PVR

EHR & Practice Software — Checklist

EHR selection and go-live checklist

Give yourself 90 days for selection and 120 days for implementation for a small practice; double both for groups over 10 providers. Skipping the requirements-gathering step is the #1 reason EHR projects fail — you'll buy on demo dazzle and regret it in workflow month one.

By Jordan Alderman, MBA, CMPE · Reviewed by Rania Hassan, JD, CHC · Last reviewed · Methodology

Disclosure: Independent editorial. No pay-for-placement, no affiliate rankings. Full editorial standards.

Work through this checklist in order. Each phase gates the next.

Phase 1 — Requirements (weeks 1–4)

  • Document current workflows: visit types, note templates, referral loop, billing handoff
  • List must-have integrations (labs, imaging, e-Rx, clearinghouse, HIE)
  • Enumerate specialty-specific needs (templates, coding sets, compliance)
  • Define success metrics (note time, days-in-AR, patient satisfaction)
  • Set budget with 5-year TCO ceiling

Phase 2 — Vendor shortlist (weeks 5–8)

  • 3 vendors shortlisted (not 8 — you'll never decide)
  • Reference calls with practices in your specialty at similar size
  • Sandbox access for 2+ weeks of hands-on testing
  • Clinician trial with real charting scenarios
  • Written pricing with all add-ons enumerated

Phase 3 — Contract & data (weeks 9–12)

  • Contract reviewed by healthcare attorney (see /contract-clauses)
  • Data-ownership clause explicit
  • Termination + data-export terms defined
  • BAA signed
  • Implementation SOW with milestones + dates

Phase 4 — Implementation (weeks 13–24)

  • Data migration test with sample charts
  • Templates and order sets built
  • Interfaces tested end-to-end (lab result → chart → billing)
  • Training scheduled by role (clinician, MA, front desk, billing)
  • Cutover date + rollback plan

Phase 5 — Go-live & stabilization (weeks 25–36)

  • Reduced schedule week 1 (50%), week 2 (75%), week 3 (100%)
  • Vendor on-site or on-call for 5 business days
  • Daily standups first two weeks for issue triage
  • 30-day, 60-day, 90-day KPI review vs baseline
  • Optimize templates and workflows based on real use

Use as a project plan; assign an owner and target date to each item.

Evidence & sources

Every recommendation on this page traces back to a primary reference — federal regulation, an industry benchmark, or peer-reviewed literature. Follow the links to verify claims independently.

  1. [1]Certified Health IT Product List (CHPL)

    Regulatory

    Office of the National Coordinator for Health IT (ONC)

    Supports: Authoritative registry of ONC-certified EHR products used to confirm certification claims made by vendors.

  2. [2]ONC Cures Act Final Rule — Information Blocking

    Regulatory

    HealthIT.gov

    Supports: Federal basis for data portability and interoperability requirements referenced in the EHR contract criteria.

  3. [3]KLAS Research — Ambulatory EHR

    Industry benchmark

    KLAS Research

    Supports: Independent third-party ratings of ambulatory EHR vendors on satisfaction, support, and specialty fit.

  4. [4]AMA Digital Health Research

    Professional association

    American Medical Association

    Supports: Physician-reported EHR usability data used to weight documentation efficiency in the scoring rubric.

Frequently asked questions

How much does an EHR cost for a small practice?+

Cloud EHRs for independent practices typically run $200–$600 per provider per month, plus implementation ($1,500–$10,000 per provider) and migration if applicable. Integrated EHR + practice management + billing bundles run higher, $500–$1,200 per provider per month. Three-year total cost of ownership is a better comparison than monthly rate.

How long does an EHR implementation take?+

For a small practice with no data migration, 60–120 days from contract to go-live is realistic. With historical data migration, plan 4–9 months. Anyone selling a 30-day implementation for a real practice is either doing a minimal setup or setting you up to blame delays on your team.

What is the best EHR for a private practice?+

There is no single best EHR. The best EHR for your practice is the one purpose-built for your specialty at your size, at a total-cost-of-ownership you can afford, whose reference clients your size in your specialty are genuinely satisfied. A specialty-first shortlist beats a 'top 10 EHRs' list every time.

Should I choose a specialty EHR or a general one?+

For most independent specialties (behavioral health, PT/OT, dermatology, ophthalmology, pediatrics, and others), a specialty-purpose-built EHR outperforms a general one on documentation speed and reporting. General EHRs make sense for multi-specialty groups and primary care with heavy interoperability needs.

Can I switch EHRs? How hard is data migration?+

Yes, and thousands of practices switch every year. Structured data (medications, allergies, problem lists) migrates via CCDA. Unstructured historical notes usually come over as PDFs attached to the patient chart. Budget 4–9 months, insist on a fixed-price migration statement of work, and negotiate the export rights from your outgoing vendor before you sign with the new one.

Do I need practice management software separately from an EHR?+

Most modern cloud EHRs include practice management (scheduling, billing, patient accounts) in the same platform. Standalone PM systems still exist for practices that want to keep a specialty EHR but a stronger billing engine. If you outsource billing, coordinate PM choice with your billing vendor.

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