EHR/EMR Selection & Optimization: Maximizing Value From Your Clinical System

Your EHR represents your largest technology investment and biggest workflow impact. Get the selection right, implement it well, and optimize usage, and your EHR becomes a practice asset that improves care quality and operational efficiency.

Get it wrong, and you'll spend years fighting a system that slows providers down, frustrates staff, and delivers minimal value beyond regulatory checkbox requirements.

The difference isn't always the EHR itself. Two practices using identical systems can have completely different experiences based on how well they selected for their needs and how thoroughly they optimized for their workflows.

The EHR Paradox

Electronic health records promised to revolutionize healthcare. Better care coordination. Reduced errors. Improved efficiency. Enhanced decision support. Those promises are real—but achieving them requires intentional effort.

EHRs are simultaneously essential and frustrating. You can't practice modern medicine without one. But many providers consider their EHR the worst part of their day.

This stems from a fundamental tension: EHRs must serve multiple masters. Clinical documentation. Billing requirements. Quality reporting. Legal protection. Care coordination. Patient engagement. These purposes often conflict, creating systems that excel at none.

Your goal isn't finding the perfect EHR—it doesn't exist. Your goal is finding the best fit for your practice and then optimizing relentlessly.

Selection Process

Effective EHR selection follows a disciplined process that begins with understanding your needs, not evaluating vendors.

Needs Assessment

Start by documenting your requirements across multiple dimensions:

Clinical workflows: Map your typical patient encounters from check-in through documentation to follow-up. What documentation templates do you need? What decision support would improve care? How do clinical staff collaborate?

Operational requirements: How do you handle scheduling, prescription management, lab ordering, referrals, and care coordination? What reports do you need for practice management?

Regulatory requirements: What quality reporting programs do you participate in? What specialty-specific regulations apply? What billing and coding capabilities do you need?

User preferences: Survey your providers and staff. What frustrates them about your current system? What features matter most? What vendors have they used successfully before?

Future growth: Where will your practice be in five years? Additional locations? New service lines? More providers? Your EHR must support growth, not constrain it.

Document these requirements in detail. Specific needs lead to better selection than general feature lists.

Specialty Considerations

General EHRs technically work for any specialty but often lack workflows optimized for your practice type.

Specialty-specific considerations include:

Template libraries: Does the vendor offer templates designed for your specialty or will you build everything from scratch?

Procedure documentation: If you perform procedures, does the system handle procedure notes, consent forms, pre/post-operative orders efficiently?

Specialty-specific orders: Orthopedics needs different order sets than internal medicine. Does the system include relevant orders or require extensive customization?

Required reporting: Many specialties have registry reporting or quality program requirements. Does the system support these natively or require complex workarounds?

Imaging integration: If you perform imaging, how does the system integrate with PACS? Can you view images within the EHR?

Ask vendors specifically about their experience in your specialty and request references from similar practices.

Vendor Research

Create a short list of vendors worth serious evaluation. Research sources include:

Peer recommendations: What do colleagues in your specialty use? What are their experiences?

Industry rankings: KLAS Research, Black Book, and similar services rank EHR vendors by specialty, practice size, and user satisfaction.

Professional associations: Many specialty societies maintain lists of recommended vendors or host vendor exhibitions at conferences.

Online reviews: Read user reviews on G2, Capterra, and similar platforms, recognizing that unhappy users are overrepresented in reviews.

Narrow to 3-5 vendors for detailed evaluation. More creates analysis paralysis. Fewer risks missing better options.

Demo and Evaluation

Don't accept generic demos. Request demonstrations using your actual workflows.

Provide vendors with representative scenarios:

• Document a typical new patient visit in your specialty
• Show how you'd handle a procedure from scheduling through documentation
• Demonstrate prescription management for a complex patient
• Walk through your quality reporting process
• Show care coordination for a patient referred to specialists

Real workflow demonstrations reveal usability issues that generic demos hide.

Involve your actual users in demos. Providers, nurses, and front desk staff will notice workflow issues that administrators miss.

Take detailed notes and score each vendor consistently across the same criteria.

Reference Checking

Speak directly with current users of your shortlisted vendors. Vendors provide references, but also find users independently through professional networks.

Ask specific questions:

Implementation experience:

• How long did implementation take?
• What went well and what was challenging?
• Was vendor support adequate?
• What would you do differently?

Daily usage:

• How long did it take staff to become proficient?
• What do users like most/least?
• How has it affected provider efficiency?
• How responsive is support when issues arise?

Integration and reporting:

• How well does it integrate with other systems?
• Is reporting adequate or do you export to spreadsheets?
• Any significant limitations or workarounds?

Value assessment:

• Would you select the same vendor again?
• How does reality compare to demo promises?
• Any unexpected costs or challenges?

The time invested in thorough reference checking prevents expensive mistakes.

Key Selection Criteria

Evaluate vendors across criteria that predict long-term satisfaction and value.

Usability and Workflow Fit

The best feature set matters little if the system is difficult to use. Evaluate:

Intuitive navigation: Can users find what they need without extensive training?

Click efficiency: How many clicks does common documentation require? Excessive clicking slows providers down.

Customization: Can you configure workflows to match your practice or must you adapt to rigid system workflows?

Mobile access: Can providers access the system from tablets or phones for hospital rounds, home calls, or after-hours needs?

Provider efficiency directly impacts patient volume and satisfaction. Prioritize usability.

Integration Capabilities

Your EHR must exchange data with other systems in your healthcare technology stack.

Critical integrations include:

Practice management: Seamless exchange of scheduling, demographics, and billing data

Labs and imaging: Electronic ordering and results delivery

Prescription systems: e-Prescribing with formulary checking and prior authorization

Health information exchanges: Connecting to regional or national patient data networks through standards promoted by ONC (Office of the National Coordinator for Health IT)

Patient portals: Two-way communication and information sharing

Ask specifically about each integration's depth. Some "integrations" are manual exports/imports rather than automated data exchange.

Reporting and Analytics

You need data to manage your practice effectively. Evaluate reporting capabilities:

Standard reports: Does the system include reports you need or must you build everything custom?

Custom reporting: Can you create ad-hoc reports or are you limited to predefined options?

Quality measures: Does the system calculate quality measures you report or require manual tracking?

Population health: Can you identify patients due for preventive care, manage chronic disease panels, or analyze outcomes?

Many EHRs have weak reporting, forcing practices to export data to spreadsheets. This limitation creates significant ongoing frustration.

Mobile and Remote Access

Providers increasingly need EHR access from anywhere:

• Hospital rounds
• Nursing facility visits
• After-hours patient questions
• Remote work scenarios

Evaluate mobile and remote access:

Browser-based vs applications: Web-based systems work on any device. Apps may offer better functionality but limit device options.

Functionality parity: Can you perform all essential tasks remotely or just view records?

Performance: Does the system work well over consumer internet or require high-speed connections?

Security: How is remote access secured? Two-factor authentication? VPN requirements?

Provider satisfaction correlates strongly with remote access quality.

Implementation Support

Implementation quality determines whether your EHR becomes an asset or a nightmare. This should align with your overall approach to building an effective healthcare technology stack.

Evaluate implementation support:

Included services: What's included in standard implementation vs additional cost?

Timeline: What's the typical implementation period? Shorter isn't always better—rushed implementations often fail.

Training: How much training is provided? What formats? Is ongoing training available?

Go-live support: What support is available during and after go-live?

Project management: Does the vendor provide a dedicated project manager?

Request detailed implementation project plans and verify commitments in your contract.

Implementation Best Practices

Successful implementation requires disciplined project management and change leadership.

Project Planning

Develop a detailed implementation plan covering:

Project timeline: Major milestones from contract signing through go-live and optimization

Team structure: Who has what responsibilities? Who makes decisions?

Training schedule: When and how will each role receive training?

Testing plan: How will you verify system readiness before go-live?

Go-live approach: Will you go live all at once or phase in gradually?

Build slack into timelines. Delays almost always occur. Planning for them reduces stress.

Data Migration Strategy

Decide what data to migrate from legacy systems:

Essential: Active patient demographics, insurance, medication lists, problem lists

Highly valuable: Progress notes, lab results, imaging reports

Valuable: Historical visits, old medications, resolved problems

Lower value: Very old records, inactive patients

Migration effort and cost increase exponentially with data volume. Focus on data that improves patient care and practice operations.

Test migrations thoroughly. Verify accuracy and completeness before go-live.

Training Programs

Inadequate training guarantees poor adoption. Plan comprehensive training:

Role-based training: Different staff need different knowledge. Don't make front desk staff sit through clinical documentation training.

Learning formats: Combine live training, recorded videos, quick reference guides, and hands-on practice

Practice environment: Let staff practice in a training environment before go-live

Ongoing education: Learning doesn't end at go-live. Plan regular refresher training and updates

Super users: Develop power users who can provide peer support after go-live

Budget significant time for training. Rushing training creates long-term problems.

Go-Live Support

The go-live period is stressful. Plan extra support:

Vendor support: Ensure vendor resources are available on-site or immediately accessible

Reduced scheduling: Consider lighter patient schedules during the first week

Documentation support: Consider hiring temporary scribes to reduce provider burden during adjustment

Daily huddles: Meet daily to identify and resolve issues quickly

Patience: Expect temporary productivity decreases. They're normal and temporary.

Most practices reach pre-implementation productivity within 4-8 weeks.

Optimization Phase

Don't consider implementation complete at go-live. Plan a formal optimization phase:

Workflow refinement: Identify inefficiencies and adjust workflows

Template customization: Refine templates based on actual usage

Training gaps: Provide additional training where needed

Feature utilization: Activate features not used initially

Performance measurement: Compare actual performance to goals and adjust

Schedule optimization reviews at 30, 60, and 90 days post go-live.

Workflow Optimization

Continuous optimization differentiates practices that love their EHR from those that tolerate it.

Template Customization

Generic templates create excessive documentation burden. Customize for your needs:

Smart phrases: Create shortcut phrases that expand to frequently used text

Pick lists: Replace free-text fields with pick lists for common responses

Note templates: Build templates for common visit types

Chief complaint-specific templates: Different presenting complaints need different documentation elements

Well-designed templates reduce documentation time by 30-50% while improving note quality.

Order Sets and Favorites

Standardize common orders to reduce clicking and decision fatigue:

Provider favorite orders: Let each provider build their frequently used orders

Diagnosis-specific order sets: Pre-built order bundles for common conditions

Procedure-specific order sets: Standard pre/post-procedure orders

Preventive care order sets: Age and gender-specific preventive care orders

Good order sets reduce ordering from dozens of clicks to two or three.

Documentation Efficiency

Reduce documentation burden without sacrificing quality:

Copy forward selectively: Don't just copy entire previous notes. Copy relevant chronic problems and medications while documenting today's encounter fresh.

Use defaults intelligently: Set smart defaults for normal findings, allowing quick documentation while flagging abnormalities.

Voice recognition: Consider dictation software if it improves provider efficiency

Team documentation: Let nurses document vital signs, medication reconciliation, and care coordination rather than providers repeating it

Documentation should capture what matters clinically and legally without excessive burden.

Clinical Decision Support

Configure decision support that helps without annoying:

Drug interaction checking: Set severity thresholds appropriate for your practice. Too sensitive creates alert fatigue.

Preventive care reminders: Flag overdue screenings and vaccinations

Chronic disease management: Prompt for appropriate monitoring and management

Evidence-based guidelines: Integrate relevant clinical guidelines

Good decision support improves care. Excessive alerts train users to ignore everything.

Maximizing ROI

Your EHR investment should deliver returns beyond regulatory compliance. Consider ROI alongside your broader patient acquisition economics.

Feature Utilization Assessment

Most practices use a fraction of their EHR's capabilities. Assess what you're not using:

Patient portal activation and utilization

E-prescribing full capabilities (formulary checking, prior authorization)

Care coordination features

Patient education materials

Quality reporting automation

Population health tools

Each underutilized feature represents unrealized value. Identify high-value features and plan systematic adoption.

Ongoing Training

User knowledge degrades without reinforcement. Plan ongoing education:

Monthly tips and tricks: Share efficiency shortcuts

Quarterly refresher training: Review key features and introduce new capabilities

Vendor webinars: Many vendors offer free training webinars

User group participation: Learn from other practices' experiences

New staff onboarding: Formal training for new hires

Ongoing education improves efficiency and job satisfaction. Build this into your comprehensive staff training development program.

Workflow Refinement

Workflows should evolve based on experience:

Measure documentation time: How long does each provider spend documenting? Identify outliers for coaching or workflow improvement.

Monitor provider productivity: Track patients per day, revenue per visit. Declining productivity may indicate workflow issues. Optimize your schedule optimization to maximize efficiency.

Survey staff satisfaction: Regular brief surveys identify frustration points requiring attention

Collect improvement suggestions: Front-line staff see inefficiencies you might miss

Build continuous improvement into your practice culture.

Reporting Optimization

Better data drives better decisions:

Identify key practice metrics: What metrics matter most for your practice?

Automate routine reports: Eliminate manual report creation where possible

Create dashboards: Visual dashboards make trends obvious

Share data widely: When staff see performance data, they understand how their work impacts results

Good reporting transforms your EHR from a documentation tool to a practice management asset.

Switching Considerations

Sometimes your current EHR simply isn't working. When should you switch?

When to Switch

Switching EHRs is expensive and disruptive. Only consider switching when:

Vendor viability concerns: Vendor is being acquired, losing clients, or showing financial instability

Inadequate support: Vendor support is consistently poor with unresolved issues

Missing critical functionality: System lacks essential capabilities for your specialty

Growth limitations: System can't support your expansion plans

Cost unjustified: Total cost of ownership far exceeds value delivered

Poor usability: After thorough optimization attempts, the system remains inefficient

Don't switch for minor frustrations. Do switch when fundamental limitations constrain your practice.

Migration Planning

Switching EHRs requires careful planning:

Data migration strategy: What data must migrate? Historical records? Active patients only?

Overlap period: Run old and new systems in parallel briefly or hard cutover?

Training timeline: Allow adequate training before go-live

Patient communication: How will you inform patients about the transition?

Revenue cycle protection: Ensure billing isn't disrupted during transition

Plan switching during slow periods if possible. Avoid major transitions during peak patient volume.

Minimizing Disruption

Reduce switching disruption:

Phase by location: If multi-location, switch one at a time rather than simultaneously

Phase by provider: In single locations, consider switching providers in waves

Enhanced support: Provide extra support resources during transition

Reduced scheduling: Lighter schedules during initial adjustment period

Clear communication: Keep staff informed throughout the process

Most practices require 3-6 months to fully transition to a new EHR.

The Long-Term Relationship

Your EHR is a long-term commitment. Few practices switch frequently—the disruption is too significant.

Choose carefully, focusing on long-term fit rather than initial cost savings or flashy demonstrations.

Implement thoroughly, investing time in training, customization, and workflow design.

Optimize continuously, never accepting "that's just how it works" when inefficiencies exist.

Maintain your vendor relationship, providing feedback and participating in user communities.

Your EHR should improve over time as you learn its capabilities and vendors add features. If it's not getting better, you're not optimizing enough—or you've chosen the wrong system.

Focus your next 90 days on utilization assessment and targeted optimization. Most practices have significant unrealized value in their current EHR before considering switching.

The right EHR, properly implemented and continuously optimized, becomes invisible—supporting excellent care without getting in the way. That's the goal worth pursuing.