Background: Electronic health record (EHR) transitions are common and complex organizational changes, yet limited published literature is available to guide health systems that are changing from one EHR to another. Clinicians and staff end users at sites that have undergone EHR transitions may have critical insights that could inform future transitions.

Objective: To assess end user perspectives on organizational practices that support successful EHR transitions.

Design: Multi-site qualitative study of end users at healthcare systems that transitioned to a new EHR (either Epic or Cerner) within the prior 3 years.

Participants: Forty-two participants, including providers, clinical leaders, and informaticists at four geographically and organizationally diverse US healthcare systems.

Approach: We conducted semi-structured telephone interviews, which were audio-recorded and transcribed. We used content analysis to identify key practices that influenced EHR transition success.

Key results: Participants described specific organizational practices that they found most helpful in supporting EHR transitions, and these practices transcended individual sites and EHR systems. We categorized practices based on how they were described relative to the stage of implementation. During pre-go-live, recommended practices included communicate rationale and anticipated outcomes of the EHR change; understand baseline workflows; and plan for appropriate customization. During go-live, recommended practices included personalize training and support; invest in robust internal support; reduce workload expectations; and proactively address challenges. The recommended post-go-live practice was to continue to invest in the change.

Conclusions: Our findings may act as a roadmap for future EHR transitions by identifying specific and actionable organizational practices across stages of implementation. These recommendations highlight the role of health system leaders in preparing for the organizational change, working with and supporting end users, and addressing challenges that arise.