Electronic Health Record (EHR) optimization has been defined as, “post-EHR implementation efforts to improve organization performance.” EHR optimization is necessary for electronic medical record sustainability, regulatory compliance, and practitioner buy-in. The EHR has significant potential to facilitate PBM metrics for both adult and pediatric patients. Because medical record transparency is a priority of the United States (US) 21st Century Cures Act, personalized and electronically-based consents for blood transfusion are accessible to patients and practitioners alike when faced with complex blood management plans. The EHR can facilitate evidence-based PBM practices through computerized physician order entry (CPOE) and clinical decision support (CDS) that are based on regularly updated best practice guidelines, are in sync with practitioners’ real workflows, and are optimized through regular end-user usability testing. Meta-analyses and systematic reviews over the past decade have failed to establish a direct association between EHR implementations and improved patient morbidity and mortality rates. Most studies examining the effect of the EHR on patient outcomes are underpowered, of short duration, lack controls, or vary in the functionality studied. There is a crucial need for EHR- and Information technology (IT)-related outcomes research in blood management, particularly perioperative PBM. Limitations to successful EHR optimization include, but are not limited to, implementation of an EHR function prior to end-user education, electronic processes that are viewed by practitioners as irrelevant or burdensome, and multiple types of software programs within and across hospital systems.