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Why your practice needs ONC-certified EHR technology

Why your practice needs ONC-certified EHR technology

Last updated: Aug 21, 2025 | 6 min read | By Lisa Eramo | Reviewed by: Dr. Jesse P. Houghton

Key takeaways

Certified EHRs are federally verified to meet standards for security, interoperability, and functionality — ensuring your practice can safely exchange patient data and meet CMS requirements.
MIPS participation requires certified EHR technology and practices using non-certified systems risk downward payment adjustments of up to 9% on Medicare reimbursements.
Tebra offers ONC-certified EHR+ technology that combines clinical documentation, billing, and patient experience in one integrated platform that’s designed specifically for independent practices with 1-10 providers.
As of 2021, 78% of practices have adopted certified EHRs — with numbers growing due to security advantages, quality reporting capabilities, and interoperability requirements.
Choosing the right certified EHR requires verification, make sure to check the ONC Certified Health IT Product List (CHPL) to confirm certification status and review which specific criteria the system meets.

As of 2024, practices in the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program must use ONC-certified EHR technology for at least 180 continuous days or risk losing up to 9% of Medicare reimbursements. Beyond avoiding penalties, certified EHRs offer a federal stamp of approval for security, interoperability, and technical capabilities.

This article explains what certified EHR technology means, why it’s essential for compliance, and how to choose the right system for your practice.

What is a certified EHR?

To be certified, an EHR system must be officially verified by an ONC-authorized body to meet federal standards for functionality, security, and interoperability. The Office of the National Coordinator for Health Information Technology (ONC) sets the criteria to ensure all certified systems are technically sound.

This federal stamp of approval guarantees that an EHR can:

Exchange patient data securely with other providers and health information networks
Support clinical decision-making and quality improvement
Protect patient privacy through robust security measures
Enable practices to participate in value-based care programs

When an EHR earns certification, it receives a unique ID and is listed on the Certified Health IT Product List (CHPL), the official federal registry. This verification is crucial, as using a certified system is essential for meeting CMS quality reporting requirements and avoiding penalties.

Tebra offers an ONC-certified EHR+ solution that’s purpose-built for independent practices with 1-10 providers.

Overview and history of certified EHRs

Various regulations preceded what we now recognize as certified EHR technology. Let’s take a moment to review the 20-year timeline and notable regulatory milestones.

2004: ONC was established, with the goal of stimulating the use of computerized health records across the nation’s healthcare systems.

2007: The Institute for Healthcare Improvement’s Triple Aim framework laid the foundation for providers to improve patient care quality, reduce healthcare costs, and enhance population health in the United States. EHRs played a large role in these efforts.

2009: The federal government adopted the Health Information Technology for Economic and Clinical Health (HITECH) Act to promote interoperable health information technology and regulate the secure transmission of health information.

2010: EHR adoption began to ramp up as ONC issued its Standards and Certification Criteria Final Rule for EHR systems. In addition, CMS finalized its definition of “meaningful use” of EHR technology and began to introduce EHR incentive programs that required the use of certified EHR technology.

2015: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) supported the transition from fee-for-service payment models toward value-based care.

2016: The 21st Century Cures Act focused on improving patient access to electronic health information, promoting information sharing, and establishing anti-information blocking provisions. The act also established criteria for EHR certification — where HealthIT vendors must satisfy certification requirements and pass testing to become certified electronic health record technology (CEHRT).

2017: Physicians were given clear pathways to participate in the newly launched CMS Quality Payment Program, which offers two payment tracks — the Merit-based Incentive Payment System (MIPS), and the Alternative Payment Model (APM) — that require certified EHR technology.

2018: The Medicare EHR Incentive Programs transitioned to the Medicare Promoting Interoperability Program, replacing the term “meaningful use.”

2022: The Trusted Exchange Framework and Common Agreement (TEFCA) began to support the nationwide exchange of electronic health information across health information networks. In addition, CMS announced a new reporting option to fulfill MIPS requirements called MIPS Value Pathways (MVPs).

2024: CMS updated MIPS requirements to mandate 180 continuous days of certified EHR use during the performance year, ending automatic exclusions for certain specialties. ONC also finalized the HTI-1 Final Rule, which updates the Certification Program with an edition-less framework and establishes USCDI v3 as the baseline standard as of January 1, 2026.

Understanding EHR certification criteria

ONC certification criteria are the functional requirements that define the capabilities a certified EHR must demonstrate. These standards are organized into eight core categories to ensure comprehensive functionality, including:

Electronic exchange — Standards for sharing patient data across different systems and networks
Clinical processes — Features like computerized physician order entry (CPOE), clinical decision support, and e-prescribing
Care coordination — Capabilities for care plan creation, patient referrals, and transitions of care
Clinical quality measurement — Tools to record, calculate, and report quality measures
Privacy & security — Encryption, access controls, audit logs, and authentication requirements
Patient engagement — Patient portals, secure messaging, and health information access
Public health — Connections to immunization registries, syndromic surveillance, and case reporting
Health IT design & performance — Usability, interoperability standards, and certification transparency

Key categories in the current certification framework

The current certification framework was updated through the HTI-1 Final Rule and introduced significant changes focused on three main priorities, including:

Interoperability: New technical requirements make it easier for patients to access their health information on smartphones. They also enable providers to exchange data using standardized APIs and support for the United States Core Data for Interoperability (USCDI) standard.
Security: Enhanced privacy and security certification criteria help practices protect against increasingly sophisticated cybersecurity threats. This includes updated authentication standards and data encryption requirements.
Patient access: Revised criteria ensures patients can view, download, and transmit their health information to any third party they choose. This directly supports the Cures Act’s anti-information blocking provisions.

The EHR certification process explained

EHR certification is a rigorous, multi-step process that verifies a system meets federal standards before it can be marketed as certified technology.

Who certifies EHR technology?

The ONC doesn’t directly certify EHR systems. Instead, it authorizes independent organizations to conduct testing and certification.

ONC-Authorized Certification Bodies (ONC-ACBs): These organizations perform the official certification and issue certification IDs. They assess whether an EHR system meets all applicable criteria.
ONC-Authorized Testing Laboratories (ONC-ATLs): These labs conduct the technical testing that precedes certification. They evaluate functionality, security features, and interoperability capabilities.

Current ONC-ACBs include Drummond Group, Leidos, and SLI Compliance, which have tested hundreds of EHR systems over the years.

Steps in the certification process

The path from development to certification typically follows four steps::

Step 1: Preparation — EHR developers build features that meet certification requirements, focusing on security protocols, data exchange, and patient engagement tools.

Step 2: Testing — An ONC-ATL conducts comprehensive testing against all certification criteria. This includes evaluating interoperability standards, security measures, and functional requirements.

Step 3: Certification — If the system passes all tests, an ONC-ACB issues official certification and a unique certification ID. The product is then added to the CHPL.

Step 4: Ongoing compliance — Certification isn’t permanent. Vendors must maintain compliance through regular updates and respond to surveillance activities by ONC-ACBs.

This multi-layered process means a certified EHR has undergone rigorous third-party verification, not just vendor claims.

Why certified EHR technology matters for your practice

Using a certified EHR system delivers tangible advantages that directly impact your practice’s operations, compliance, and financial performance.

Ensures regulatory compliance and avoids penalties

A certified EHR helps your practice meet HIPAA requirements, avoid information blocking violations, and comply with CMS quality programs. Without one, you risk downward payment adjustments of up to 9% on Medicare reimbursements through MIPS.

The 2024 MIPS updates require 180 continuous days of certified EHR use. Practices using non-certified systems automatically lose all Promoting Interoperability category points — a significant hit to their composite score. You can review the latest MIPS requirements here.

Strengthens data security and patient privacy

As data breaches ramp up, independent practices are particularly vulnerable. Certified EHRs include verified security features like:

Multi-factor authentication and automatic session timeouts
End-to-end encryption for data in transit and at rest
Role-based access controls to limit who can view sensitive information
Comprehensive audit logs, tracking all system access

Plus, these features aren’t optional add-ons, they are tested and verified during certification..

Enables interoperability and care coordination

Certified EHRs use standardized formats to exchange patient data with hospitals, specialists, labs, and other providers. This interoperability is essential for:

Receiving electronic referrals and care summaries
Transmitting patient information during transitions of care
Connecting to health information exchanges (HIEs)
Reporting to public health agencies and registries

Supports quality measure reporting and value-based payments

Certified EHRs provide the technical infrastructure to record, calculate, and report clinical quality measures required by CMS. This functionality helps practices maximize reimbursements through performance-based payments.

Improves clinical workflows and reduces burnout

Certification criteria requires features that streamline provider workflows and reduce administrative tasks. These tools help providers complete notes faster and spend less time on paperwork. E-prescribing with EPCS: Prescribe controlled substances electronically, a requirement in many states
Clinical decision support: Get drug interaction checks, allergy alerts, and evidence-based guidance
Computerized physician order entry (CPOE): Reduce errors and speed up lab and imaging orders
Care plan templates: Save valuable documentation time on common conditions

Enhances patient engagement and satisfaction
Certified EHRs include patient-facing features that meet modern expectations for convenience and access. These capabilities improve patient satisfaction scores and support higher retention rates.

Positions your practice for future requirements
Healthcare regulations continue to evolve. Certified EHRs receive regular updates to keep pace with new standards, so you won’t need to replace your system every time CMS introduces new rules.

Get actionable steps to eliminate administrative burdens with Tebra’s free guide to practice automation.

How certified EHRs ensure regulatory compliance

Partnering with a vendor that offers an ONC-certified product is the best way to ensure compliance with current and evolving regulations.

HIPAA compliance and data security

All certified EHRs must meet strict HIPAA security requirements that are verified during the certification process. This includes technical, administrative, and physical safeguards like encryption and access controls.

For independent practices without dedicated IT security staff, this verified compliance provides peace of mind and reduces legal risk.

Anti-information blocking provisions

The 21st Century Cures Act prohibits practices from interfering with patient access to their health information. Certified EHRs include built-in features to help practices comply, such as patient portals and standardized APIs.

Using a certified EHR with features like patient portals demonstrates good faith compliance with these important regulations.

CMS quality programs and MIPS reporting

Certified EHRs provide the technical capabilities needed to participate in the Quality Payment Program. Specifically, they enable crucial reporting functions, including:

Promoting Interoperability (PI) category reporting
Quality measure calculation and submission
Improvement Activities (IA) documentation
Data submission through qualified registries or directly to CMS

Without these capabilities, practices cannot fully participate in MIPS which could result in lost incentives and potential payment cuts.

Price transparency requirements

Recent CMS rules require practices to provide patients with good faith estimates of treatment costs. Certified EHRs with integrated billing, like Tebra’s platform, streamline this compliance.

State-specific mandates

Many states have their own requirements around e-prescribing controlled substances (EPCS) and public health reporting. Certified EHRs include the technical standards needed to meet these varying state mandates.

Common barriers to certified EHR adoption (and how to overcome them)

Small and rural medical practices face unique challenges when adopting certified EHR technology. Understanding these barriers and their solutions can help you move forward confidently.

Barrier 1: Upfront and ongoing costs
Cost is a significant barrier — including expenses related to purchase, implementation, training, and maintenance.

Solution: Federal grants can offset the financial burden for small and rural providers. There are also plenty of additional resources that can help medical practices understand costs and establish a budget. Research on EHR return on investment shows variable timelines depending on practice size, implementation approach, and workflow optimization — with billing efficiencies and staff time savings contributing to long-term value.

Barrier 2: Implementation disruption and staff bandwidth
Practices worry about the learning curve and workflow disruption during implementation.

Solution: Cloud-based platforms require minimal IT infrastructure, and vendors typically handle data migration. Implementation timelines vary by vendor, scope, and practice size, so it’s important to work with your vendor to establish a realistic implementation timeline based on your specific needs.

Barrier 3: Uncertainty about which system to choose
With dozens of certified EHR options, practices struggle to identify which system best fits their needs.

Solution: Start by verifying certification on the CHPL, then evaluate based on your specialty, practice size, and growth plans. Look for integrated platforms that combine clinical, billing, and patient experience tools.

Barrier 4: Concerns about interoperability
Practices worry their certified EHR won’t connect with local hospitals, specialists, or health information exchanges.

Solution: Certification criteria addresses interoperability standards. Verify that potential vendors support direct messaging, FHIR APIs, and relevant health information exchanges (HIEs).

How to choose the right certified EHR for your practice

Finding the right certified EHR for your practice takes time, but it’s time well spent to improve patient care and ensure your future financial security. Start the research process by verifying an EHR’s status, evaluating its functionality, and assessing vendor reliability.

Where to verify EHR certification status

Before evaluating any EHR, confirm its certification status using the official ONC Certified Health IT Product List (CHPL) at chpl.healthit.gov. This database lets you search by vendor, product name, and certification edition.

Pay close attention to the certification ID and date to ensure the system is current. Red flags include outdated certifications or certification for only individual modules instead of a complete system.

Key factors to evaluate beyond certification

Once you’ve verified certification, assess whether the EHR meets your practice’s specific operational needs. Use this checklist to guide your evaluation.

Evaluation factor	What to look for
Specialty fit	Does the EHR include templates and workflows designed for your specialty (e.g., primary care, psychiatry, therapy)?
Prescribing capabilities	Verify it includes e-prescribing with EPCS, PDMP integration, and real-time benefits checking.
Integration	Can one platform handle billing, patient communications, and telehealth, or will you need separate systems?
Scalability	Ensure the EHR can scale as you add providers or locations without requiring a platform change.
Implementation & support	What is the implementation timeline and what training is included? Does the vendor handle data migration?
Compliance maintenance	Does the vendor have a track record of regularly updating the system to maintain certification?
Transparent pricing	Request clear pricing that includes all implementation, training, licensing, and add-on fees.

You can also learn the step-by-step process with this easy-to-follow EHR implementation guide.

Questions to ask during EHR demos

When evaluating certified EHR vendors, be prepared with specific questions, including:

What is your current certification ID in the CHPL?
How do you maintain certification as requirements evolve?
What is your typical implementation timeline for a practice our size?
How do you handle data migration from our current system?
What’s included in your base pricing versus add-on costs?
Can you provide references from practices similar to ours?

For practices evaluating Tebra: Our ONC-certified EHR+ platform combines clinical documentation, billing, and patient experience in one integrated system. It’s built specifically for independent practices with 1-10 providers to ensure compliance with evolving federal requirements.

Frequently Asked Questions

What’s the difference between certified and non-certified EHR systems?

Certified EHRs are federally verified to meet standards for security and interoperability, which is required for MIPS. Non-certified systems may lack these features and can lead to payment penalties.

How do I verify if an EHR is ONC-certified?

Check the ONC Certified Health IT Product List (CHPL) at chpl.healthit.gov. This official database lists all certified systems, their IDs, and the specific criteria they meet.

Does my practice need a certified EHR to participate in Medicare programs?

Yes, participation in CMS’s Quality Payment Program (MIPS) requires using an ONC-certified EHR for at least 180 continuous days. Failure to do so risks a downward payment adjustment of up to 9% on Medicare reimbursements.

What happens if my EHR loses its certification?

If an EHR loses certification, your practice may become ineligible for MIPS incentives and face payment penalties. Reputable vendors maintain certification, but you should verify status annually on the CHPL.

Can I switch to a certified EHR mid-year?

Yes, but for full MIPS participation you need 180 continuous days of certified EHR use. Work with your vendor to establish a realistic implementation timeline, and plan your switch accordingly to meet the reporting requirements.

How much does a certified EHR cost?

Costs typically range from $300-800 per provider, per month for cloud-based systems. However, consolidating multiple tools into one certified platform often reduces total technology spending and provides value through improved efficiency over time.

Certified EHR technology is the foundation for delivering modern, secure care while positioning your practice for long-term success. As regulations evolve, certified systems adapt seamlessly, while non-certified solutions face mounting compliance gaps.

The practices thriving today have invested in technology that reduces administrative burden. Verification through the CHPL and careful evaluation will guide you to the right choice.

For independent practices, Tebra’s ONC-certified EHR+ platform delivers clinical, billing, and patient experience capabilities in one integrated solution. This gives you more time to focus on providing exceptional patient care.