EHR go‑live mistakes still common

A hospital can spend months installing a new electronic health record and still end up with nurses writing notes on scraps of paper, then copying them in later. A new 2026 how-to piece says the same five mistakes keep showing up during go-live, even after electronic records became standard in most U.S. hospitals. (nurseseducator.com) An electronic health record is the hospital’s shared chart, order pad, medication list, and inbox in one system. The federal Office of the National Coordinator says the updated 2025 Safety Assurance Factors for Electronic Health Record Resilience guides exist because safe care depends on how the system is used, not just whether the software is turned on. (healthit.gov) The first failure is skipping workflow analysis, which is the step where teams watch how work actually moves through an emergency department, ward, or clinic before they redesign screens. A 2025 study on electronic health record workarounds says the mismatch between record workflows and real clinical practice is one reason nurses invent side routes. (nurseseducator.com, sciencedirect.com) Those side routes are called workarounds, and they are exactly what they sound like: a nurse finds a faster path because the official one gets in the way. A review highlighted by the Agency for Healthcare Research and Quality found nursing workarounds often show up around electronic records and medication administration, where extra steps can collide with safety. (psnet.ahrq.gov) The second failure is weak training, especially when hospitals train once before launch and assume the job is done. The 2025 federal Safety Assurance Factors guides frame training, configuration, and ongoing monitoring as part of resilience, which means the system has to keep working safely after the first day. (healthit.gov, cms.gov) The third failure is leaving frontline staff out of design decisions, which is how a build that looks tidy in a conference room becomes clumsy at 3 a.m. on a medical floor. A 2024 quality improvement report on handoffs found teams used frontline feedback, mandatory education, direct observation, and an electronic health record dashboard for more than a year after rollout. (nurseseducator.com, bmjopenquality.bmj.com) The fourth failure is botched data migration, which is the move from the old chart to the new one. If allergy lists, medication histories, or problem lists arrive incomplete or messy, the new system starts life with bad memory. (nurseseducator.com, healthit.gov) The fifth failure is treating go-live like a ribbon cutting instead of the start of a long debugging period. The federal guides are built as self-assessments and worksheets because organizations are expected to keep checking high-risk issues, not declare victory when the login screen works. (nurseseducator.com, healthit.gov) This is why “extra clicks” are not a small complaint in nursing units. A 2024 study in BMC Health Services Research says poor electronic record design has been implicated in user errors, including medication safety problems, when usability breaks down. (bmchealthservres.biomedcentral.com) By 2026, the surprise is not that hospitals know these risks. The surprise is that the same five mistakes still need repeating in a fresh checklist, which tells you the hard part of electronic records was never the software install but fitting the software to the people using it every hour of every shift. (nurseseducator.com, healthit.gov)