EHR vendor questions to ask before you sign

Use the same list with every vendor, in the same order, and write down the answers. A reply on a sales call is not a promise. Anything that matters to your practice should end up in the contract, in writing, before you sign it. This page is general information. Have your counsel read the agreement and your compliance officer review the privacy and security terms.

Your data

• Who owns the clinical data in the system, and does the contract say so in plain words?
• Which formats can you export everything in, both the structured chart and the attached documents and images?
• Can you run a test export before you sign, using a sample of your own records?
• Is there a fee to export, either during the contract or after it ends?
• After termination, how long do you keep access to read and export records? When is the data deleted, and will the vendor confirm deletion in writing?
• Can you export the audit log along with the chart?

Fit for your workflow

• Ask for a demo built around a typical visit from your own practice, not the vendor’s prepared script.
• Count the clicks and screens for the three tasks your staff do most, and ask who in your office performs each one.
• Who builds and maintains templates and order sets: you, the vendor, or a paid consultant?
• Does the system handle the forms, measurements and workflows your specialty relies on, or does that need customization? What does customization cost in time?
• What can staff still do when the internet is down, and what is the vendor’s downtime plan?

Connections to other software

• Which scheduling, billing, lab, imaging, e-prescribing and patient communication tools connect out of the box, and which need a separate interface?
• Is each interface included in the quote or priced on its own line?
• When a connection breaks, who fixes it: you, this vendor or the other vendor?
• Can the vendor put you in touch with a practice that uses the exact connection you need?
• Is the product listed on the federal Certified Health IT Product List, and for which certification criteria? Certification tells you the product met a set of tested functions. It does not tell you the product suits your practice.

Security and privacy

• Will the vendor sign a business associate agreement, and can you read it before you commit? HHS explains what a business associate is.
• Where is the data hosted, and which subcontractors can reach it?
• Does every user get a unique login, with roles that limit what each person can see?
• Is multi-factor sign-in available for all users, or only for administrators?
• What is encrypted, in transit and at rest, and are backups covered too?
• If the vendor has a security incident that touches your data, how fast will it tell you, and is that deadline in the contract?

The HIPAA software checklist goes further on these points.

Cost and contract

• Ask for one written quote that lists every line: licenses, implementation, data migration, training, interfaces, storage and support tiers.
• What triggers extra charges when you add a provider, a location or a module?
• How does renewal work: automatic or not, how much notice you must give, and whether price increases are capped?
• What are your rights to leave early if the product changes, the vendor is acquired or support gets worse?
• What happens to your access if the vendor stops selling the product?

Rollout and support

• Who migrates your existing records, how long does it take, and what do you have to provide?
• How many training hours are included, for which roles, and is there a refresher after go-live?
• Are support hours, channels and response times written into the contract or only into the brochure?
• Who do you reach after hours when something fails?
• How are updates released, and how much warning do you get when a screen your staff relies on changes?

Before you decide

Call two or three practices of similar size and specialty that have used the system for at least a year, and ask what they would put to the vendor if they were choosing again. Then compare the answers across vendors on one sheet. If you are replacing a system rather than buying your first, read switching EHR systems before you commit to a date.