Government incentives and pressure to move from a paper medical record to an electronic medical record is resulting in healthcare facilities implementing electronic medical records at an accelerated pace. Historically, there have been committee structures charged with reviewing the content and quality of the medical record. A literature review of this subject indicates the issues surrounding the management of documents created electronically and data integrity monitoring following project completion are being overlooked by facilities in the rush to meet electronic record implementation deadlines. Document creation by various means such as structured data entry, templates, self entry, copy and paste, and traditional transcription requires guidelines describing how these are to be used and when it is appropriate to use each method. Policies and procedures related to creating, editing, and removing documents from the electronic health record need to be in place due to the affects on downstream systems and future health information exchange. Additionally, monitoring of document integrity needs to be accomplished allowing data integrity issues to be identified in a proactive manner, eliminating patient safety issues and substandard medical decision-making. Methods of electronic document creation and document management as well as important considerations in developing policies and procedures surrounding document management are outlined in this project. A quality monitoring program also needs to be in place which in turn drives change management related to revised document management processes. The role of a security program and user privilege delineation to ensure data integrity needs to be considered for determining which personnel will have the authority to complete crucial actions in the electronic record. Integrated delivery networks in particular need to develop techniques for creating, communicating, and enforcing standardized policies and procedures related to document data integrity. Document monitoring results should facilitate necessary change management needed for workflow redesign and standardization of processes related to document creation and maintenance.