Top Risks to Watch for in Health IT Projects

In a healthcare environment, a single missed risk can affect patient safety, disrupt care delivery, or compromise compliance. Clinical operations run 24 hours a day, and the people using IT systems are already under intense pressure. When projects intersect with clinical work, there is no such thing as a harmless delay or minor oversight.

Exceptional health IT project managers learn to anticipate the risks that others don’t see. These are not the typical project pitfalls about scope, budget, or resourcing. They are the subtle, industry-specific issues that make healthcare both complex and rewarding to work in.

Informal workarounds hide in plain sight

Healthcare teams are masters of adaptation. Over time, clinicians and support staff create area-specific workarounds to meet immediate needs or to compensate for system limitations. These adjustments often go undocumented and unnoticed until a new project changes the process. Then, suddenly, what appeared to be a small configuration shift causes major workflow disruption. 

Workarounds thrive because the "official" process rarely reflects how work truly happens. During workflow design sessions, people describe what they are supposed to do, not what they actually do. They may leave out the steps they know are unofficial, or simply forget how much they adapt in practice. The result is a blind spot that often emerges during, or shortly after go-live, when the system stops supporting how people actually work. 

How to mitigate:

⚠️ Build time for genuine discovery and ask users to show you the workflow steps, rather than having them explain verbally. 

🦸🏻 Involve super users early and encourage honesty by framing conversations as opportunities to understand, not to audit.

📝 Capture any unofficial steps and make sure they they are considered by the working group during design sessions.

Clinical roles often need different things

Clinical stakeholders are rarely a single, unified group. Physicians, nurses, pharmacists, and allied health professionals often have overlapping but conflicting needs, and what helps one group may hinder another. A workflow that makes physician documentation more efficient might add extra steps for nursing staff. A pharmacy configuration that works well for inpatient units might slow down order verification in perioperative areas. 

Not all the right people are always at the table. Sometimes certain roles are missing, or the people representing their areas think too narrowly about their own routines instead of the broader group they represent. For example, a hospitalist may not consider what an emergency physician needs, or a medical-surgical nurse might not think about how documentation works in labour and delivery.

To keep a project moving forward, it's both realistic and necessary to limit how many participants are involved in design and validation sessions. This makes consistent attendance and balanced representation critical. When key people miss sessions, or when the discussion lacks perspective from different roles, decisions can stall. Under tight timelines, if decisions move ahead without full representation, they often need to be revisited later so inputs missed earlier can be considered. 

How to mitigate:

👥 Identify diverse clinical voices from the start and make sure participants know who they are representing in discussions.

🔄 Seek input from different care areas and test workflows across real clinical scenarios, not just in static reviews.

🧭 Build time for negotiation between groups and make conflict resolution an expected, not exceptional, part of governance.

Regulations change and shift project scope

Healthcare projects are built on moving regulatory ground. Privacy, data security, and clinical quality reporting requirements evolve frequently, and many are introduced with limited implementation timelines. A project that begins compliant can quickly find itself behind if new mandates emerge midstream. 

This challenge is compounded by the volume of change in IT. Large initiatives such as EHR replacements or enterprise integrations often span multiple years, which is long enough for several policy cycles to pass. When new regulations are passed, or changes to best practice standards are released, project teams must adapt quickly, often before vendors have updated their systems to support the changes. 

How to mitigate:

⚖️ Schedule regular meetings with compliance, privacy, and health information management teams to monitor upcoming changes. 

💰 Include contingency in both budget and timeline for regulatory adjustments.

🚦Establish fast-track approval pathways for changes required to meet compliance so they don’t get lost in standard change queues. 

Interconnected systems amplify small changes

Every health IT environment is an ecosystem. Clinical, administrative, and financial systems exchange data continuously through complex interfaces and data feeds. In large organizations, hundreds of different IT systems may be in place to support clinical care delivery and operational activities. 

With the pace of change in health IT, documentation showing where all those connection points are is often incomplete or out of date. Even experienced technical staff may not know every dependency or how each system influences another. When project testing begins, these hidden connections often reveal themselves in unexpected ways. What seemed like a straightforward and contained project can suddenly affect scheduling, equipment integrations, billing, or analytics in ways that are challenging and costly to fix under tight timelines. 

How to mitigate:

 🧐 Assume every project touches more systems than initially mapped.

🔍 Engage integration and reporting teams early and conduct full dependency reviews, not just interface lists.

⌛️ Allocate sufficient time for integrated testing and include downstream system owners in script review.

Clinical time is the hardest resource to secure

Project plans often rely on super users and clinical subject matter experts (SMEs) for design, validation, testing, and training. Yet those same people are also providing patient care in environments where staffing is already stretched. Even when clinical leaders allocate staff time to project activities, patient care must always take priority.

This creates a recurring pattern of delays and rework. Clinicians intend to participate but get pulled back to the bedside when patient volumes rise, acuity increases, or staffing changes unexpectedly. When that happens, milestones may slip, sessions need to be rescheduled, and discussions often have to be revisited to include input from those who were absent. Each missed opportunity increases the risk of design gaps, incomplete validation, and post-live issues that could have been prevented with consistent engagement. 

How to mitigate:

🗓️ Schedule sessions during lower-volume periods and budget for temporary backfill or protected time when possible.

⏲  Divide participation into shorter, more frequent blocks of time rather than long workshops.

🙌 Recognize the contribution of clinical staff and make sure their involvement feels valued rather than burdensome.

When project managers anticipate that workflows and integrations are more complex than they appear, stakeholder needs may conflict, and regulations can evolve before projects end, they are far more likely to identify and manage the risks that matter most. 

Staying aware is not a one-time task. It's a steady habit that depends on regular communication with both the project team and stakeholders. The risk register should be a living document that is updated, discussed, and reviewed often enough that new risks can surface before they escalate. Encouraging open conversations about potential challenges in health IT projects builds trust and helps the team respond early, adjust plans appropriately, and protect delivery so outcomes goals can be achieved.