EHR Migration: What Small Hospitals and Practices Can Expect

Change is scary for healthcare leaders. No one wants disruptions that will affect patients, providers, staff, or revenue. And while an electronic health record (EHR) migration for a hospital is more complex than for a clinic or medical practice, no one wants to go into an EHR migration not knowing what to expect. That’s true for rural and community hospitals, urban hospitals as well as rural clinics and independent practices everywhere. 

In this article, we cover what to expect when undertaking an EHR migration (aka EHR transition), including timelines, the process, what you need to do to prepare and participate, and what you should expect from your vendor. 

What to Expect During an EHR Transition

An EHR transition should be a joint project between you and your vendor. You, your team, and your vendor have to show up and participate. And your vendor has to guide you through the process. Here’s a checklist of what you should plan on.

Internal Participation Needed for Migration

Initiate or plan for the following before you sign a contract with your new EHR vendor. 

• Select an assigned internal contact or group of contacts for your vendor to work with.
  • If you’re transitioning a hospital EHR, contacts should include relevant department heads who can work with the vendor as needed.
• Plan to be available to participate in regular meetings — likely weekly — with your vendor implementation team. 
• Be ready to help your vendor understand and document your processes, procedures, and workflows — your vendor needs to know what your processes, procedures, and workflows are to ensure they’re mapped to your new EHR. Few hospitals or practices have these documented, so plan on meetings with your vendor to map them out. Note that if you want to change processes and procedures, that may extend your timeline. 
• Document and decide on integrations — what third-party integrations, such as a lab information system (LIS) radiology information system (RIS), clearinghouses, e-prescribing etc., do you have and what will you keep, add, or change?
  • Your EHR vendor should be able to recommend their preferred integration vendors. But if your organization is contracted with other vendors, it’s important to review and scope integration with the new EHR. 
• Plan to get your chargemaster (Charge Description Master [CDM]) ready within the first month or two — this is a critical part of the transition and not having it ready will extend your timelines. 
• Plan time to work with your vendor to migrate data to your new EHR.
• Address change management and staff adoption early to mitigate or eliminate staff resistance.
• Allow time for staff and providers to train on the new system and any new integrations.

What Your EHR Vendor Should Provide

The minimum you should expect from your vendor includes:

• Regulatory and compliance expertise relevant to your organization type — especially true for rural  organizations that face strict federal oversight.
• A dedicated implementation team and team lead who works with you and your team as a partner throughout the process.
• A detailed implementation plan with defined timelines and milestones.
• Clear communication and regular meetings on progress, needs, and changes to your timeline.
• Data migration services and support including what can and will be migrated and how regulatory data will be retained.
• Discovery and analysis to work with you to understand and map out your processes, procedures, workflows, templates, forms, and clinical content and configure them in your new EHR.
• Integration support and contract management when applicable.
• Thorough role-based training — live or online or both — and super-user training.
• Rigorous system testing and validation.
• Comprehensive post-go live support.

What Timeline to Expect for an EHR Migration 

The timeline to migrate an EHR depends on the organization type, the internal team and their availability, and the vendor. A hospital EHR migration may take three times as long as one for a clinic or medical practice. Timelines can be extended to work for busy teams with competing priorities. Timelines can also be impacted by any number of factors, including unexpectedly complex unanticipated data migration needs, scope changes, limited client availability, integration delays, staff resistance.

Rough timeline estimates are as follows:

• Critical access and rural emergency hospitals (25 to 50 beds): 6–12 months
• Community hospitals (50 to 300 beds): 12–24 months
• Large health systems (300+ beds, multiple facilities): 18–36+ months
• Rural health clinics (RHCs): 3–9 months
• Independent medical practices: 2–6 months
• Specialty practices: 4–12 months

Ranges assume a full EHR implementation that includes configuration, integrations, training, and migrating historical patient data.

The steps in a timeline include and might break down as shown in the following table.

Phase	Smaller Hospital	RHC	Independent Practice	Specialty Practice
Planning and design	3–6 months	1–2 months	2–4 weeks	1–3 months
Configuration and build, integrations, data migration*	4–8 months	1–4 months	1–3 months	2–6 months
Testing and training	2–4 months	2–6 weeks	2–4 weeks	1–2 months
Go live and post go-live stabilization	1–3 months	2–8 weeks	2–6 weeks	1–2 months
Total	12+ months	3–9 months	2–6 months	4–12 months
Azalea’s averages**	6–9 months	2–3 months	2–3 months	2–3 months

Ranges here are broad industry averages across different vendors unless otherwise noted.

*EHR data migration preparation is usually done alongside system configuration, interface development, testing, and validation rather than as a separate project phase. 

**Azalea timelines reflect the depth of experience implementation specialists bring from supporting a high volume of clients. They also reflect a hands-on, prescriptive process that keeps projects moving while building client confidence at each stage.

Hospital timelines are longer because an EHR migration for a hospital typically involves more integrations than for a clinic or medical practice as well as more patient data. Integrations can include an LIS and the analyzers that integrate with it, an imaging system and/or RIS, inpatient vital systems, clearinghouses, health information exchanges (HIEs), pharmacy, e-prescribing merchant services, and an enterprise resource planning (ERP) platform. 

Those integrations have to be implemented along with the EHR. And some hospitals, clinics, and practices may switch or add integrations during an EHR migration, which can further extend a timeline, especially with needed training on new systems.

While integrations are more common for hospitals, they can also be part of an EHR migration for a clinic or practice. The difference is that clinics and practices usually use an API to connect integrations to the EHR, which is a simpler switch.

Migration Kick Off

Before you kick off your migration, you’ll sign a contract with your new EHR vendor and have a kick off meeting with your internal and vendor implementation team. 

That kickoff meeting is critical. It lets you understand what your team needs to do and how things will proceed, and who your implementation team is and what you can expect from them. You’ll also review your timeline, so everyone has the same expectations. 

EHR Transition Planning and Design

During the planning and design phase of an EHR systems implementation, you and your vendor will fully define the scope and goals of your migration. Some of that will happen before you sign the contact, but details are fully finalized in this phase. 

This phase includes:

• Formalizing internal decision makers and stakeholders.
• Finalizing timelines and milestones.
• Doing discovery and analysis of existing and future processes, procedures, and workflows — including for registration, scheduling, clinical documentation and content, order entry, medication management, billing and revenue cycle, and referral and care coordination.
• Planning for data migration, including what will and won’t be migrated and how much historical data will be migrated.
• Planning for interface and integration migration or addition.
• Reviewing and designing orderables, fee schedules, the CDM, and payer lists and setups.
• Planning for technical needs, such as user provisioning and security.
• Determining super users and the training process.

For hospitals some or a large part of the discovery and analysis process may happen with the vendor implementation team onsite. For ambulatory practices, most are done with the team remotely.

Tips for Success

• Work with your vendor to get your fee schedule and CDM ready early in the process. Not having the ready will extend your timelines. 
• If you haven’t documented your workflows (and few hospitals and practices do), your vendor will work with you to do so to ensure your new EHR reflects your standard processes. This process involves multiple stakeholders, including billing, front office, finance, and other teams. 

Configuration and Integration

For this phase, vendors may involve your internal team to build out your new EHR alongside them. That helps ensure your team understands and learns the system. 

An example is your vendor building two order sets while your internal team watches and then building a third alongside your team. Your internal team member who’s participated in building an order set, can now show other team members how, and becomes a valuable resource alongside your vendor as your team learns your new EHR.

The configuration and build process includes creating chart notes, SOAP notes, templates, forms, and handouts.

Integrations

Deploying integrations can be one of the most complex parts of an EHR implementation, because every system that sends data to or receives data from the current EHR must be evaluated, rebuilt, tested, and validated in the new EHR.

For hospital EHR migrations, third-party integrations can consume 20 to 30% of implementation. Integrations are typically managed alongside build, workflow design, and data migration. 

If not before, during the planning and design phase, it’s best to document the integrations you use or want to change or add. You also want to work with your vendor to document data flows and dependencies. Some vendors, like Azalea, will manage the contracts with preferred or white-labeled integration vendors for you and ensure integrations get mapped to the new EHR. And, as part of the configuration and build phase, ensure integrations are configured, tested, and validated.

EHR Data Migration

Data migration is the process of taking your existing clinical, financial and operational data from your current EHR into the new EHR without losing data integrity or affecting compliance. 

Many hospitals choose not to migrate all data and instead migrate 2 to 10 years worth of active clinical data and archive older records. 

To avoid workflow disruption, final data migration is ideally done near the time of go-live to ensure patient data is as current as possible. If new patients are seen between migration and go-live, facilities may need to manually re-enter data. 

Migrating data involves guidance from the EHR vendor on what can and can’t be migrated. You’ll be asked to provide a sample data extract. The vendor tests the sample extract to ensure it works as needed and that fields in the sample map to fields in the new EHR. If they do, you’ll use the format from the working sample to provide the entire data set you’re migrating to the vendor. If they don’t, the vendor will work with you to make modifications as needed until you have a working sample.

You may choose to clean up data before creating the sample extract. Your internal team can do that or you can ask the vendor depending on staff availability.

The vendor will take your final data and do test migrations to ensure a smooth transition. Your team will be asked to participate to ensure data appears correctly, record counts match, financial data is consistent, and more in the new EHR before going live. 

The biggest lift here is providing the data to your vendor in the needed format. 

Training and Testing

Every vendor’s approach to training will vary. But any EHR migration process should include a training period. That may involve virtual learning or live onsite training with the vendor. Onsite training is more common for hospital EHR migrations. Training can happen after configuration is complete or begin before.

Clinics and practices migrating to an Ambulatory EHR might use an eLearning platform and train virtually. That way training can start anytime and usually kicks off with the initial kick-off meeting and continues through go-live. 

A Training Example

Prior to an initial training event, Azalea hosts an onsite champion review. During the review, the implementation team sits down with department heads and shows how workflows work in the EHR. This happens before integrations are finalized and includes an overview of:

• What workflows look like
• What templates look like, including order stats and room and bed configuration

The review gives leads a chance to know how things are configured and lets them adjust or sign off as needed. It eliminates any surprises and ensures the system functions as planned and needed before super users are trained.

Once department heads have signed off on workflows, internal trainers are training onsite as super users. Super users can then help train peers.

Azalea then flips the narrative and has the super users train the implementation team. This helps ensure that they’ve retained the training. It includes providing checklists for training, later use, and as a refresher.

Azalea also does an integrated training and testing event with department heads once integrations are complete. All workflows are tested end-to-end with real users to ensure that everything works as needed and planned. 

Scenarios include admitting a patient who needs labs ordered to:

• Make sure the order goes to the LIS
• Make sure the result populates where it’s expected to in the patient’s chart. 
• Make sure that the right forms — a consent form or a nursing evaluation — are populated at the right time. 

Go Live

Typically, you’ll have a go-live date and a cutoff date for your previous EHR. That’s the date all new encounters are processed through your new EHR.

At Azalea, for hospital EHR migrations, the first day of a new month is the preferred go-live and cutoff date. It’s recommended that you work down your AR prior to going live.

The most common approach to AR is to leave AR for encounters processed in the legacy EHR in the old EHR system and continue processing them there. Often the legacy system is kept in a read-only mode for 6 to 24 months, depending on the size of the organization.

Some large hospitals and provider groups choose to migrate outstanding balance information with or without detailed claim lifecycle data to the new EHR. Migrating without lifecycle data may still require that auditors can access the legacy EHR. Either way carries more risk and requires mapping, which can extend timelines and add complexity. Your vendor will work with you during the planning and design phase to outline your preferred approach and plan accordingly.

Post Go-Live Optimization and Support

After go-live, you enter what may be called the hypercare period. That’s a phase of heightened support.

With an Azalea Hospital EHR implementation, the Azalea implementation team goes onsite for one week during this phase and then offers heightened support for another three. For clinics and practices, the Azalea Ambulatory EHR implementation team does remote check-ins for four weeks. At the end of the four weeks, the hospital or clinic is transitioned to regular support and assigned a customer success manager.

During this phase, templates or processes can be adjusted if needed and training can be reinforced. 

For hospitals, Azalea also does an onsite post go live optimization visit at six months. The visit is a time Azalea works with the team to make adjustments that can be made to optimize outcomes and use.

How to Avoid Surprises During an EHR Transition

When transitioning to a new EHR, there are steps you can take to maximize your success and avoid surprises.

• Address staff adoption early. Staff resistance is a top reason EHR transitions struggle. 
• Review existing systems, integrations, and workflows when implementation begins if not before. Overlooked dependencies can create delays later in the project.
• Keep the scope manageable. Avoid making major operational or workflow changes at the same time you’re implementing a new EHR.
• Start preparing staff for training early. Prepare users to take the time to learn new workflows, ask questions, and build confidence before go-live.
• Don’t wait to set up e-prescribing. Identity verification, controlled substance prescribing requirements, and provider enrollment can take longer than expected.
• Make sure your vendor treats the implementation as a partnership and works closely with your team to ensure there are no surprises.

What to Expect if You Transition to Azalea 

Years of implementation experience give the Azalea team a strong understanding of what works, where challenges tend to arise, and how to keep projects moving without losing momentum. That lets one of the biggest differences with an Azalea implementation be how quickly organizations can move from a signed contract to go-live. 

Azalea pairs the team’s experience with a hands-on approach. Hospitals and practices work closely with implementation specialists throughout the process, including professionals with clinical and revenue cycle backgrounds who understand the day-to-day realities of healthcare operations.

Just as important, Azalea’s implementation focus isn’t just on getting an organization live. Instead, the process is designed to help care teams understand their workflows, make confident decisions, and feel prepared to manage and grow their system day one and long after go-live.