How thoughtful preparation across staffing, workflow integration, training and revenue cycle can help health systems navigate EHR transitions with greater efficiency and less disruption
Key Facts (At-a-Glance):
- Technical readiness and operational readiness are different: An EHR can be configured, tested and technically ready for launch while employees are still unclear about new workflows, responsibilities and escalation paths.
- Decision-making capacity is a readiness factor: EHR implementations require thousands of interconnected decisions, and decision fatigue can leave important issues unresolved as go-live approaches.
- Cross-functional handoffs are critical: Workflow gaps frequently emerge between departments, particularly across clinical, administrative and revenue cycle processes.
- Employee “resistance” can indicate a readiness gap: Questions or hesitation may reflect a lack of context, communication or training rather than unwillingness to adopt the new system.
- Scenario-based preparation can expose gaps: Day-in-the-life exercises, preparation labs and integrated tabletop sessions can test how teams respond to real-world situations before launch.
- The first week can reveal organizational readiness: Problems such as unclear ownership, repeated escalations and employees searching for answers can expose workflow gaps that technical testing did not identify.
- Post-go-live planning should begin before go-live: Health systems should establish optimization priorities, ownership and measures of success before launch.
Farmington Hills, Mich. (Oct. 5, 2026)—An electronic health record (EHR) can be technically ready for go-live without an organization being operationally ready to use it.
That distinction can have significant consequences for hospitals and health systems. A registrar may be unable to access the right tools to check in a patient. A nurse may not know which department owns the next step in a workflow. A physician may struggle to locate information from a legacy system. A payer issue that appeared minor during testing may later contribute to a denied claim.
According to Healthrise, a health care consulting and technology firm, these individual issues can point to a broader readiness gap: the technology is ready, but the organization is not yet prepared to operate differently.
“Operational readiness is not a checklist you complete before go-live,” said Michele Woodley, MBA, PMP, CPC, CHAM, CRCR, vice president, EHR Readiness and IT, Healthrise. “It is about understanding how the organization is going to function in a completely different environment. The technology is one part of that. The bigger question is whether the people, processes and leadership are prepared to work together when something does not go according to plan.”
Healthrise identifies seven areas health systems should address when preparing for an EHR go-live.
1. What is the difference between technical readiness and operational readiness?
Technical readiness means the EHR has been built, configured and tested for launch. Operational readiness means the organization is prepared to use that technology in real-world patient care and business operations.
The distinction is important because technical testing typically evaluates whether the system performs as designed. Operational readiness evaluates whether people know how to perform their jobs within the new environment and how their work affects other teams.
Healthrise recommends evaluating not only whether an individual can complete a task, but whether employees understand:
- What happens before and after their step in a workflow
- Who owns the next step
- Where work should be routed
- When and how to escalate an issue
- How clinical, administrative and financial processes connect
“Training someone to register a patient is different from preparing them to understand how registration affects the entire patient journey,” Woodley said. “You have to put people into the situations they will actually encounter and see how the organization responds.”
2. Why is decision-making capacity important during an EHR implementation?
Decision-making capacity is a critical EHR readiness factor because implementation teams must make a high volume of interconnected decisions while continuing to operate the existing health system.
Those decisions can involve workflow design, system settings, legacy data, access, staffing, ownership and downstream impacts.
Health systems can spend years preparing for an EHR transition, but the volume and pace of decisions often accelerate in the final months before launch. The same subject matter experts responsible for making implementation decisions are frequently still responsible for their day-to-day jobs.
“You are facing an almost relentless pace of decisions,” Woodley said. “Every one has downstream consequences, and the people making those decisions still have their day jobs. The lift is enormous, and the margin for decision fatigue is real.”
Healthrise recommends beginning operational readiness planning as early as 18 months before go-live to identify decision bottlenecks, clarify ownership and evaluate the downstream effects of major workflow changes.
3. Why can EHR workflow gaps appear between departments?
Cross-functional handoffs are often where operational readiness gaps become most visible because individual teams can understand their responsibilities without understanding what happens between departments.
A patient encounter may move through registration, clinical care, documentation, coding, billing and payment. A breakdown at one point in that process can affect multiple teams downstream.
For example, an incorrect payer selection may begin as a registration issue but ultimately affect reimbursement.
Healthrise recommends assessing workflows across the entire patient journey rather than treating clinical, administrative and revenue cycle processes as separate implementation tracks.
“When people can see how their decisions affect the next team, the conversation changes,” Woodley said. “It becomes less about who owns the problem and more about how everyone contributes to the patient experience.”
4. Does employee resistance always mean employees are resistant to change?
No. Employee hesitation during an EHR transition can indicate a readiness or communication gap rather than simple resistance to change.
Employees may question a new workflow because they do not understand why it was designed differently, how it affects another department or what they are expected to do when something goes wrong.
“I don’t think what we’re seeing is really resistance,” Woodley said. “Often, people do not have the context they need to understand why a workflow change matters or how it affects the people downstream from them.”
Healthrise recommends using readiness activities to connect workflow changes to the broader patient journey and explain not only what employees need to do differently, but why the change matters.
5. What types of EHR readiness exercises are most useful before go-live?
Real-world, cross-functional scenarios can reveal readiness gaps that traditional role-based training may not identify.
Healthrise recommends using:
- Day-in-the-life scenarios to recreate common patient and employee experiences
- Preparation labs to allow teams to practice workflows before launch
- Integrated tabletop exercises to test how multiple departments respond to the same issue
- End-user workflow testing to identify gaps in real-world processes
- Escalation exercises to determine who makes decisions when something goes wrong
The objective is to answer practical questions before go-live: Who owns the next step? Where does the work go? What happens when the expected process fails? Who has authority to make a decision?
The 90 to 180 days before go-live can serve as a critical operational stress test, according to Healthrise. During this period, health systems should validate access and staffing models, test integrated workflows with end users and examine where work changes hands between departments.
6. What should health systems watch during the first week of EHR go-live?
Health systems should closely monitor workflow ownership, cross-functional handoffs and escalation patterns during the first week of go-live.
No EHR implementation is likely to be completely free of issues. The more important question is whether an organization can identify, route and resolve problems efficiently.
Healthrise recommends watching for signs such as:
- Employees repeatedly asking who owns an issue
- Problems being escalated that should be resolved at the department level
- Work being routed to the wrong team
- Employees relying on informal workarounds
- Patient delays caused by unclear processes
- Registration or documentation errors
- Revenue cycle issues that originate earlier in the patient journey
“If people are hunting for answers, forwarding emails or escalating issues that should be resolved laterally, that tells you something,” Woodley said. “The technology may be working, but the organization is showing you where its readiness gaps are.”
These patterns can provide an early indication that the issue is not necessarily the EHR itself, but the connections between people, processes and workflows.
7. What should happen after EHR go-live?
Go-live should mark the beginning of stabilization and optimization, not the end of EHR readiness planning.
Healthrise recommends defining post-go-live priorities before launch, including:
- Which workflows need to stabilize first
- Who owns post-go-live decisions
- How issues will be prioritized and resolved
- What metrics will determine whether the implementation is succeeding
- Which EHR capabilities should be optimized next
- What success should look like 12 to 18 months after launch
Some organizations may need to focus first on stabilizing core workflows. Others may be prepared to introduce additional capabilities soon after launch. The appropriate approach depends on the organization's readiness, priorities and capacity for change.
“What is important is having that conversation intentionally and understanding the tradeoffs before you commit,” Woodley said.
A successful EHR go-live requires more than a working system
An EHR implementation succeeds when the technology, people and processes work together in the real-world environment of patient care.
For health systems, that means readiness cannot stop with system configuration, testing and training. Organizations also need to understand how decisions are made, how work moves between departments, who owns problems and how employees respond when workflows do not operate exactly as planned.
“Go-live is not the finish line,” Woodley said. “It is the point when the organization has to prove that all of the decisions, preparation and change management can come together in the real world.”
For health systems preparing for an EHR transition, that work should begin well before the first patient encounter. By identifying decision bottlenecks, testing cross-functional workflows, preparing employees for real-world scenarios and establishing post-go-live priorities, organizations can enter go-live with a clearer understanding of how the new system will function in practice.
To learn more about EHR go-live readiness and Healthrise’s approach to helping health systems prepare for a smoother transition, visit www.healthrise.com.
About Healthrise
Healthrise is a healthcare consulting and technology firm that provides revenue cycle management, electronic health record optimization and strategic advisory services to hospitals and health systems across the United States. Founded in 2012, the company partners with organizations to improve financial and operational performance through customized, data-driven solutions. Healthrise has supported more than 25 health systems and managed over $35 billion in net patient revenue, helping clients strengthen long-term sustainability and care delivery. For more information, please visit www.healthrise.com.
Release Summary
- Healthrise identifies seven factors that health systems should address to improve EHR go-live readiness and reduce operational disruption.
- The release defines operational readiness as the ability of people, processes and leadership to function effectively in a new EHR environment, beyond simply having the technology configured and tested.
- Decision-making capacity is a critical EHR readiness factor, as implementation teams must manage a high volume of interconnected decisions involving workflows, system settings, staffing, access and ownership.
- Cross-functional workflow handoffs are a major source of readiness gaps, particularly between clinical, administrative and revenue cycle teams.
- Healthrise explains that employee resistance to an EHR change may indicate a readiness or communication gap, rather than unwillingness to adopt the technology.
- Healthrise recommends day-in-the-life scenarios, preparation labs and integrated tabletop exercises to test real-world workflows, clarify ownership and identify escalation points before go-live.
- The 90 to 180 days before EHR go-live should be used to stress-test integrated workflows, staffing models, system access and end-user readiness.
- Healthrise recommends monitoring the first week after EHR go-live for unclear ownership, repeated escalations, workflow workarounds, patient delays, registration errors and revenue cycle issues.
- Post-go-live optimization should be planned before launch, including stabilization priorities, ownership, success measures and longer-term EHR optimization goals.
- Michele Woodley, Healthrise vice president of EHR Readiness and IT, emphasizes that EHR go-live is not the finish line; it is the point when an organization must demonstrate that its technology, people and processes can work together in practice.
Frequently Asked Questions
What is EHR operational readiness?
EHR operational readiness is an organization’s ability to use a new electronic health record effectively in real-world operations. It includes people, processes, workflows, decision-making, staffing and leadership, not just technical system readiness.
What is the difference between technical readiness and operational readiness for an EHR go-live?
Technical readiness means the EHR has been configured and tested for launch. Operational readiness means employees and leaders are prepared to use the system, execute new workflows, manage cross-functional handoffs and respond when problems occur.
How can health systems prepare for a successful EHR go-live?
Health systems can improve EHR go-live readiness by starting operational planning early, clarifying decision ownership, testing cross-functional workflows, using real-world scenarios and establishing post-go-live priorities before launch.
How far in advance should health systems begin preparing for EHR go-live?
Healthrise recommends beginning operational readiness work as early as 18 months before go-live to identify decision bottlenecks, clarify ownership and prepare teams for workflow changes.
What are the biggest EHR go-live readiness risks?
Common readiness risks include decision fatigue, unclear workflow ownership, gaps between departments, insufficient end-user preparation and employees who do not understand how workflow changes affect downstream teams.
How can health systems identify EHR workflow problems before go-live?
Health systems can use day-in-the-life scenarios, preparation labs, integrated tabletop exercises and end-user testing to recreate real-world situations and identify workflow gaps, unclear ownership and escalation issues before launch.
What should health systems monitor during the first week after EHR go-live?
Health systems should monitor repeated escalations, unclear ownership, workflow workarounds, patient delays, registration errors, documentation issues and revenue cycle problems. These can indicate broader operational readiness gaps.
Why is post-go-live planning important for EHR implementations?
Go-live is the beginning of the stabilization and optimization phase. Health systems should establish post-go-live priorities, ownership and measures of success before launch so teams can address issues and optimize workflows intentionally.
