Background: First start delays in the operating room have a downstream effect on operating room efficiency and patient satisfaction. In accordance with the American Recovery and Reinvestment Act, in February 2014, our institution adopted EPIC TM as our electronic health record (EHR). The impact of the transition from paper to electronic documentation on operating room efficiency is not known. This study analyzed first start data as a measure of overall operative suite efficiency, looking at the initial impact and the learning curve to return to baseline parameters. Methods: A retrospective review of on time start data was reviewed for three months prior and 4 months after implementation of the EHR. A start was considered delayed if the patient arrived to the room after the 7:30 start time. Patients transported from the intensive care unit were excluded from analysis. Data was analyzed using control charts for the percentages and comparison of means using Dunnet's methods. Confidence intervals were calculated at .05 and .01 for significance. Results: After EPIC implementation, there was an initial drop in on time starts from over 60% to 41% followed by gradual return to pre-implementation level within 4 months (p < .01). Conclusions: Implementation of an EHR produced decreased efficiency in on time first starts in the operative suite, but the learning curve was brief, returning to baseline values in 4 months. These findings can serve as a guide for other institutions that are undergoing transition from a paper to an electronic medical record.