By Sheryl Bushman, DO, FACOOG(D) | SVP, Physician Advisory
Implementing an EHR system takes months of planning and collaboration, with governance structures in place to guide decisions and keep workflows aligned. But too often, once go-live happens, that governance fades, leaving the system to evolve in ways that may not serve providers, staff, or patients.
At Continuum Health IT, I help health systems maintain a structured approach to EHR management long after implementation. In this blog, I’ll explore why governance matters beyond go-live, how it prevents inefficiencies, and the best ways to keep it active.
Why EHR Governance Shouldn’t End After Go-Live
It’s easy to think of go-live as the finish line, but in reality, it’s just the beginning. During implementation, governance structures – committees that include IT, clinical leadership, and other key stakeholders – help ensure decisions are made with the entire health system in mind. These structures provide oversight on workflow design, system customizations, and prioritization of updates.
However, once the system is live, many organizations de-prioritize governance. Leadership shifts focus to other pressing initiatives, and before long, changes start happening in silos. Individual departments make system updates based on their needs, analysts work on the requests that seem easiest to complete, and there’s no unified vision for the EHR’s evolution.
Without governance, there’s no historical knowledge of why certain decisions were made, which can lead to unintended consequences when workflows are altered. There’s also no structured process for evaluating system updates, meaning new upgrades or changes may disrupt end users rather than help them.
Decision Example: “Why Does My Screen Look Different?”
Imagine logging into your EHR system one morning and realizing the layout has changed. The buttons you relied on are no longer where they used to be, and you now have to click through extra steps just to complete documentation. No one warned you about the change, and now you’re losing valuable time figuring out how to navigate the system again.
This kind of disruption happens all the time when governance is missing. Without structured oversight, system changes roll out without proper communication or training, leaving end users frustrated and inefficient. Governance committees ensure that before any changes happen, they are reviewed, prioritized, and, most importantly, communicated clearly to those who rely on the system daily.
The Risks of Letting Governance Structures Dissolve
When governance disappears, inconsistencies start creeping in. Analysts may tweak workflows based on individual requests without realizing how those changes impact the broader system. Nurses who float between departments might struggle because similar tasks are now completed differently in different areas. Providers may waste time searching for features that used to be easily accessible.
I’ve seen cases where a lack of governance led to serious patient safety concerns. One organization discovered that a medication allergy wasn’t flagging correctly in the system after an update. Because there was no governance structure to oversee changes and catch errors before they became problems, the issue wasn’t identified until multiple patients had already been prescribed medications that could have triggered an allergic reaction. A strong governance model would have caught this early, preventing a major safety risk.
How to Establish and Maintain EHR Governance
Governance doesn’t have to be complicated, but it does need to be intentional. The key to keeping it strong after go-live starts with maintaining the steering committee. The same leadership that guided implementation should continue overseeing governance for at least a year, if not permanently.
Having strong leadership within governance committees is equally essential. Clear leaders are needed to keep meetings on track, facilitate discussions, and ensure system priorities align with organizational goals.
The frequency of governance meetings may also need to evolve over time. Initially, monthly meetings are ideal, but as the system stabilizes, they can shift to quarterly or as-needed discussions. Leadership transitions should also be planned in advance. Governance success depends on continuity, so having a clear plan for transitioning responsibilities ensures ongoing effectiveness.
Finally, if internal teams are stretched too thin, bringing in external support can help maintain structure and efficiency. A consultant who specializes in EHR governance can provide guidance, streamline decision-making, and help organizations stay on track with their long-term EHR strategy.
The Role of Leadership in Governance Success
Executive leadership plays a crucial role in ensuring governance remains a priority. The CEO, CIO, and other senior leaders should reinforce the importance of structured decision-making and provide the necessary resources to sustain governance efforts.
Day-to-day governance responsibilities, however, typically fall on committee chairs and co-chairs, supported by administrative staff or consultants who help manage meeting agendas, coordinate discussions, and strategize messaging around system changes. Having dedicated leadership at both the executive and operational levels ensures that governance remains strong and effective.
How Governance Impacts Nurses, Providers, and Patient Care
A lack of governance doesn’t just create IT issues, it affects frontline healthcare workers and patient care. For nurses rotating across departments, inconsistent workflows can be frustrating and lead to inefficiencies. If medication order screens differ between oncology and surgery, it slows down processes and increases the risk of errors.
For providers, poorly managed changes can make documentation more time-consuming, reducing the time available for patient care. Without governance, patient safety risks, like missed allergy flags or inconsistent medication protocols, may go unnoticed.
Strong governance also improves financial efficiency by ensuring analysts prioritize high-impact changes rather than wasting time on low-priority requests. Health systems can enhance patient safety, provider satisfaction, and overall workflow effectiveness by focusing on critical improvements.
Schedule a Consultation With Continuum Health IT
EHR governance is essential for maintaining an efficient, well-structured system. Without it, workflows become inconsistent, upgrades cause confusion, and patient care can suffer. At Continuum Health IT, we help healthcare organizations develop governance strategies that keep their systems running smoothly and their teams working efficiently. If your governance model has faded post-go-live, we can help you rebuild it.
Let’s start the conversation. Contact us today to ensure your EHR system continues to support your team, your patients, and your long-term success.