Many electronic health record (EHR) challenges for public health professionals begin early—during implementation and training—and can continue throughout the system’s life.
A strong EHR is essential for local public health agencies. It serves as the central hub for patient management, data analysis, and reporting, offering clear benefits when it works well.
However, the transition from paper to digital systems hasn’t been smooth. A study published in the National Library of Medicine found that healthcare workers often face increased administrative burdens and workflow disruptions. These issues lead to clinician frustration, patient care errors, reduced patient interaction, and a rise in “technostress”—stress caused by using complex digital tools (Provenzano et al., 2024).
Based on feedback from public health agencies, the most common EHR pain points fall into six key challenges. In response, we offer practical solutions to help agencies overcome these obstacles and use EHRs more effectively to serve their communities.
Challenge #1: EHR Onboarding Process is Too Long and Too Hard
The Problem: The setup process for a new EHR can feel like an endless and daunting project. Timelines stretch far beyond what was promised, and the complexity of the system can make it feel overwhelming before it’s even operational. The burden of setup often falls squarely on the agency, requiring a significant investment of time and resources that are already stretched thin.
The Solution: Look for a vendor that takes on the heavy lifting of the setup process. An effective onboarding plan should be streamlined, not “one-size-fits-all.” The vendor’s team should work closely with you to understand your agency’s business model and priorities from day one. Specifically, they should take the lead in customizing and setting up the system for your initial priority programs, ensuring a smooth and rapid launch.
Customer feedback can be a good indicator of a vendor’s commitment to this approach. Wells County, North Dakota moved from another vendor to Nightingale Notes by Champ Software and found the EHR onboarding process to be effective and efficient.
Challenge #2: Poorly Executive EHR System Training
The Problem: Many agencies receive generic, lecture-style training that ignores their specific workflows and programs.
As noted in Bridging Theory and Practice: Software Training Best Practices Grounded in Adult Learning Theory:
“Experiential learning is a cornerstone of effective adult education… Simulations allow for the application of theoretical knowledge in a practical setting, reinforcing understanding and increasing retention.”
Without a trainer who understands your daily operations, the EHR system can feel more like a burden than a tool. Worse, training often ends abruptly, leaving agencies unsupported when real-world issues arise.
The Solution: Seek out a vendor that offers hands-on, side-by-side training tailored to your specific goals and workflows. The training should be focused on empowering your team to use the software effectively, not just showing them features. Look for a vendor with extensive experience working with public health departments.
A key differentiator is a vendor that provides free, ongoing training for new staff and on all new features, ensuring your team is always confident and comfortable with the software. As Caitlin from Wells County, ND, noted after onboarding with a new EHR, “The amount of support we get… is truly amazing.” Read more about the fresh approach to EHR onboarding that Wells County, ND found successful.
Challenge #3: Burden of Signing Long-Term Contracts
The Problem: Many EHR vendors lock agencies into multi-year contracts, often lasting three to five years. While this may seem like a stable partnership, it can become a burden if the system doesn’t meet your needs. If the software is hard to use, unreliable, or lacks support, you’re stuck with an expensive, ineffective solution. This leaves you with a system that causes more problems than it solves, and no easy way to switch to a better option.
An article from the HIPAA Times defines EHR Vendor lock in:
“EHR vendor lock-in occurs when a healthcare provider is overly reliant on a specific vendor’s EHR system. The reliance usually happens because the system has unique features or contracts that make it hard to connect with other systems or switch to a different vendor.”
The Solution: Choose a vendor confident in their product, one that doesn’t rely on long-term contracts. Vendors like Champ Software, who offer one-year contracts, earn your business every year. This keeps them accountable, ensuring high-quality products and exceptional support, knowing you can switch if they fail to meet your needs.th if they fail to meet your needs.
Challenge #4: Hidden Fees and Lack of Price Transparency
The Problem: Many EHR vendors attract clients with a low base price, then add hidden fees for essential features. These “unbundled” services—like billing modules or connections to state immunization registries—often are presented after the contract is signed. In effect, this lack of transparency leads to unexpected costs and budget overruns, leaving agencies with an incomplete system.
The Solution: Insist on an itemized list of all potential costs upfront. Ask vendors to define what’s included in the base package price. Importantly, core features, like billing or state immunization registry connections, should be included. A transparent pricing model should cover one-time fees, subscription costs, and charges for implementation, training, and support.
Example questions to ask vendors:
- “Does the base price include a billing component and a connection to our state’s immunization registry? If not, what is the additional cost for these features?”
- “Can you provide a list of all potential one-time and recurring fees that are not included in the standard package price?”
- “What is the shortest term contract you offer and what happens if the product is not working halfway through our contract and we want to leave?”
Challenge #5: Not Customizable for Workflows and Programs
The Problem: A major “gotcha” for local public health agencies is investing in an EHR designed for physician practices. These systems force you to shoehorn diverse public health programs—from home visiting and immunizations to family planning and environmental health—into a system that simply doesn’t fit. Unquestionably, this leads to inefficiency, frustration, and a lack of accurate data.
The Solution: Prioritize an EHR that was built specifically by and for public health. A system designed for your unique business model will be highly customizable, allowing it to align with your specific workflows, programs, and goals. The vendor should work closely with you to deeply understand your unique needs, ensuring the system is a precise tool for your department’s mission. Horizon Public Health shares the requirements they need in an EHR and the solution they found in this user story.
Challenge #6: Unreliable System with Frequent Downtime
The Problem: You’ve invested time and money into an EHR system that’s unreliable and often crashes. This disrupts operations, compromises patient care, and risks data integrity.
The Solution: Choose a stable, dependable system. Reliability is essential. A strong EHR should have a proven track record of uptime, backed by positive customer testimonials. Vendors who prioritize reliability show a commitment to supporting your work. Look into what other agencies use the system you’re considering. Call them to ask about bugs and downtime.
References:
Mohn, C. (2023). Bridging Theory and Practice: Software Training Best Practices Grounded in Adult Learning Theory. Retrieved from https://ellitgroups.com/bridging-theory-and-practice-software-training-best-practices-grounded-in-adult-learning-theory/#:~:text=Experiential%20learning%20is%20a%20cornerstone,reinforcing%20understanding%20and%20increasing%20retention.
Peremore, Kirsten. “The Issue with EHR Vendor Lock-In.” HIPAA Times News, Paubox, 12 Dec. 2024, https://hipaatimes.com/the-issue-with-ehr-vendor-lock-in#:~:text=Lock%2Dins%20make%20it%20expensive,healthcare%20providers%20and%20legacy%20systems.
Provenzano, Maria et al. “Electronic Health Record Adoption and Its Effects on Healthcare Staff: A Qualitative Study of Well-Being and Workplace Stress.” International journal of environmental research and public health vol. 21,11 1430. 28 Oct. 2024, doi:10.3390/ijerph21111430. https://pubmed.ncbi.nlm.nih.gov/39595697/