How to Choose an EHR: 15 Questions to Ask Before You Sign

How to choose an EHR comes down to one test: does the system fit the work your team actually does, and can you leave it if it stops fitting? A polished demo answers neither. The 15 questions below are for you to ask any vendor, in the same words, so the answers can be compared side by side. Ask for each answer to be shown in the product, not described.

Before you ask anything: write down your own workflow

A vendor's demo follows the vendor's script. Before the first call, write down what happens to a patient at your practice from the first contact to the paid claim: who touches the record, which forms are filled, which visits you bill, and which other systems are involved. Bring two or three real scenarios (a new patient, a follow-up, a correction after signing) and ask each vendor to walk through them.

Decide too who is in the room. A provider, someone from billing and the person who runs the front desk will each notice things the others miss.

Questions about the record and the clinical workflow

1. Does the encounter workflow match the visits we actually bill?

Ask to see the visit types you do most, start to finish, including the note template and how codes are suggested. If your practice does annual wellness visits, new patient visits and follow-ups, watch all three. Count the clicks for a routine visit.

2. Who can prepare a note, and who must sign it?

Your team may include medical assistants, nurses and providers licensed in different states. Ask how the system handles preparation by one person and signature by another, how it records who did what, and whether it checks a provider's state licensure before they act on a patient in that state.

3. What happens when a signed note needs correcting?

Ask how an amendment or addendum works, who may make one, and what the record shows afterwards. The original should be kept beside the correction, with the reason, the person and the date. A system that overwrites a signed note is a problem in an audit.

4. How does patient information get in?

Ask how new patients are added: typed by staff, filled in by the patient or a referral partner through a form, or imported from another system. Then ask how your existing charts will be moved, what comes across as data and what comes across only as attached documents.

Questions about billing and the rest of the business

5. What happens between a signed note and a claim?

Ask to see a signed encounter become a claim. Where do diagnosis and procedure codes come from, can a claim be held before it is sent, and how do rejections and denials come back to the person who can fix them? If billing is done by an outside company, ask how they get what they need.

6. Which parts of our work does it cover, and which need another system?

List everything your practice does: scheduling, intake, e-prescribing, lab orders and results, a patient portal, phone calls and texts, billing, remote monitoring, device shipping. For each, ask whether it is part of the system, a paid add-on or a separate product, and how the pieces share information. A gap is not a reason to say no, but you should know about it before you sign.

7. Is it certified, if we need certification?

If your practice takes part in a CMS program that requires certified EHR technology, ask which certification the product holds and check it on the public federal list of certified health IT. If you do not take part in such a program, ask anyway, so you know your options later.

8. How does it exchange data with other systems?

Ask whether there is an API, what kind it is (a general web API such as REST or GraphQL, or one built on a healthcare standard such as FHIR or HL7), what it can read and write, and whether the documentation is public. Our guide to healthcare API integration lists the follow-up questions.

Questions about security, access and your data

9. Who can see what?

Ask to set up two staff members with different jobs and see what each one can open. Access should follow the job, and viewing a record should be a separate permission from changing it.

10. What does the audit trail record, and can we read it ourselves?

Ask to see the history of one record: who opened it, what changed, when, and what it said before. You should be able to read it without asking the vendor for a report.

11. Will you sign a BAA, and what does it say?

Any vendor that holds your patients' information must sign a business associate agreement. Ask for it early, and have your adviser read it. Our HIPAA compliant software checklist covers what to look for in it and in the system's safeguards.

12. Can we get all of our data out if we leave?

Ask in what format you can export your records, notes, documents and history, how long it takes, whether it costs extra, and what happens to your data after the contract ends. Ask for this in writing.

Questions about setup, support and the contract

13. What does setup involve, and who does it?

Ask for a plan with names: who configures the system, who moves your data, who trains your staff, how long each step takes, and what the vendor needs from you. Ask what your team's time commitment will be in the weeks before going live.

14. What does support look like after go-live?

Ask how you reach support, during which hours, and who answers: a person who knows your setup, or a general queue. Ask how changes to your setup are requested after launch, and how product updates are announced.

15. What does the price include, and what does the contract commit us to?

Ask for every charge in writing: per user or per provider fees, modules, setup, data migration, training, interfaces and support. Then read the term, the renewal terms, how prices may change at renewal, and how you can leave.

How to compare the answers

Put the answers in one table, a row per question and a column per vendor. Mark each as shown in the product, described only, or not available. A described-only answer is a promise; give it less weight. Then call a practice that already uses each system, if the vendor can arrange it, and ask what surprised them in the first months.

Read our comparison of EHR, EMR and practice management software if you are still deciding which kind of system you need.

Frequently asked questions

How long does it take to choose an EHR?

It depends on how many vendors you compare and how many people need to agree. Leave time to see real scenarios in each product, read the contract and the BAA, and talk to a current user before you commit.

Should we choose an EHR before or after a billing system?

Decide them together. The handoff from signed note to claim is where much of the money is won or lost, so test that handoff in every combination you consider.

Can we switch EHRs later?

Yes, but it costs time and attention, which is why question 12 matters. Know before you sign how your data comes out and in what form.

Sources

• Medicare Promoting Interoperability Program, CMS
• Certification of Health IT, ONC (HealthIT.gov)
• Certified Health IT Product List (CHPL), ONC (HealthIT.gov)
• Business Associate Contracts, HHS Office for Civil Rights
• FHIR Overview, HL7 International
• HL7 Version 2 Product Suite, HL7 International
• 45 CFR 164.312, Technical safeguards (audit controls), Code of Federal Regulations