Selecting an EHR Vendor — A Complete Guide
An EHR vendor and its platform can make or break daily workflows. A new EHR often involves a long onboarding and data migration process that can disrupt day-to-day workflows. So selecting the right one requires more than a product demo and a price quote. This guide walks through what to evaluate before you commit — including onboarding and data migration, interoperability needs, specialty and rural fit, usability, and the day-to-day features that affect both clinical and financial performance.
It includes practical checklists and questions to ask at every stage. It also covers when it makes sense to switch systems, what types of EHRs exist (web-based, cloud-based, SaaS, and on-premise), and how to compare vendors based on implementation support, customization, billing and claims workflows, reporting, and long-term scalability.
An Introduction to EHRs
An EHR is a digital version of a patient’s paper chart. It’s designed to give clinicians secure, real-time access to a patient’s comprehensive health data. By centralizing medical history, diagnoses, medications, treatment plans, and more, an EHR helps healthcare providers deliver efficient, coordinated, high-quality patient care.
The adoption of EHR systems is widespread across the healthcare industry. And the ambulatory EHR market has had especially rapid growth. Ambulatory care providers, community hospitals, and large health systems use EHR solutions to streamline clinical workflows, improve patient management, and support better decision-making. Leading vendors in the EHR market offer a range of EHR features for different care settings — from small practices to large, multisite health systems. And leaders in rural and specialty EHRs, like Azalea Health, offer solutions tailored to rural health and specialty clinic settings.
As the EHR market evolves, healthcare providers want systems that help them meet regulatory requirements and improve efficiency, support interoperability, and are designed for their unique practice needs and patient populations.
How to Select an EHR Vendor
Choosing an EHR vendor is a major decision. The wrong fit can create costly workflows, frustrated clinicians, and a poor patient experience. The right system should support your care teams, streamline operations, and meet your needs for interoperability, reporting, and patient engagement.
A good approach to selecting an EHR vendor is to use an EHR evaluation checklist. A list helps you clarify what you need, compare vendors consistently, and negotiate with confidence. Start with these seven steps to identify the best EHR for your organization’s patients, providers, and long-term goals.
1. Decide If It’s Time for a New EHR Vendor
Migrating EHR solutions can be labor and time-intensive. Make sure that you’re prepared to take on the challenge and to spend the time needed. Also be sure the vendors you’re evaluating have a well-defined onboarding process with reliable implementation and support teams.
Read more in Is It Time for a New EHR Vendor? below.
2. Understand Why You Want to Change EHR Vendors
Do you need to change EHR vendors or do you want to? You might need to change EHR systems because yours is sunsetting, or your business merged. You might want to change EHRs because you want enhanced functionality, like integrated telehealth, or an easier-to-use interface. Some practices also switch from electronic medical records (EMRs) to EHRs to gain broader functionality, improved data sharing, and support for multiple care settings. (EMRs typically focus on a single facility’s patient data and cover a narrower set of needs.)
Understanding your situation will help you make a better, more informed decision.
Read more in Why Switch EHR Vendors? below.
3. Decide What Type of EHR System — and Which EHR Vendor — Is Best for You
The most common types of EHR systems are cloud-based, web-based, SaaS-based, and self-hosted. The different types are covered below. Make sure you understand the benefits and drawbacks of each type before making a decision.
Read Which Type of EHR System is Right for Us? below.
4. Define Your Budget
EHR vendor contracts are often multiyear agreements, and the upfront costs associated with choosing a different vendor might seem like a setback at first. But selecting an EHR system that supports time savings, reduced days in A/R, and improved patient loyalty, delivers dividends down the line. Make sure you can make the upfront investment and see a return on it in a timeframe that makes sense for you.
Read What Should You Consider When Selecting an EHR Vendor?
5. Decide What EHR Features Are Most Important to You
Take the time to define your business goals and your patient needs from an EHR to identify the EHR features that matter most to you.
When evaluating an EHR vendor, look for one that offers tailored solutions that address the specific needs of your practice or specialty and care setting.
See Which EHR Features Matter Most? for more information.
Regardless of the features that matter most to you, ask Is the Vendor Up-to-Date on Security and Compliance?
6. Compile a List of EHR Vendors and Compare Them
Once you know your needs and budget, start identifying EHR vendors that meet your criteria and compare them. Make a checklist of criteria. Do research online and speak to sales reps and check the boxes on your list so you can evaluate them in an organized way.
7. Make Sure Fit, Features, and EHR Implementation Cost and Support Are Right
Once you narrow your list of possible vendors, do a final evaluation. Read reviews, ask for referrals from the sales people, and do your due diligence, so you can make your decision about your new EHR vendor with confidence. Schedule demos with potential vendors too.
Find more detail on things to consider when choosing a new EHR vendor.
- Is It Time for a New EHR Vendor?
- Why Switch EHR Vendors?
- What Type of EHR System Is Right for Us?
- What Should You Consider When Selecting an EHR Vendor?
- Which EHR Features Matter Most?
- Is the Vendor Up-to-Date on Security and Compliance?
- How to Navigate Making a Decision
- How to Negotiate
The adoption of EHR systems is widespread across the healthcare industry. And the ambulatory EHR market has had especially rapid growth. Ambulatory care providers, community hospitals, and large health systems use EHR solutions to streamline clinical workflows, improve patient management, and support better decision-making. Leading vendors in the EHR market offer a range of EHR features for different care settings — from small practices to large, multisite health systems. And leaders in rural and specialty EHRs, like Azalea Health, offer solutions tailored to rural health and specialty clinic settings.
As the EHR market evolves, healthcare providers want systems that help them meet regulatory requirements and improve efficiency, support interoperability, and are designed for their unique practice needs and patient populations.
Is It Time for a New EHR Vendor?
In addition to your EHR being discontinued by your current vendor, the usability of your EHR is a big factor when considering a switch. Because inefficient and time-consuming EHRs can contribute to physician — and staff — burnout and job dissatisfaction.
An analysis of physician EHR use published in 2024 in JAMIA found that for every eight hours of scheduled patient time, providers spent more than five hours in the EHR. And a study published in JAMA Network in the same year, found that EHRs are a key contributor to burnout. With documentation/clerical burden, complex usability, electronic messaging/inbox workload, cognitive load, and time demands all being cited as contributing factors in a 2023 review published on SAGE Journals.
And Black Book’s 2025 The Rural EHR Replacement Wave found that 83% link clinician burnout and dissatisfaction to EHR usability.
Consider that:
- More time in the EHR reduces direct patient interaction
- Inbox load disrupts workflows
- Documentation burden drives after-hours work and burnout
Also consider that an EHR that lets you manage the entire patient journey on as few screens and with as few clicks as possible saves not only providers but also office staff time and effort.
Why Switch EHR Vendors?
Reasons to switch EHR vendors are sometimes optional, other times, they’re not.
Reasons for practices not having an option to switch EHRs can include:
- The existing EHR vendor has ended — or is ending — its support for the system
- A practice merged with another practice and now has multiple EHRs with no or little interoperability
- An EHR isn’t certified for federally mandated programs, like the Promoting Interoperability (PI) Program (formerly Meaningful Use) and Medicare Access and CHIP Reauthorization Act (MACRA)
When practices and health systems do have a choice, common reasons to switch EHR vendors include:
- To access added functionality like integrated telehealth capabilities or a combined back-office/front-office platform with revenue cycle management capabilities.
- To get a more user-friendly interface. If an existing EHR isn’t intuitive, it can be time to make a change. In its 2023 EHR purchasing trends, KLAS Research reported that EHR decisions were influenced in part by the desire to improve usability.
- Poor performance, such as time-consuming issues like entering data, frequent crashes, delayed data access, and more.
- Lack of interoperability, like the inability of an EHR to exchange data with other systems or connect to a health information exchange (HIE).
Some practices also consider company age to ensure they choose a vendor with a strong presence and ongoing support in the industry.
What Type of EHR System Is Right?
There are four types of EHR software systems, each with its own pros and cons:
- Web-based EHRs
- Cloud-based EHRs
- SaaS (software as a service) EHRs
- On-premise EHRs
Web-Based EHR
Web-based means that the software’s user interface is accessed through an Internet browser, for example, Google Chrome, Safari, or Microsoft Edge. A web-based EHR lets you open a browser on any trusted computer, log in, and access your EHR anytime, anywhere — as long as you have Internet access.
The vendor likely houses the EHR instance on its own servers. You don’t have to download any software locally. And the vendor typically handles all updates and security needs.
Cloud-Based EHR
“The cloud” is an infrastructure of externally located servers, (like Amazon Web Services (AWS), Microsoft Azure, or Google Cloud) that deliver software and data to your computer, usually over the Internet.
Being cloud-based means that you can access your data, software, or EHR from anywhere at any time. Usually your data isn’t on a single server, but stored on several, typically at a data center, to offer backup and consistent access.
The main benefits of using cloud-based software are cost, scalability, and fast access. Like a web-based EHR, you don’t have to download any software locally. And the vendor handles all updates and security needs.
Note: Many cloud EHRs are also web-based, but not all web-based systems are truly cloud-based.
SaaS EHR
SaaS is really a pricing model for cloud-based EHR solutions. It typically refers to the pricing model, usually a subscription, for cloud-based software. Rather than buy a license from Microsoft for their latest edition of Office, you pay a subscription and always have access to the most recent software provided your subscription is paid.
When you look at SaaS through the health IT lens, it means lower upfront costs and eliminates the need for hardware and software updates. When software companies control version updates, you have a better user experience by accessing new features and corrections and security updates with little downtime and no impact on internal resources.
On-Premise EHR
The alternative to web-based, cloud-based, and SaaS EHRs are on-premise systems also called “client-server” software.
On-premise software solutions typically rely on legacy or older technology. Many legacy software systems require IT professionals to maintain server hardware and software, security updates, data vulnerability detection, and backups. And maintaining servers locally is expensive and time-consuming.
Modern software companies, like Azalea Health, understand the burden on-premise systems put on practices and hospitals. A cloud-based EHR lets practices focus on delivering healthcare without having to worry about patient data, hardware, or making software updates.
What Should You Consider When Selecting an EHR Vendor?
An objective buying process can be broken into three parts: evaluation, requirements, and negotiation.
Depending on who you buy from and what you buy, the process can affect how you manage operations and deliver care. Don’t view your new EHR solely as a replacement to the current application. Look at the bigger picture. Where is your organization headed in the next few years? How can the EHR grow with you?
You save money by properly evaluating a vendor up front. On the flip side, you could lose money by choosing a “one-size-fits-all” solution.
When evaluating an EHR vendor, consider their commitment to your specific healthcare setting as well as their stability and ability to support your long-term needs.
Questions to Ask
- What is the implementation/support process?
- How flexible is the system?
- If you want to change the templates, how easy is it to do that?
- What is its customer base? What do their references look like?
What to Consider When Selecting an EHR System?
Fifty-five percent of rural and critical access hospitals plan to reassess or replace their current EHR systems by the end of 2026. When considering a switch, consider usability, cost, and interoperability, among other factors.
Is Your EHR Vendor the Right Choice for You?
One of the first questions to ask during the EHR software selection process is, “Does your EHR vendor understand your practice and business model?”
If you’re a hospital or clinical provider serving a rural market, you may not need, and probably can’t afford, something like Epic or Cerner, which are designed for large, urban health systems. You also want to avoid highly specialized software (for example, plastic surgery) that isn’t designed for your clinical and billing needs. Some EHR vendors, like Azalea Health, offer specialized solutions for clinics and rural healthcare providers that focus on the documentation, interoperability, and resource needs unique to smaller practices and community-based settings.
When selecting a new EHR vendor, focus on capabilities that improve everyday performance — not just feature depth. A Black Book survey of ambulatory EHR users found several areas practices consistently prioritize and that you want to investigate:
- Registration and scheduling tools
- Interoperability and patient communications
- Billing and claims management
- Accounts receivable (A/R) management
- Best-of-breed technology and ongoing process improvement
- Vendor implementation performance and consistent service levels
Fifty-five percent of rural and critical access hospitals plan to reassess or replace their current EHR systems by the end of 2026. When considering a switch, consider usability, cost, and interoperability, among other factors.
Is Your EHR Vendor the Right Choice for You?
One of the first questions to ask during the EHR software selection process is, “Does your EHR vendor understand your practice and business model?”
If you’re a hospital or clinical provider serving a rural market, you may not need, and probably can’t afford, something like Epic or Cerner, which are designed for large, urban health systems. You also want to avoid highly specialized software (for example, plastic surgery) that isn’t designed for your clinical and billing needs. Some EHR vendors, like Azalea Health, offer specialized solutions for clinics and rural healthcare providers that focus on the documentation, interoperability, and resource needs unique to smaller practices and community-based settings.
When selecting a new EHR vendor, focus on capabilities that improve everyday performance — not just feature depth. A Black Book survey of ambulatory EHR users found several areas practices consistently prioritize and that you want to investigate:
- Registration and scheduling tools
- Interoperability and patient communications
- Billing and claims management
- Accounts receivable (A/R) management
- Best-of-breed technology and ongoing process improvement
- Vendor implementation performance and consistent service levels
Is the Vendor Up-to-Date on Security and Compliance?
As you investigate EHR vendors, you have to consider a solution that lets you maintain patient trust, support quality care, and reduce the risk of costly data breaches. Any EHR system you look at must comply with industry regulations, including HIPAA and the HITECH Act. This means evaluating the vendor’s track record in protecting patient data, their adherence to security standards, and their ability to provide ongoing support and timely updates. Key areas to assess include:
- Data backup and recovery processes to prevent data loss.
- Disaster recovery and business continuity planning to ensure access to patient data during emergencies.
- Regular security updates and monitoring to address emerging threats.
By prioritizing security and compliance, healthcare providers minimize your risk of data breaches, maintain the confidentiality and integrity of patient information, and support clinicians in delivering high-quality patient care. Strong security practices also help reduce physician burnout by ensuring that systems are reliable and support is available when needed.
Which EHR Features Matter Most?
An EHR should fit your unique needs. To evaluate if the vendor can help you properly, take a detailed look into the vendor’s history. Request information and then look back into their seven-year costs, seven-year operational costs, year-by-year prices, and transaction costs for things like electronic billing. What do their references look like? What applications are those references using?
Depending on the size of your hospital or practice, especially if it’s smaller, the more hats everyone wears. Your prospective EHR should have a similar feel across the entire patient journey, while not being so broad that it complicates applications for certain departments.
To get a feel for the system, generate a request for information (RFI). An in-depth examination, that encompasses more than just functionality, will help you do a proper evaluation.
Have every stakeholder or department create a top 10 list of items most critical for their needs. Sort out the deal-breakers, the negotiable items, and the things you want to have, or your wish-list criteria. Simply ask yourself, what do you like most about your current EHR system, what do you dislike? How can your needs be better met?
1. Implementation
Ask about the quality and amount of training the vendor offers, and whether the training will be onsite or remote or both. Each has advantages and you need to decide which works best for your environment. Ask for references specific to implementation.
2. Customization
This is a major pain point for many practices, especially specialties. If you’re part of a multispecialty practice it’s still helpful to have specialty modules available and be able to customize workflow templates. Also, the ability to internally modify or configure certain features within the EHR may be attractive.
3. Customer Service
As you review EHR vendors’ capabilities, ask about key customer support issues and functions. What is the average wait time on a support call? What is the service level agreement (SLA) for support calls and incident response? How is their ability to resolve technical problems? Ask for examples of problems they’ve solved and how quickly. What is their process for communicating on and resolving issues?
4. Productivity
Make sure to follow up on the sales rep’s well-practiced navigation of the system by asking to see certain functions yourself, such as moving within different sections of the EHR, navigating through a patient visit, and accessing specific, important data.
5. Technology
Where will your data be stored and is the system ONC and SOC certified? Some EHRs now use the cloud to provide anywhere access to data while maintaining HIPAA-compliant security.
6. Financial impact
Will the new system support e-prescribing and telehealth? How difficult is it to exchange patient health information with outside specialists and other providers? In other words, does it offer everything you need or will you have to buy add-ons.
The Decision-Making Process
As you evaluate EHR vendors, determine who in the hospital or practice will be involved in choosing the EHR vendor. Key staff and users should be part of the decision.
Individuals and departments need to communicate with each other during the process to ensure a successful implementation later. Departments will better understand how the choice of vendor will affect their area.
Questions to Ask Internally
- What are your dealbreakers?
- What are the vendor’s seven-year costs?
- Who are the vendor’s references? And what do their online reviews say?
- What are the vendor’s priorities? And do they match with your own?
EHR Vendor Negotiation
When negotiating with your top vendor choices, the vendor should be open and willing to discuss and negotiate the contract. The contract is a roadmap as you continue to use the vendor’s EHR. It helps control future costs and creates a better working relationship between the EHR vendor and your organization. Due to the requirement part of this process, you want to know what you’re willing to compromise on and what you absolutely require from the vendor.
The next step is understanding other costs. What will the contract cost your hospital or practice in the long run? The vendor needs to be able to articulate every aspect of the contract. When breaking the contract down, go over any recurring fees, subscription costs, and future increases. Know what you will be paying now and later.
The implementation process may come with fees itself. Know what you’re paying for in terms of setup and training. Is the cost of the investment justifiable? You might want to receive help from a legal consultant when negotiating to better understand the agreement. Even after the contract is signed, it’s important to manage your relationship with the EHR vendor. A successful contract and relationship will ensure the long-term health of your EHR system.
Questions to Ask During Negotiation
- Will there be annual cost increases?
- What are the subscription costs? Or recurring fees?
- Are there software maintenance fees?
- What are the setup costs, if any?
- Are there third-party vendors? Is their cost included in the contract?
Final Word on Selecting an EHR Vendor
The healthcare landscape is changing, and you need to keep up. So does your vendor of choice.
An effective EHR solution can impact many aspects of your hospital or practice. And they can positively impact the quality of care you deliver. It’s critical to invest time researching EHR vendors. You want to evaluate the vendor and your care setting, create a list of requirements, evaluate options, and negotiate in terms of pricing and contract.
If the process is done right, your hospital or practice will see better clinical results and patient care, growth in health data, and transparent, efficient practices.
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