Epic is one of the most widely used EHRs on the market, with Epic holding medical records for 325 million patients worldwide. However, transitioning to a new EHR is one of the most complex and high-stakes projects in healthcare, and poorly planned Epic conversions can lead to expensive delays, workflow inefficiencies, and clinician dissatisfaction—which can impact patient care and make it harder to realize the full benefits of your Epic investment.
For hospitals and health systems looking to make the switch, we’ve outlined eight common challenges that healthcare organizations face during Epic conversions, as well as our recommendations on how to avoid them. Whether you’re planning a future transition or already underway, here are a few pitfalls to avoid:
1) Underestimating Change Management & Governance
Successful Epic conversions aren’t just about setting up the system—it requires structured governance and strong buy-in from all stakeholders, including administrators, clinicians, and revenue cycle teams. Without a clear governance model, small decisions—such as template standardization and order set approvals—can snowball into delays. Fragmented decision-making can lead to inconsistent workflows, miscommunication, and resistance to change, all of which make adoption even more difficult.
Solution: Develop a clear governance model early, involving representatives from all key areas. There should be clear accountability, decision-making paths, escalation, and project roles across IT, clinical, and operational teams. Further, be sure to implement a structured change management plan that prioritizes securing executive buy-in early, which will help make the process run more smoothly. Utilize Epic’s Good Install program to understand best practices and track progress on your implementation journey.
2) Poor Workflow Optimization
Another common trap is replicating legacy workflows within Epic. While it can be tempting to try this approach, these outdated workflows may not align with Epic’s best practices—which can lead to inefficiencies that slow down adoption and reduce system effectiveness.
On the other hand, over-customization can create unnecessary complexity, making the system harder to use and maintain—which risks lengthening the implementation timeline and driving up costs. Without thoughtful planning, teams may find themselves stuck in a system that feels just as cumbersome as the one they left behind.
Solution: Focus on finding the middle ground. Conduct a thorough workflow analysis to identify which processes should be reworked to align with Epic’s best practices rather than simply replicating existing workflows. Follow Epic’s Foundation System where possible and minimize unnecessary customization. Remember—if further customization is needed, it can always be introduced post-go-live.
RELATED: How to Use Epic Gold Stars to Maximize Your EHR Investment
3) Data Migration Issues
Migrating data from a legacy EHR to Epic is one of the most complex aspects of the conversion process. Organizations often underestimate the challenges associated with data mapping, integrity, and accessibility—leading to significant disruptions post-go-live.
If historical patient data is not accurately transferred, for example, clinicians may lack the necessary information to provide effective care, which can result in operational inefficiencies and patient safety risks. Additionally, inconsistencies in data formatting between systems can lead to missing or incorrect information, further complicating workflows and requiring extensive remediation efforts.
Solution: Engage experienced partners who understand both systems and have an extensive background in Epic conversions. The right partner should be able to conduct multiple test migrations, ensure rigorous validation processes, and involve key stakeholders in data mapping and crosswalking to ensure key clinical and operational data elements—such as patient demographics, problem lists, medications, allergies, and historical encounters—are all aligned between the legacy system and Epic’s data structures.
Before migration, it’s also crucial to conduct a data validation assessment to determine what can be converted versus archived. Certain data elements—such as structured lab results or imaging—may require alternative integration, while unstructured notes might need OCR or indexing. Implement rigorous extraction, transformation, and validation protocols to catch inconsistencies, and run multiple test conversions and parallel runs to validate accuracy. Engage clinical and operational champions early to review data usability and develop a structured cutover plan with downtime procedures and legacy access strategies to minimize disruption and maintain access to critical historical information.
4) Insufficient End-to-End Testing
Testing isn’t just about ensuring workflows function correctly—it’s also critical for validating data migration success. Insufficient testing of workflows, interfaces, and integrated systems often results in post-go-live disruptions, including system slowdowns, incorrect data transfers, and workflow failures. If migrated data isn’t thoroughly validated, clinicians may lack access to complete patient histories, leading to care delays, misdiagnoses, or billing errors. A lack of thorough testing may also result in undetected integration failures, causing problems with billing, scheduling, and clinical decision support tools.
Solution: Implement comprehensive testing protocols, including unit testing, integrated testing, and end-to-end workflow validation before go-live. Involve key stakeholders—including IT teams and end-users—in testing phases to ensure that workflows align with real-world clinical and operational use. You should also review all workflows, interfaces, and data conversion to mitigate any potential issues.
5) Device Compatibility Issues
Device compatibility issues can significantly impact system adoption and overall workflow efficiency. If critical devices—such as workstations, mobile tools, and tablets—fail to integrate properly with Epic, clinicians may experience disruptions that lead to slower patient care, increased frustration, and higher IT support demands. Common compatibility problems include outdated hardware, network connectivity issues, and software conflicts that go unnoticed until go-live.
Solution: Conduct thorough device compatibility testing prior to go-live and verify that all devices meet Epic’s system requirements and function as expected. Addressing these concerns early helps prevent operational slowdowns and improves user adoption from day one.
6) Inadequate Training & User Adoption
Without proper training, even the most well-designed Epic implementation can flounder. Inadequate training causes productivity dips and staff resistance to new workflows. When users don’t fully understand how to navigate Epic, frustration builds—leading to errors, slower adoption, and increased reliance on IT support. If training is rushed or poorly structured, users may default to old habits, negating the benefits of Epic’s optimized workflows.
Solution: Invest in a structured, role-based training program with simulations, hands-on practice, and Super User training. Additionally, tie your training plan into your change management strategy, and get buy-in from providers, nurses, and front-line staff through advisory councils and Super Users. Not only will this support your Epic conversion process, but having end-users on board is a key component of driving long-term success.
RELATED: 5 Proven Steps for a Successful Epic Implementation
7) Poor Go-Live Support
Inadequate support during activation can derail the transition process, leading to prolonged system downtime, frustrated end-users, and an overwhelmed IT helpdesk. Without a developed go-live strategy and experienced Epic conversion experts on hand, organizations may struggle with troubleshooting issues in real time—resulting in delayed patient care and operational inefficiencies.
Solution: Work with an experienced partner to guide you through the entire EHR conversion process, from strategy to post-go-live. The right partner will provide support throughout the transition process by setting up a Command Center for real-time issue resolution, deploying at-the-elbow (ATE) support for clinicians and staff, and implementing a structured optimization strategy. For ongoing support post-go-live, consider partnering with a managed services provider to ensure uptime, security, and efficiency while freeing your internal teams to focus on strategic priorities.
8) Budget Overruns
Epic conversions are complex processes, and budgets can often be surpassed due to prolonged timelines, unexpected resource demands, and scope creep. Common culprits include extended training periods, unforeseen technical challenges, and additional system customizations that were not accounted for in the initial plan. Hidden costs—such as increased staffing needs during go-live, additional consulting hours, or necessary infrastructure upgrades—can further strain the budget. Without proactive planning and cost controls, these financial pressures can lead to project overruns and delayed returns on investment.
Solution: Use a phased approach, track KPIs, and maintain strong governance structures to control scope throughout the entire project. Establish a formal review board or financial oversight team to assess and approve scope changes before they impact the budget and consider pushing any additional requests to be considered by the team post-go-live to help keep the project on track.
The Bottom Line
Successfully converting to Epic is no small feat—it requires careful planning, strong governance, and a proactive approach to overcoming common pitfalls. When executed properly, however, an Epic conversion can streamline operations, enhance clinician efficiency, and improve patient outcomes.
At Healthcare IT Leaders, we understand the challenges that come with Epic conversions, and we specialize in guiding organizations through every phase of the process. Unlike firms that focus solely on Epic, we bring cross-platform expertise that extends to Oracle Health (Cerner), Meditech, and other EHR systems—allowing us to bridge the gap between legacy systems and Epic—so we can provide well-rounded, strategic support for complex migrations like yours.
Ready to learn more? Contact us today to learn more about our industry-leading Epic consulting practice, and let’s get started.