There is no single “greatest” risk that applies to every electronic health record (EHR) system or healthcare organization. The risks depend on the setting, system configuration, workflows, and safeguards in place. Common concerns include cyberattacks and unauthorized access, system downtime, usability problems that disrupt care, inaccurate or mismatched data, implementation challenges, and ongoing costs. A useful risk review asks which issues could most affect this organization’s patients and operations—and how the team will detect and manage them.
Common EHR risks and challenges
Privacy, security, and cyber incidents
EHRs contain sensitive health information and depend on connected technology. Weak access controls, phishing, malware, misconfigured systems, or vendor and supply-chain issues can expose information or disrupt access. The likelihood and impact vary; organizations should identify their own risks through a documented security risk analysis and appropriate safeguards rather than assume that a product label guarantees security.
Downtime and loss of availability
Planned maintenance, connectivity failures, hardware problems, or a cyber incident may make some or all of an EHR unavailable. If teams cannot retrieve records or route orders and results, work may be delayed or shifted to manual processes. A downtime plan should specify how care continues, how urgent information is communicated, and how records are reconciled after service returns.
Usability and workflow-related safety hazards
Confusing screens, alert overload, duplicate documentation, unclear task ownership, or poorly designed handoffs can add burden or contribute to missed steps. These problems are shaped by the interaction of people, technology, and the work environment. Review workflows with the staff who use them and monitor unintended effects after configuration changes.
Data quality, patient matching, and information exchange
Incomplete or outdated information, duplicate records, patient-matching mistakes, and inconsistent data meanings can make information difficult to trust or use. Connections between systems do not guarantee that every field transfers correctly or that the receiving team understands its source and context. Define ownership for data corrections and test interfaces using realistic cases.
Implementation, adoption, and change management
Migration, configuration, training, workflow redesign, and go-live support require time and coordination. Rushed preparation or inadequate testing can disrupt operations. Involve clinicians and staff early, clarify responsibilities, and test common as well as exception workflows before relying on the new system.
Upfront and ongoing costs
Costs may include licensing or subscriptions, implementation, data migration, interfaces, hardware, training, support, upgrades, security, and internal staff time. The cost structure varies by vendor, practice size, service model, and negotiated terms. Compare a practice’s own written proposals and expected operating needs rather than relying on a generic price estimate.
How to decide which risks matter most
- List the critical workflows and information. Identify what the organization needs to access for safe operations, who depends on it, and what happens if it is delayed or unavailable.
- Consider both likelihood and impact. Assess plausible scenarios such as a mistaken patient match, unavailable results, a compromised account, an interface failure, or a prolonged outage. Include patient-care and operational consequences.
- Review current safeguards and gaps. Check user access, backups, downtime procedures, training, vendor responsibilities, interface monitoring, and correction workflows.
- Prioritize and assign owners. Give each material risk an accountable owner, a mitigation action, and a review date. Use relevant ONC SAFER Guides to structure EHR safety self-assessments.
- Test the plan. Run tabletop or workflow exercises for downtime and other high-impact scenarios. Record gaps and update procedures based on what the team learns.
- Monitor after changes. Review incidents, near misses, downtime, unresolved interfaces, user feedback, and security events. Reassess when the system, workflow, vendor, or threat environment changes.
