Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations
Open accessAbstract
Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery. Methods We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions. Results Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation. Discussion There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support—all factors affecting potential clinician burnout. Conclusion EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.
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Challenges such as system construction variability, missing data, and dependence on original systems lead to conversion errors such as corrupted data and mismatched patient records, disrupting clinical workflows and compromising patient safety.
“However, challenges, such as system construction variability, missing data, and dependence on original systems, lead to conversion errors such as corrupted data and mismatched patient records [167], disrupting clinical workflows and compromising patient safety [168].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [168]
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- Authors
- Huang, C., Koppel, R., McGreevey, J. D., Craven, C. K., & Schreiber, R.
- Affiliations
- University of Louisville (US)
- University at Buffalo, State University of New York (US)
- University of Pennsylvania Health System (US)
- Mount Sinai Health System (US)
- Geisinger College of Health Sciences (US)
- Corresponding author
- Schreiber, Richard
- Venue
- Applied Clinical Informatics
- Publisher
- Georg Thieme Verlag KG
- Published
- 2020-10
- Volume
- 11
- Issue
- 05
- Pages
- 742-754
- ISSN
- 1869-0327 (ISSN-L)
- PMC
- PMC7657707
- OpenAlex
- W3101984434
- Cited by
- 97
- References
- 54
- Citations by year
- 2026: 26 · 2025: 18 · 2024: 19 · 2023: 23 · 2022: 7 · 2021: 4
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Applied Clinical Informatics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pennsylvania
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- patient safety, data integrity, semantic interoperability, cybersecurity, clinician burnout, transition planning, health information technology adoption, workflow changes
- MeSH terms
- Burnout, Professional, Humans, PubMed, Workflow, Electronic Health Records
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