patient trust.
Related: Custom EHR Requirements Checklist (Clinical, Admin, RCM, Compliance)
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