Prerequisites
- Your specialty and expected volume
- Your entity count now and in three years
- Whether you’ll want programmatic access to your data
- A shortlist from the EHR directory
The criteria, in priority order
1. Specialty fit
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2. Clearinghouse flexibility
Ask before you sign: does this system permit me to use my own clearinghouse, and can I change later? Get it in writing. Many EHRs embed a clearinghouse and make switching hard or impossible. It is far easier to choose an EHR that permits your clearinghouse than to change clearinghouses afterward. See Choose a clearinghouse.3. Data export rights
Read the contract clause. You will want your data, for analytics, a migration, or diligence. Ask specifically: what can I export, in what formats, how quickly, and at what cost? Some vendors charge thousands to return data that is already yours. Get the answer in the contract, not in an email from a salesperson.4. ERA auto-posting quality
This determines how many hours a week your biller spends posting manually. Test it properly: ask for a demo using a real 835 that includes a PLB takeback, an interest payment, and a secondary transfer. Watch what lands in the exception queue. Every system auto-posts clean lines; the difference is what happens to the messy ones.5. Eligibility checking
Integrated 270/271 at scheduling prevents more denials than anything else you can buy. Confirm it is real-time, covers your payer mix, and surfaces deductible remaining rather than just “active.”6. Reporting
Can you get, without exporting to a spreadsheet:- Days in AR, by payer
- Denial rate by CARC, by payer
- Net collection rate
- Unbilled encounters
- AR aging
- Revenue per clinician
7. Multi-entity support
Specific to MSO-PC groups and routinely overlooked:- Can it run multiple legal entities with separate Tax IDs and separate group NPIs?
- Can claims for each entity carry that entity’s billing provider information correctly?
- Can payments settle to different bank accounts per entity?
- Can you report per entity and consolidated?
- Is it one login, or one instance per entity?
8. Pricing model
Per provider per month is the common and most predictable. Be cautious of percentage-of-collections pricing from a software vendor: it scales your cost with your success for a product whose cost to serve doesn’t, and it makes benchmarking impossible.Steps
1
Write your requirements before you take demos
Ten to fifteen must-haves, ranked. Demos are designed to reframe your requirements around the product’s strengths.
2
Shortlist three specialty-appropriate systems
3
Demo with your own scenarios
Your specialty’s common encounter. Your multi-entity structure. A messy 835. Your reporting questions.
4
Ask the contract questions in writing
Clearinghouse flexibility, data export, price escalation, term, termination.
5
Talk to reference customers in your specialty and at your scale
Ask specifically about support responsiveness and about anything that broke during implementation.
6
Negotiate
Term length, price escalation caps, implementation fees, and data export terms are all negotiable.
Verify it worked
- Requirements written before demos
- Specialty fit confirmed by a clinician who will use it
- Clearinghouse flexibility confirmed in the contract
- Data export rights specified in the contract
- ERA auto-posting tested with a messy 835
- Multi-entity support tested with your actual structure
- Reporting tested against your six KPIs
- References contacted
- Term and escalation negotiated