Ensuring successful EHR implementations: A holistic approach to people, data, and technology

January 28, 2025 | By Kyle Knoke 

Electronic health records (EHRs) are the backbone of modern health IT, transforming patient care, operational workflows, and clinical efficiency. The implementation of an EHR system like Epic is more than a simple software installation, and the implementation’s success doesn’t just hinge on the software being installed. Unfortunately, only 38% of healthcare leaders consider their EHR implementations successful, according to a recent report from KLAS Research. Avoiding common pitfalls and gaining maximum value out of an EHR requires careful orchestration of people, processes, and technology to enable true organizational transformation. To ensure a sustainable health IT ecosystem, it's essential to approach EHR implementations with a structured governance model, adaptable staffing, optimized data solutions, and a focus on continuous improvement.

Here’s a closer look at the key elements that contribute to a successful EHR implementation.

Centralized project governance with enhanced support structure

From the very beginning, active participation from top executives is foundational for aligning the EHR implementation with organizational strategy, making effective governance the cornerstone of any successful EHR implementation. The choice to implement an EHR was most likely born from organizational strategy, and a proper, centralized governance ensures that the activities done and choices made during the implementation line up with strategic goals while preventing common pitfalls, such as misalignment of priorities or lack of accountability. A governance framework should be structured enough to provide clarity, yet flexible enough to adapt to the unique organizational needs.

This begins with establishing clear decision-making frameworks. It’s crucial to define who makes decisions at each level of the implementation process, ensuring that the right people are involved at the right time. Decision-making frameworks are most effective when decisions are pushed to the “lowest” tier of governance possible, empowering those using the EHR tool every day, and are closest to the issues, to make decisions.

A well-established escalation process is also vital. Issues will inevitably arise, and decision-making groups can’t always reach a consensus. Centralized governance ensures that these issues are escalated and addressed swiftly, maintaining the project’s momentum. Centralized governance helps mitigate bottlenecks by empowering decision-makers with the authority to make timely, impactful choices without unnecessary delays.

Adopting core practices such as “foundation first” and “analytics-minded” methodologies can greatly enhance the implementation process. “Foundation first” refers to using Epic’s recommended configuration and workflows as a starting point, deviating only when standard workflows do not meet your organization’s needs, and customizing thoughtfully to address your organization’s specific requirements. By focusing on a solid foundation, the system’s long-term maintenance is simplified, ensuring future updates and customizations are more manageable. “Analytics-minded” governance emphasizes the importance of data and reporting throughout the implementation, ensuring that your system supports robust analytics from day one.

Epic foundation-first methodology

The “foundation-first” approach is a cornerstone of Epic’s implementation methodology, providing a proven pathway to simplify the complexity of adopting an EHR. By leveraging Epic’s standardized workflows and best practices, organizations can build a stable and maintainable system that minimizes unnecessary complexity, streamlines support, and facilitates seamless upgrades as Epic evolves. This approach allows your organization to take full advantage of new features, such as AI-driven workflows, without the challenges often associated with heavily customized systems.

However, foundation-first is not a one-size-fits-all solution. Every organization has unique operational needs and existing processes that may not align perfectly with Epic’s standard workflows. There are times when deviation from the foundation-first strategy is necessary to meet these unique requirements. This is where a trusted partner can help.

A good implementation partner should specialize in helping organizations strike the right balance between adhering to foundation-first principles and tailoring the system to address specific needs and improve operational and patient outcomes. This requires experienced consultants to guide you through identifying when and where customizations are essential and ensure they are designed thoughtfully to minimize long-term risks. Whether it’s supporting operational workflows that don’t fit into Epic’s standard offerings or integrating third-party solutions, a trusted partner ensures that customizations enhance your system without compromising its future flexibility.

By maintaining a foundation-first mindset while adapting to your organization’s unique requirements, you position your EHR for long-term success. This balanced approach ensures your system is easier to maintain, quicker to upgrade, and better equipped to scale alongside your strategic initiatives. With a trusted partner, you can navigate these complexities confidently, knowing your EHR implementation is optimized for both immediate impact and sustainable growth.

A team-based, collaborative approach

The success of an EHR implementation hinges not only on the tools and technologies but also on assembling the right team to guide the project through its full lifecycle. At Cardamom, we take a unique, team-based, collaborative approach to implementation, ensuring your organization benefits from a diverse mix of talent that spans technical experts, clinical users, and consultants. This collaborative model positions your organization to maximize knowledge-sharing, streamline workflows, and enhance user adoption while adding long-term value to the health IT talent pool.

Traditional consulting approaches often fall short, leading to pitfalls such as over-reliance on senior consultants, a lack of documentation and knowledge transfer, or a failure to plan for long-term sustainability. At Cardamom, we rethink this traditional staffing by using a flexible and scalable model that balances expertise with cost efficiency. Our approach ensures senior consultants focus on strategic, high-impact challenges while mid-level and junior consultants take ownership of day-to-day implementation tasks such as configuration, testing, and training. This not only controls costs but also prevents bottlenecks and promotes a more sustainable implementation process.

By leveraging a staffing strategy that adapts to the project’s evolving needs, you gain the flexibility to scale resources up or down as needed. In the early stages, our team focuses on customization, integration, and aligning Epic’s best practices to your unique operational goals. As the system stabilizes, our emphasis shifts to long-term maintenance, optimization, and ongoing support. This ensures continuity, reduces reliance on costly senior consultants over time, and positions your team for success post-implementation.

Adopting an analytics-focused mindset

A key benefit of EHRs is their ability to generate valuable data insights that drive decision making. To maximize this potential, organizations must prioritize analytics and reporting needs from the start, ensuring it aligns with both immediate and long-term goals.

Reporting should be a deliberate part of the implementation process. Begin by making an inventory of existing reports and classifying them as "operationally essential," “strategic/performance-oriented,” or "reference and informational.” Focus on developing operationally essential reports with clear ownership during implementation, while cataloging strategic/performance-oriented or reference and informational reports for post-go-live optimization.

Customizing reporting tools to reflect organizational needs ensures actionable insights across clinical, financial, and operational domains. Early prioritization of essential analytics can streamline workflows, enhance patient outcomes, and improve financial performance. Advanced reporting can support predictive analytics, close performance gaps, and enable real-time monitoring of key metrics. While some reporting may take a backseat during go-live, revisiting it as part of system optimization is critical. Stakeholder feedback on analytics gaps or new needs helps evolve the system to meet organizational priorities, transforming data into a strategic asset.

Optimizing EHR data fosters cross-departmental integration, creating a holistic view of performance. This enables providers to identify trends, address challenges, and implement evidence-based improvements. Tailored analytics empower informed decision making, efficient resource allocation, and agility in adapting to the evolving healthcare landscape.

Continuous post-go-live support and optimization using external resources

An EHR implementation doesn’t just end once the system is live. Continuous support and optimization are critical for ensuring long-term success. Leveraging external teams in a managed services capacity can ensure that internal teammates stay focused on strategic initiatives that move the organization forward. With an external managed services team, a dedicated service manager, who is also engaged during the implementation, can oversee managed services, monitor service level agreements (SLAs), and ensure that workflows continue to function smoothly post-go-live.

Clear SLAs and quality metrics help track system performance, identify potential issues, and guide improvements. Continuous analysis of run history and ticketing data informs future enhancements, ensuring that the system evolves in response to user feedback and operational needs.

By using external managed services for ongoing support and continuous optimization, organizations can shift their focus away from maintenance and more toward innovation. This enables healthcare teams to focus on initiatives that drive quality improvements, reduce costs, and improve patient outcomes.

Getting the maximum value out of implementing an EHR system like Epic is a multifaceted process that involves more than just installing software — it requires a strategic combination of governance, people, processes, and technology. By adopting a centralized governance structure, leveraging Epic’s foundation-first methodology, fostering a team-based collaborative approach, and optimizing data and analytics, organizations can ensure that their EHR system remains sustainable, scalable, and adaptable to the ever-changing healthcare landscape. With the right combination of these elements, your EHR implementation can become a catalyst for improving both operational efficiency and patient care and lead to true organizational transformation.

Learn more about our Epic Consulting Services.

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