Your budget allocation for labor should include a subset of categories including, but not limited to, your existing IT staff who will be focused on implementing your new EHR, external consultants who will support your implementation and/or backfill the existing IT team, and EHR vendor personnel. More broadly, your implementation talent strategy and budget must also account for the internal staff who will be pulled into the project at various stages (clinical informaticists, project managers, operational leaders, and others).

You must carefully evaluate your current IT workforce to determine who will be dedicated to the implementation and who will maintain the legacy system during the transition. If you don’t carefully manage your staffing strategy, there can be budget ramifications and staff can become overextended, leading to burnout.

And if your go-live date gets delayed, implementation resources will need to be extended beyond initial projections, resulting in additional labor costs. Organizations that fail to account for delays may find themselves scrambling for or extending resources well into the implementation, which could extend timelines further and erode stakeholder confidence.

As your IT staff develops new capabilities, accrues certifications, and establishes credibility during an EHR implementation, they will develop expertise that is highly valuable. This creates a retention risk many organizations fail to anticipate.

IT staff with certain EHR certifications and qualifications are in high demand. Without proactive compensation planning, you may lose your most knowledgeable team members just when you most need them.

This issue is particularly important in rural and/or resource-constrained areas, where the pool of experienced EHR talent may be limited. You should plan for retention bonuses, salary adjustments, and subsequent career development opportunities as part of your implementation budgeting strategy. In addition, in today's world of telecommuting, remember that you are no longer competing for talent just within your city — you’re competing against the broader region and country.

For example, legacy applications may not be compatible with the new EHR, requiring upgrades or replacements. Hardware such as scanners, printers, and mobile devices may also need to be refreshed to meet new performance standards. When implementing a new EHR, you should earmark time, effort, and funds to renegotiate contracts with third-party vendors, a responsibility that often falls on clinical and revenue cycle leaders.

To manage these complexities, you should develop a comprehensive third-party contracting strategy early in your planning process. You should also establish realistic expectations with leaders about where savings will be derived across the IT ecosystem (e.g., application rationalization) and where incremental investment may be required, especially if upgrades and enhancements have been neglected in recent years. Make sure your EHR implementation strategy includes a full inventory of existing systems, an assessment of compatibility with the new EHR, and a roadmap for integration or replacement.

There will assuredly be savings across parts of your IT ecosystem as you implement a new EHR. However, you must establish expectations that incremental investment across parts of your IT ecosystem will still be necessary to take full advantage of your new EHR.

Training and activation are frequently treated as afterthoughts in the budgeting process, yet they are critical to the success of any EHR implementation. Without adequate training, users may struggle to adopt the new system, leading to errors, inefficiencies, and frustration.

Effective training programs must be tailored to different user roles and learning styles. They should include hands-on practice, scenario-based learning, and ongoing training after go-live. In addition, you should plan for temporary productivity dips that could occur as users dedicate their time to training and become more proficient in the system.

Activation — the process of transitioning users to the new system at go-live — also requires significant investment. A well-informed budget estimate for activation support should include overtime pay, travel expenses for trainers, and the cost of backfilling clinical roles.

By investing in comprehensive training and activation programs, you can accelerate adoption, reduce errors, and maximize the return on your EHR investment.

While acknowledging and celebrating the significance of your organization’s EHR go-live is absolutely warranted, treating go-live as the end of the project is a misstep. In fact, successful go-live is just the beginning of your EHR journey.

Post-implementation needs often include optimization projects, new applications, enhanced workflows, and integration with emerging technologies such as AI-driven decision support or patient engagement tools.

These efforts often require capital investment, yet many leaders fail to allocate funds for these efforts so soon after go-live. The unintended consequence of this oversight is that leaders frequently resort to tapping into their existing support team utilizing operational budgets, which are already stretched thin.

A forward-looking strategy for effective budgeting should include a multi-year capital plan that anticipates these needs and aligns them with organizational goals. This ensures that your EHR continues to evolve in conjunction with clinical and operational priorities.

As EHR platforms evolve, they're increasingly accompanied by a suite of advanced technologies designed to amplify their impact. Unfortunately, many health systems fail to account for these innovations in their budgeting and strategic planning. This oversight can significantly limit the return on investment and delay the realization of transformative benefits.

Modern EHR implementations are no longer stand-alone software upgrades. Rather, they often include ambient listening tools that automate clinical documentation, workflow automation platforms that streamline payer interactions and care coordination, and AI-powered assistants that help clinicians with real-time decision support and task automation.

Meanwhile, workflow automation tools can engage payers in real time, automate prior authorizations, and optimize revenue cycle management. In addition, AI-driven platforms support predictive analytics, patient outreach, and personalized care planning, all of which enhance the EHR's utility and improve outcomes.

These technologies require thoughtful budgeting. You should plan for licensing fees, integration costs, training, and ongoing support. Also, be sure to consider the organizational change management required to ensure adoption.

Without a dedicated budget stream and strategic roadmap for these innovations, organizations risk underutilizing their EHR investment and falling behind in digital maturity.

By proactively addressing these common missteps, healthcare organizations can better safeguard their EHR investments and position themselves for long-term success.