Every EMR implementation has a period where both systems run. It is the right decision. Staff need a fallback while they build confidence, and the practice needs a way to keep working if the system misbehaves in its first weeks.
The problem is that this period has no natural end. Nothing forces it to stop, and the longer it continues the harder stopping becomes.
Why indefinite parallel running is worse than either system alone
Two records of the same encounter will diverge. When they do, nobody knows which is authoritative, and the answer usually depends on who you ask. Staff do double entry, which is resented and therefore done badly. And because the paper system still works, nobody has to confront the parts of the digital system that are configured wrongly, so those never get fixed.
Most damagingly, the practice never learns whether the EMR is actually sufficient, because it has never had to be.
Set the end date at the start
Before go-live, agree the date the paper system stops, and write it where everyone can see it. Two to four weeks is realistic for a small practice, longer for a hospital with many departments, but it should be weeks rather than months and it should be a date rather than a condition.
Conditions like "when everyone is comfortable" never arrive.
Decide what authoritative means, immediately
From day one, one system is the record. Usually that should be the EMR, with paper as a temporary safety copy rather than an equal. If a discrepancy arises, the rule for resolving it should already exist rather than being improvised.
Retire in stages
Stopping everything at once is unnecessarily risky. A sensible order:
- Registration and appointments go digital first. Lowest clinical risk, highest daily volume, quickest confidence.
- Billing and payments next, because reconciliation gives you an immediate check that the data is right.
- Clinical notes after that, once the population in the system is largely complete.
- Pharmacy and stock last, since these need the most accurate opening data.
Each stage ends with the corresponding paper process stopping, not merely becoming optional.
Handle the objections properly
When the date approaches, resistance appears, and it is usually specific rather than general: a task the system does badly, a report that is missing, a step that takes longer than it did. Collect those specifics before the cutover and fix them. They are legitimate, and forcing the change without addressing them is how a practice ends up with a shadow paper system nobody admits to.
Archive the paper properly
Stopping does not mean discarding. Existing files go into an organised archive with a documented retrieval process, retained for as long as your obligations require. What ends is the creation of new paper, not the existence of old.
The practices that complete this transition are not the ones with the best software. They are the ones that decided in advance when the book would go, and then took it.