Selecting an EHR System: What Medical Practices Actually Need to Know

If you're shopping for an electronic health records (EHR) system, you've probably discovered that every vendor claims to be the best, the most innovative, the most user-friendly, and the most cost-effective. They all have impressive feature lists, glowing testimonials, and slick demos.

How do you actually choose? Let's cut through the marketing and talk about what matters for small to mid-sized medical practices making EHR decisions in 2017.

Cloud vs. On-Premise: The Real Trade-offs

This is usually the first decision point. Cloud-based (hosted) vs. on-premise (server in your office).

Cloud/Hosted EHR

Advantages:

• No server hardware to buy or maintain
• Access from anywhere with internet
• Automatic updates and backups
• Predictable monthly costs
• Vendor handles IT infrastructure

Disadvantages:

• Completely dependent on internet connection
• Ongoing monthly fees forever (no "we own it" point)
• Less control over data and system configuration
• Vendor can raise prices or change terms
• If vendor goes out of business, you're scrambling

On-Premise EHR

Advantages:

• Works even if internet is down
• You control your own data completely
• Higher upfront cost but lower long-term cost potentially
• More customization options usually
• Not dependent on vendor's ongoing viability

Disadvantages:

• Need to buy and maintain server hardware
• Responsible for backups and disaster recovery
• Need IT support for updates and troubleshooting
• Higher upfront capital cost
• Remote access requires additional setup

Neither is universally better. It depends on your practice's specific situation, technical capabilities, and preferences.

Specialty-Specific vs. General Practice EHR

Some EHR systems are built for specific specialties (cardiology, orthopedics, pediatrics, etc.). Others are general-purpose with specialty templates added on.

Specialty-specific systems usually have better workflows and documentation templates out of the box. But they also tend to be more expensive and have smaller user bases (which can mean fewer third-party integrations and slower feature development).

General-purpose systems with specialty modules offer more flexibility if your practice changes focus over time, but might require more configuration to match your workflow.

Ask yourself: how specialized is your practice really? If 80% of your workflow is standard primary care with 20% specialty, a general system might serve you better than a niche product.

Integration Points That Actually Matter

Every EHR vendor claims to "integrate with everything." In reality, integrations range from deep two-way sync to "you can manually import a file if you export it in exactly the right format."

Lab Interfaces

Can the EHR send electronic lab orders to your preferred labs and receive results back automatically? This is huge for workflow. Manual lab results entry is time-consuming and error-prone.

Ask for specifics: which lab companies are supported? Is it bidirectional? How long does setup take?

Imaging Integration

If you do imaging in-house (X-rays, ultrasound, etc.), how does the EHR handle those images? Can you view them directly in the patient chart or do you have to switch to a separate PACS system?

Practice Management/Billing Integration

Some EHRs include practice management (scheduling, billing). Others require separate PM software. If they're separate, how well do they integrate?

You want patient demographics, insurance information, and scheduling to sync automatically between systems. Manual data entry between systems causes errors and wastes time.

E-Prescribing

This should be standard now, but verify: does the EHR include e-prescribing with EPCS (electronic prescribing of controlled substances) if you need it?

Patient Portal

Can patients view test results, request appointments, send messages, and pay bills online? How easy is it for them to use? What percentage of your patients will actually use it?

A poorly designed patient portal that nobody uses is just additional overhead.

Training and Implementation Reality Check

EHR vendors will quote you implementation timelines that are wildly optimistic. Here's what actually happens:

Plan for 3-6 Months

From signing the contract to being fully live and comfortable with the system, plan for at least three months, possibly six. Anyone promising faster is either lying or cutting corners that will hurt you later.

Training Is Ongoing

Initial training gets you operational. Actually getting efficient and using the system well takes months of daily use and continuing education.

Ask vendors about ongoing training resources. Are there regular webinars? Video libraries? User forums? Phone support for questions?

Champion Model Works

Designate one or two people in your practice as EHR champions. They get extra training and become the first line of support for other staff. This reduces your dependence on vendor support and builds internal expertise.

Real Cost of Ownership

EHR vendors quote prices that sound reasonable until you realize they don't include everything you actually need.

What's Often Extra

• Additional user licenses beyond a base number
• Interface fees for labs, imaging, other systems
• Advanced features (telemedicine, patient portal, analytics)
• Training beyond basic implementation
• Ongoing support after the first year
• Data migration from your old system
• Hardware requirements (tablets, printers, scanners)

Get a complete quote that includes everything you need for actual operation, not just the base software.

Hidden Costs

• Productivity loss during transition (plan for slower patient flow for 2-3 months)
• Staff overtime for training and data migration
• Consultant fees if you need help with implementation
• Lost revenue if implementation problems cause extended disruption

Questions to Actually Ask During Demos

Vendors control demos to show you what looks good. Take control back by asking specific questions:

• "Show me how a provider documents a typical patient visit from start to finish." (Watch for how many clicks, how intuitive the workflow is)
• "How does a front desk person check in a patient?" (Check if it's simple enough for your actual staff)
• "What happens when your internet goes down?" (If cloud-based)
• "Show me what your support portal looks like and how I submit a ticket." (You'll be using this a lot)
• "Can I talk to three practices similar to mine who are current customers?" (Then actually call them and ask about problems)
• "What's your average response time for support tickets by priority level?"
• "How often do you have unplanned downtime and what's your communication process when it happens?"

Meaningful Use and MACRA Compliance

In 2017, EHR certification for Meaningful Use and MACRA participation matters for Medicare reimbursement.

Verify the EHR is certified for current requirements. But also ask how the vendor handles updates when requirements change. Do they update automatically? Is there a fee? How much warning do you get?

Exit Strategy

Nobody wants to think about switching EHRs right after buying one, but you need to know how you'd get your data out if you ever need to.

Ask:

• What format is data exported in?
• Can you get a complete database dump?
• Is there a fee for data extraction?
• How long do they retain your data after you cancel?

The Decision Process

Here's a practical approach:

1. Define your must-haves (specialties supported, cloud vs. on-premise, integrations required)
2. Get 3-5 vendors that meet those requirements
3. Watch demos and take detailed notes
4. Call current customers and ask about problems
5. Get complete pricing including all extras
6. Narrow to 2 finalists
7. If possible, visit practices using each finalist system
8. Make decision based on best total fit, not just cheapest price

Our Take

We've implemented EHR systems with dozens of Arizona medical practices since the early 2000s. The practices that have smooth transitions and end up happy with their choice are the ones that:

• Take time to evaluate properly instead of rushing
• Get complete cost information upfront
• Plan realistic timelines for implementation
• Invest in thorough staff training
• Pick systems that match their actual workflow, not the fanciest features

If you want help evaluating EHR options or managing an implementation, we can provide objective guidance. We don't sell EHR systems, so we have no stake in which one you choose. We just want you to pick the right one and implement it successfully.