How to select an EHR/EMR: A comprehensive guide

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:

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.

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.

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. 

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.

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:

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:

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.

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:

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.

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:

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.

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.

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:

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:

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 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.

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:

Make sure the EHR system offers:

A good EHR will be able to integrate with existing practice tools and external healthcare systems. Look for:

An effective EHR system simplifies and safeguards the prescription process, ensuring accuracy and compliance. Look for:

EHR systems should offer features that enhance patient convenience and communication while improving practice efficiency. Look for:

Engagement surveys generate and manage patient engagement surveys that gather valuable feedback on care quality and satisfaction. Look for:

EHR systems should provide advanced tools to harness data for better decision-making and care outcomes. Look for:

Evaluating the cost and value of an EHR system is essential to ensure long-term success. Check the following:

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.

An effective EHR system streamlines billing and coding processes to improve accuracy and efficiency. Look for:

Ensure a smooth transition to your new EHR system by focusing on these key steps:

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.