How to select an EHR/EMR: A comprehensive guide
Find out how to select an EHR and what to consider when determining the best EHR medical software for your practice.
- Current Version – Apr 07, 2025Written by: Jean LeeChanges: This article was updated to include the most relevant and up-to-date information available.
- Mar 08, 2025Written by: Amantha MayChanges: This article was updated to include the most relevant and up-to-date information available.
At a Glance
- Choosing the right EHR enhances efficiency and patient care.
- Interoperability and customization are key selection factors.
- User-friendly platforms reduce training time and improve adoption.
Selecting and implementing a new electronic health record (EHR) software platform or electronic medical record (EMR) system can significantly impact a private healthcare practice, offering numerous long-term benefits. Research shows that EHRs:
But they not only help providers — they also encompass a patient's entire medical journey, not just their records.
However, if your EHR doesn't suit your practice's needs, you may not experience all the benefits. The wrong system could disrupt practice workflows; affect clinicians, administrative staff, and patients; and potentially damage your business's health.
The different types of electronic records system and their features, and the wide range of EHR vendors, add to the complexity and further complicate the choice.
Here, we'll help you simplify the process of choosing a new system. The following suggestions and checklists will help you:
- Determine whether your practice and team are ready for a new EHR
- Evaluate your options
- Make an informed decision
| Looking for an EHR that won’t slow you down? This guide helps you find one that supports your care—not your paperwork. |
The difference between EHRs, EMRs, and practice management platforms
Before you begin, it's crucial to understand what kind of system you need. EHRs, EMRs, and practice management software are similar but distinct solutions.
Electronic health record (EHR)
Larger clinics, hospitals, and health systems generally use EHR systems. EHRs enable a comprehensive record of a patient's medical history and health information. They support coordinated care by allowing different providers and organizations to update and access patient information.
EHRs often include patient portals, where patients can access their records, securely message their providers, or book appointments. They may also include AI insights or population health data. Evaluate any candidate EHR system's core functionalities to ensure it meets your practice's specific needs.
Electronic medical record (EMR)
Smaller practices or specialty clinics sometimes use EMR systems. EMRs are digital versions of paper charts that contain a patient's medical or treatment data from a single provider or practice.
Unlike EHRs, EMRs are not patient-facing and may cause disruptions if a patient switches providers. While some modern EMRs are cloud-based, their interoperability is still very limited.
Though there are differences between EHR and EMR systems, especially when it comes to interoperability and secure patient portals, the terms are often used interchangeably. As you evaluate your practice's new electronic records system, keep your interoperability needs in mind.
Practice management software
While EMRs and EHRs focus primarily on clinical data, practice management software streamlines business-related tasks such as scheduling and billing. Advanced practice management software can integrate with EHRs and EMRs, automating clinical, financial, and administrative tasks.
Of these 3 options, an EHR typically offers the most robust and scalable solution — but after you determine whether you need an EHR or EMR, the evaluation process is similar for both.
How to select the right EHR or EMR for your practice
Pinpointing the best EHR system can take time and effort. Being strategic about EHR selection means focusing on your practice's specific needs, patient population, and long-term business goals.
The following steps can help you develop an EHR selection strategy to streamline the EHR selection process:
1. Assess your readiness
Before selecting an EHR or EMR system, it's important to understand your current practice landscape. Conduct an EHR readiness assessment to determine your team's preparedness.
A comprehensive readiness checklist for EHRs should include:
- Practice culture and staff survey: Assess how your medical practice approaches change and innovation. Determine whether your team embraces new technologies or shows resistance, and gather feedback through surveys to address concerns.
- Clinical requirements: Identify the features your practice needs based on the care you provide, such as telehealth or chronic disease management. Ensure these requirements align with your clinical workflows for seamless integration.
- Operational capabilities: Evaluate how your practice currently handles scheduling, billing, and patient communication. Confirm that the EHR system can support these operations and adapt to future growth.
- IT infrastructure: Review your existing hardware, software, and network systems to ensure compatibility with the EHR's requirements. Address any gaps in connectivity or system performance to prevent disruptions.
- Technical capacity: Assess your team's comfort with technology and identify those who may need additional training. Consider appointing tech-savvy staff as EHR champions to support others during the transition.
- Existing workflow analysis: Map out current workflows to identify inefficiencies or bottlenecks. You’ll use this analysis to customize the EHR system to meet your practice's unique needs.
- Current information management strategies: Review how patient data is stored and accessed to identify gaps in data practices. Plan for accurate and secure data migration to maintain continuity of care.
- Available capital: Evaluate your budget to ensure you can cover the costs of implementation, including software, training, and potential workflow disruptions. Allocate additional funds for unexpected expenses that may arise during the transition.
2. Conduct an internal data assessment
The quality of digital patient data can vary significantly between healthcare organizations and EHR systems. A data assessment evaluates the quality of existing medical records and identifies the reasons for incomplete, unreliable, or insecure data. Since data quality impacts EHR implementation, an assessment is crucial to address any issues before transitioning to a new EHR system.
To conduct an assessment, review existing data to identify inconsistencies, inaccuracies, and incomplete records. Engage key stakeholders to verify the integrity and accuracy of all records.
3. Identify your must-have features
Your key features will closely align with your practice's specialty and services. For example, a mental health practice might prioritize therapy session documentation or substance abuse treatment planning. Chronic disease management tools and pediatric care templates could be must-haves for a nurse practitioner.
You might also need clinical documentation templates to accommodate changes in the services or specialties you offer. Another feature you might look for is user role expansion, which offers scalable user management, allowing roles, permissions, and workflows to be adjusted as practice staff increases.
According to Tebra's 2024 EHR report, the top features that private practices consider essential in an EHR are:
- Usability and customization
- All-in-one solution
- Security and compliance
4. Determine your usability and interoperability priorities
Decide which features best serve your clinicians and office staff, minimizing frustration and operational disruptions. Consider the usability of patient-facing functions to ensure portals and engagement tools are easy to navigate.
In March 2024, Tebra surveyed 183 healthcare providers from small private practices who use EHRs regularly. Many respondents cited these concerns:
"It takes too long to enter information. It does not 'talk' to the local hospital so visits at the hospitals must be requested, then scanned in."
"It's not user friendly, [and] to see billing records on patients, you have to use a PC desktop and not an iPad."
Also, consider interoperability with other systems you currently use or plan to adopt. A primary care practice might prioritize integrating with lab information systems and local hospitals. Examples of features you may need include task management, workflow automation, and integrated billing and coding tools.
5. Compare vendors
Entrusting your practice operations to an EMR or EHR system also means trusting a vendor to provide readily available, quality support during implementation and in the long term.
Key steps when selecting an EMR or EHR vendor:
- Narrow selection to 5–10 vendors
- Request demos for practice-specific workflow scenarios, including clinical decision support
- Assess how the EHR handles documentation and workflow efficiency
- Ask detailed questions about features, integration, security, and total cost of ownership
6. Gather first-hand user experiences
User experiences offer valuable insight into how an EHR or EMR system functions under real-world conditions based on meaningful use cases. Compare multiple online product reviews, noting common issues, complaints, or praise. Online forums may provide deeper understanding of specific concerns.
Speak to colleagues who use the product in question. If your peers can't help, consider reaching out to industry associations. They may have detailed reviews or be able to connect you with other users.
Keep a running list of strengths and weaknesses as defined by users. Seek both negative and positive feedback. When possible, identify whether the user's EHR needs are similar to those of your practice.
7. Create a request for proposal (RFP)
A thoughtful request for proposal (RFP) is an essential tool in the vendor selection process and will help you effectively compare different EHR systems. As a formal document, it invites vendors to submit key details about how their platform would meet your specific needs.
With RFPs, you can obtain a quality pool of EHR vendors, narrow your options by asking questions, and select the best possible vendor for your practice.
Practice-specific EMR/EHR selection criteria
Private practices vary significantly in size, specialty, demographics, and operational processes. Examining how these factors shape your workflows can help you decide how to select an EHR or EMR system. It also protects you from paying for unnecessary features or investing in a system that lacks critical functions.
Consider the following:
- Practice size and growth ambitions: Evaluate your current practice size, including the number of providers, staff, and patient volume, to determine your initial needs. Ensure the system can scale to support future growth, such as adding providers, expanding locations, or offering additional services.
- Specialty: Choose an EHR that aligns with the specific tools, workflows, and protocols of your specialty. For example, cardiology requires integration with cardiovascular equipment, dermatology needs high-resolution imaging support, and psychiatry benefits from enhanced confidentiality features and medication management tools.
- Workflow and integration needs: Smaller practices may benefit from EMRs/EHRs with standard healthcare workflows and basic integrations like labs and ePrescribing. Larger or specialty practices often require customized workflows and robust integrations to support advanced diagnostic equipment and seamless information exchange with other providers.
- Current technological infrastructure: Evaluate your existing hardware, such as computers, servers, and networking equipment, to ensure compatibility with the EMR/EHR system. Up-to-date equipment, including fast processors, reliable internet, and backup power supplies, is essential for optimal system performance.
Comprehensive EHR evaluation checklists
Evaluating an EHR system requires an in-depth assessment of critical factors to ensure it meets your practice needs. Here are in-depth EHR evaluation checklists to guide your process:
Usability
A study of EHR implementation in an oncology setting found that usability testing improves the chance that an EHR will integrate successfully with existing workflows. Most users of an EHR system implemented without usability testing "expressed a high degree of dissatisfaction with efficiency and general functionality."
Tebra's 2024 EHR survey respondents also cited lack of customization (56%), difficult navigation (44%), and poor interface design (43%) as the biggest factors that interfere with EHR usability — all of which you can evaluate before implementation.
Here's what to look for:
- The system navigation should be easy and intuitive to reduce workflow steps, time, and mental load.
- The software should be customizable with templates that can be tailored to specific practice needs and specialties.
- The features should be scalable to accommodate practice growth.
- Users must be able to quickly complete common tasks like charting and prescription orders without compromising accuracy.
The following usability testing methods and other user experience evaluation protocols use different perspectives to evaluate product characteristics at various points in the implementation process:
Summative method
This method ensures your implementation goals align with actual outcomes. It analyzes how the system performs in real-world conditions to provide insight regarding gaps or issues. Addressing these issues helps the system integrate more smoothly with your practice's needs.
To use the summative method, conduct a risk assessment, performance tests, and workflow analysis. The Agency for Healthcare Research and Quality's Health IT Toolkit includes tools and resources for assessing a new EHR system's impact on your practice.
Heuristic method
The heuristic method evaluates the performance and usability of the EHR system's user interface. It's a strong first step to see if an EHR system is a good fit for your practice.
To use the heuristic method, designate small staff teams to use the system and then rate issues that hinder user interaction. This allows you to identify specific areas that could cause user frustration or data errors, promoting user satisfaction and efficiency.
Compliance
Your EHR must be Office of the National Coordinator for Health Information Technology (ONC)-certified and Health Insurance Portability and Accountability Act (HIPAA)-compliant. Check for:
Training and support
Make sure the EHR system offers:
- Initial training: Training should be available, comprehensive, and tailored to different roles. The delivery should include hands-on, interactive modules and sessions dedicated to specialty-specific features.
- Ongoing support: Robust customer support includes detailed user manuals and responsive live assistance via phone or chat, including outside regular business hours.
- Customization and onboarding: The vendor should assist with customization, provide detailed guidance for data migration, and otherwise help you with EHR implementation.
Integrations
A good EHR will be able to integrate with existing practice tools and external healthcare systems. Look for:
- Electronic labs: These populate patient records with lab results instantly and accurately via automatic result entry. A good eLabs feature provides real-time updates for immediately accessible results and includes order tracking within the EHR interface.
- Interoperability: The EHR system exchanges information, including veracity of regulatory compliance, seamlessly with other healthcare organizations. It easily transfers patient records to specialists or health facilities, with no need for faxes or phone calls.
| Love content like this? Join thousands of independent providers who receive our weekly newsletter with tips on running a more efficient, profitable practice. Sign up for the newsletter. |
Prescriptions
An effective EHR system simplifies and safeguards the prescription process, ensuring accuracy and compliance. Look for:
- eRx submits electronic prescriptions directly to pharmacies, streamlining the prescription process and enhancing patient safety.
- Drug interaction checks identify potential medication allergies and contraindications and automatically alert providers to prevent dangerous drug interactions.
- Refill management streamlines prescription management and refill approval.
- Controlled substances features ensure that controlled substance prescriptions comply with legal regulations.
Patient engagement
EHR systems should offer features that enhance patient convenience and communication while improving practice efficiency. Look for:
- Patient portals include features such as self-scheduling, encrypted messaging, and access to health records. Patients can easily book, reschedule, or cancel appointments, communicate directly with providers, and review their own health records at their convenience.
- Appointment reminders assist patients and reduce no-shows, improving care continuity and reducing revenue loss from last-minute cancellations.
- Streamlined check-ins reduce wait times, limit stress for front-desk staff, and keep clinical schedules on target.
- Telehealth supports secure, HIPAA-compliant virtual visits and remote patient monitoring. Complimentary virtual waiting rooms streamline the patient experience and save time for providers.
Patient surveys
Engagement surveys generate and manage patient engagement surveys that gather valuable feedback on care quality and satisfaction. Look for:
- Survey customization tailors patient surveys for specific groups or practice needs.
- Automated distribution sends surveys automatically after visits or procedures.
- Real-time analytics process survey data in real time for instant insights.
Data analytics
EHR systems should provide advanced tools to harness data for better decision-making and care outcomes. Look for:
- Reporting tools monitor outcomes, identify areas for improvement, and make informed, data-driven decisions. They should generate advanced, customizable reports on patient care, financial performance, and operational efficiency.
- Population health management features analyze patient data to identify trends and manage the health of specific patient groups.
Financial considerations
Evaluating the cost and value of an EHR system is essential to ensure long-term success. Check the following:
- Upfront costs: Consider the initial purchase price, installation fees, and setup fees. Include any hardware upgrades and other expenses during preparation for implementation.
- Ongoing fees: These include recurring subscription fees, maintenance, and customer support costs.
- Training expenses: Budget for staff training and any necessary upgrades or customizations that ensure your staff understands the complete system.
- Return on investment (ROI): The EHR system should save money or improve revenue through efficiency and improved patient outcomes. These results should be measurable. ROI is the most important goal of an EHR.
Pricing models
EHR vendors typically offer either subscription or one-time payment pricing models. To understand the financial implications of each, consider factors such as your available capital, monthly cash flow, scalability/customization requirements, and current technology infrastructure.
| Pros | Cons | |
Subscription pricing | - Lower initial costs - Automatic updates - Maintenance included - Scalability - Predictable spending | - Ongoing operational costs - Tied to the vendor for updates and servicing - Long-term contracts - Limited customization |
| One-time payment | - Potentially lower overall costs - Full ownership of product license - Less dependent on the vendor - One-time capital expenditure | - High initial cost - Maintenance and upgrades may require additional fees - Greater financial risk if the system doesn't meet expectations |
Medical billing and coding
An effective EHR system streamlines billing and coding processes to improve accuracy and efficiency. Look for:
- Automated coding reduces errors by automatically suggesting appropriate ICD-10-CM codes based on documentation.
- Claims management automatically submits, tracks, and facilitates insurance claim resolution.
- Revenue cycle management monitors the billing cycle from patient registration to payment collection.
- Compliance checks help prevent fines and audits by ensuring that all billing practices adhere to regulatory standards.
Prepare to implement your new EHR system
Ensure a smooth transition to your new EHR system by focusing on these key steps:
- Create a comprehensive plan. Include staff training, hardware upgrades, and data migration strategies.
- Schedule training sessions. Allocate sufficient time to familiarize your team with the system's features and workflows.
- Upgrade hardware. Ensure your equipment meets system requirements.
- Develop a robust data migration plan. Prioritize accuracy and completeness when transferring patient records, and verify data integrity throughout the process.
- Manage change effectively. Prepare for resistance and challenges; maintain open communication to address concerns promptly.
- Focus on long-term benefits. Recognize that the effort invested in implementation will lead to improved patient care, streamlined workflows, and better practice management.
Tebra's cloud-based, ONC-certified EHR software integrates seamlessly with practice management tools, offering an automated, optimized solution that enhances workflows and improves patient care. Learn more about how Tebra can transform your practice at tebra.com.
Comparing EHR vendors? These resources will help you make an informed decision:
- How to Write an RFP for an EHR (Free Template) – Get a ready-to-use template to simplify your EHR vendor search and ask the right questions.
- How to Evaluate EHR Vendors: Side-by-Side Matrix – Compare top EHR solutions based on features, usability, and support with this free evaluation tool.
- Ready to see how a top-rated EHR stacks up? Book a free demo and explore the platform firsthand.
- Current Version – Apr 07, 2025Written by: Jean LeeChanges: This article was updated to include the most relevant and up-to-date information available.
- Mar 08, 2025Written by: Amantha MayChanges: This article was updated to include the most relevant and up-to-date information available.
Stay Ahead with Expert Healthcare & Billing Insights
Get the latest industry updates, financial tips, and expert strategies — delivered straight to your inbox.
Stay Ahead with Expert Healthcare & Billing Insights
Get the latest industry updates, financial tips, and expert strategies — delivered straight to your inbox.
