Paper Charting to EHR Software: 4 Common Mistakes

As healthcare clinicians, we recognize the importance of accurate documentation for both clinical care and reimbursement purposes. But the way we manage this documentation is changing, and many of us are now actively transitioning from paper to electronic health records.

The process of moving from paper charting to EHR software (and more broadly, digitizing medical records) is still challenging, but the risks today are better understood than they were a decade ago.

From my experience, there are four common mistakes which can derail the switch:

1. Undertraining clinicians and staff

As clinicians, we want a way to make documentation easier and more streamlined. So, we all have great incentive to make EHR documentation work. However, if clinicians and staff are undertrained, we can easily get frustrated with the new system.

If a clinician knows how to care for their patient, but cannot find the right workflow, diagnosis code, or order set, frustration builds fast. Clinicians need role-specific, scenario-based training that mirrors real patient encounters, not generic system walkthroughs.

Further recommended reading: The problem with paper charting and how EHR can help

It is crucial that clinicians, office managers, and all staff members are properly trained prior to launch. Equally important, training must continue after go-live, as real-world usage reveals gaps that classroom instruction cannot anticipate.

Most organizations overtrain on system navigation and undertrain on decision-making inside the system. Teaching clinicians why a workflow exists improves adoption far more than teaching which buttons to click.

2. Expecting immediate Success and high productivity

Let’s face it, people don’t like change. Administrators must be prepared for a little resistance, especially from seasoned clinicians who have spent years refining their paper-based workflows. For many, the transition from paper to electronic medical records will be a cognitive shift, not just a technical one.

Be sure to listen to concerns and offer options for continued education; it will take time to master a new system, so don't be surprised if there's an initial decline in productivity. Recovery will be dependent more on workflow design and training quality than simple user acclimation

I also found that frustration ensued when nurses, therapists, and physicians were expected to keep up with their usual amount of patient care while learning and inputting data into the new EHR system. Allow extra time in your users' schedule for training and data entry during this transition.

3. Assuming the IT Team knows what clinicians need

Your IT department will never fully understand the intricacies of your documentation requirements. When switching from paper charting to EHR, it is important for IT and clinicians to collaborate to increase trust in the new system and avoid headaches down the line.

In my experience at the sub-acute rehabilitation facility, collaboration with IT allowed us to modify the physical therapist evaluation menu. I was able to include more detailed descriptors and a section for additional comments, which made therapy evaluations more efficient and complete.

EHR platforms are far more configurable today, but that flexibility can backfire. Without strong clinical governance, organizations risk recreating paper chart chaos in digital form...just faster.

4. Improper planning for paper chart storage and digitization

What happens to all of those large binders, portfolios, and paper reams? Establishing a protocol for accessing and storing paper information will be crucial for any transition.

I experienced a situation in which all old paper charts were stored in a remote building off-site. When a patient returned two weeks after discharge, their history was unavailable, forcing staff to re-enter information manually.

Today, this mistake often appears in a different form: organizations underestimate the complexity of digitizing medical records. Scanning alone does not equal usability. Without indexing, data validation, and clear retention policies, scanned records become digital clutter rather than clinical assets.

In general, keeping recent records accessible during the transition is still a sound guideline. However, newer best practices recommend prioritizing problem lists, medication histories, and recent care summaries for structured data entry, rather than attempting to digitize entire charts at once.

Final thoughts

The underlying lesson behind most of these mistakes is to plan for challenges and failures during a switch from paper charting to EHR. Listen to your clinical staff and address their concerns early.

Proper education on the challenges ahead is key to avoiding frustration amongst your team.