Best Practices for Large-Scale EHR Integrations: Lessons from Real-World Implementations

Large-scale EHR implementations are a once-in-a-decade process that happens in healthcare businesses. Large-scale EHR integration is a completely different story. It’s often seen as the most complicated and risky IT project, with health professionals and organizations dreading it. 

What do they dread the most? A poorly executed integration. They tend to fear disrupted workflows, clinicians’ frustration, and potential patient safety risks. However, a well-planned and strategic integration can enhance care delivery, boost efficiency, and improve care outcomes. 

At OSP, we have successfully worked with a large health system to implement an enterprise-wide EHR platform across multiple facilities. We worked on this complex project spanning various departments, legacy systems, and regulatory requirements. That’s why our focus was on adhering to the best practices. With every such project that came our way, we’ve utilized some of the most tried and tested best practices. So, here’s our take on what we think works the best. 

Best Practice to Utilize For Large-Scale EHR Implementations 

1. Engage Stakeholders Early

One of the key reasons EHR integration projects struggle is that they are purely IT initiatives. The truth is that technology is only one piece of the puzzle. It’s people and processes that make or break plans.

Getting stakeholders from hospital management, administrative, and operational teams involved from the very start. It will help you find potential problems early and design the system with the end user in mind.

What are the key considerations:

➼ Get key professionals, including doctors, nurses, administrators, and IT teams, involved at all levels so the system is designed to meet real needs.

➼ Get requirements and potential problems checked early, especially by medical staff, so there are zero problems later.

➼ This step gives frontline users a voice in workflows, templates, and functionality decisions.

2. Use a Phased Roll-out

“Big bang” go-lives may seem to speed things up, but they often cause more chaos than efficiency. It’s always better and safer to roll out the EMR/EHR integration in phases, as this allows for smoother adoption, quicker issue resolution, and less disruption to patient care. We recommend starting with a pilot program, which enables professionals to identify and resolve potential issues long before a full-scale roll-out.  

A recent example is the Department of Veterans Affairs (VA) phased implementation of the Oracle-Cerner EHR system. After initial issues, the VA refined its strategy. They will resume the roll-out in mid-2026 with four facilities in Michigan. This refined approach sheds light on the value of a measured, strategic roll-out. Moreover, it enables organizations to manage change effectively and adjust without disrupting their daily operations. 

Here’s how a phased roll-out approach works-   

➼ Start with a small-scale pilot to refine workflows and fix early issues

➼ Resolve challenges during the pilot phase for smoother, broader implementation.  

➼ Feed early lessons from pilot sites into the next phase to refine the process and ensure the system works as expected.

3. Plan for Data Migration and Integration

Getting the data right is one of the most challenging and underestimated parts of any EHR system integration plan. So, structured data migration from legacy systems must be used. It helps in achieving data integrity and accessibility. We understand the struggle of data migration. That’s why we emphasize meticulous planning and constant validation, which are important when migrating records, medical billing, lab data, or any other third-party platform data.

Migration isn’t just enough of a struggle. Data cleansing is an equally necessary step to eliminate inaccuracies. Since legacy systems often have outdated and inconsistent data, cleansing will ensure only accurate data enters the new system. The best part is ehr migration and integration planning will keep interoperability on track, enhancing patient care.

What worked for us:

➼ Data mapping and cleansing before the first pilot.

➼ Parallel testing environments to validate data without affecting live systems.

➼ API-based integrations for real-time data exchange across different platforms.

4. Implement Change Management

Even the best EHR system will fail if users don’t adopt it. So, change management strategies are key to any large-scale implementation. Implementing change management isn’t just about training. It’s more than that; it’s about building trust and addressing fears. It reduces resistance and enables the adoption of the new EHR system.

Also, transparent communication helps set realistic expectations and address concerns during the transition.

Here’s what works:

➼ Role-based training programs that focus not just on system features but on how the EHR will impact daily workflows.

➼ Train selected staff to become internal champions and help provide peer-level support across departments.

➼ Two-way feedback loops to keep communication open throughout the roll-out.

5. Focus on Continuous Improvement

Going live is not the end destination. It’s just a starting point. The objective measure of success comes months (and years) after EHR system integration when the system is optimized based on user feedback, performance data, and evolving clinical needs.

Here’s what works:

➼ Regular audits to identify potential problems and areas for improvement.

➼ Track real-time user feedback, system performance, and support requests.

➼ Continuous end-user training sessions to ensure staff are up-to-date on system updates and best practices.

➼ Quarterly system optimization to respond to new technological advances, regulatory changes, or organizational needs.

➼ A culture of continuous improvement ensures that the system remains relevant and practical over time.

Final Thoughts 

Large-scale electronic health record integration is not easy, but it doesn’t have to be painful. It can be easy and buttery-smooth with EHR integration best practices. The only difference between messed-up and successful EHR integration solutions is how well-planned they were. Of course, a planned one means users were prepared, engaged, and committed to the ongoing transformation. However, every EHR integration software implementation will have hiccups, resistance, or performance incompetencies, eventually resolving if you’re aligned with the best practices.