Electronic Health Records are an increasingly important asset to life insurance underwriting, providing faster access to medical evidence, reducing cycle times, and decreasing reliance on traditional Attending Physician Statements (APSs). Despite growing adoption, many carriers are discovering challenges in implementing EHRs at scale. This is not a technology or process issue; it is a change management issue.

The most successful EHR integrations share a common characteristic: senior leadership creates a clear vision for how EHRs fit into the underwriting evidence strategy and reinforces that vision consistently across underwriting and medical departments. Organizations that leave usage decisions entirely to individual underwriters often struggle to achieve meaningful adoption and consistency.

Leadership support – Start with the “why” 

The case for EHRs is becoming increasingly difficult to dismiss. Munich Re's retrospective study of 301 cases found that foundational data plus an EHR gave underwriters everything they needed to reach a decision in 73% of cases, and that adding an APS did not change the decision in 87% of those. Yet habit is powerful. As Swiss Re has observed, underwriters have "grown comfortable using the APS to assess overall risk and too readily accept its shortcomings."

Successfully moving to EHRs requires strong executive and senior leadership support. Helping underwriters understand why the organization is changing and how EHRs support underwriting objectives is a powerful first step.

Leadership should clearly communicate:

• The role of EHRs in the underwriting process.
• Expected use cases and workflows.
• Success measures and outcomes.
• Ongoing commitment to training and support.

Training in critical thinking skills is where EHR adoption takes off

One of the most important shifts is moving underwriters from a mindset of collecting more evidence to evaluating whether sufficient evidence already exists. Successful implementations emphasize critical thinking skills and encourage underwriters to ask:

"Do I have enough information to make an underwriting decision?"

rather than

"What additional requirement should I order?"

Training should include real case studies, calibration exercises, and side-by-side APS versus EHR comparisons that help underwriters evaluate sufficiency, identify meaningful information, and distinguish material findings from background noise.

Create a consistent review framework

Consistency is essential for both adoption and risk management. Organizations should establish a standardized EHR review methodology that guides underwriters through:

• Assessing record coverage and gaps.
• Building a medical timeline.
• Evaluating key underwriting criteria such as diagnoses, medications, labs, vitals, tobacco use, family history, and treatment plans.
• Determining when additional evidence is truly necessary.

Clear guidance reduces variability and increases underwriter confidence.

Reinforce through coaching and calibration

Training should not end after implementation. The most effective programs include ongoing coaching, peer reviews, case discussions, and regular review sessions. These exercises help ensure consistent application of underwriting guidelines and create opportunities to address emerging questions as EHR data sources evolve.

Establishing EHR champions by recognizing successful early adopters can also accelerate cultural adoption by providing peer support and practical expertise throughout the organization.

Measure adoption and outcomes

Underwriting leaders should track both operational and behavioral metrics, including:

• EHR utilization rates.
• APS reduction rates.
• Underwriting cycle times.
• Sufficiency and usability assessments.
• Quality and consistency measures.

These metrics help demonstrate value, identify training needs, and reinforce accountability across the organization. 

Leadership and change management drive EHR adoption

The future of underwriting is increasingly digital, but implementing new data alone will not drive successful adoption. Leaders who consistently invest in education, critical thinking, clear expectations, and ongoing calibration will build the confidence necessary for underwriters to embrace EHRs as a primary source of underwriting evidence. The goal is not simply to replace APS records, but to create a more efficient, consistent, and evidence-driven underwriting process.