> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Choose an EHR/PM system

> Requirements-driven selection: specialty fit, clearinghouse flexibility, ERA auto-posting quality, reporting, data export rights, and multi-entity support.

Your **EHR/PM system** holds clinical notes, demographics, insurance, charges, the patient ledger, and claim status. It is the hardest vendor to change and the one whose weaknesses you live with daily. Choose on requirements, not on demo polish.

## 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](/reference/vendors/ehr-directory)

## The criteria, in priority order

### 1. Specialty fit

A dermatology EHR has dermatology templates, biopsy and pathology tracking, and the right code sets. A generic one makes every clinician fight it daily, and clinician time is your most expensive input.

<Note>
  🦷 Dental: Open Dental, Dentrix, Eaglesoft, Curve, Archy · 🧠 Behavioral: SimplePractice, TherapyNotes · 🦴 PT: WebPT, Prompt · 👁 Optometry: RevolutionEHR, Crystal PM · 🐾 Vet: ezyVet, Cornerstone
</Note>

### 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](/guides/billing/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

If not, budget for a reporting layer or accept flying blind.

### 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?

Test this in the demo with your actual structure. A system requiring a separate instance per PC costs you a login, a configuration, and a reporting silo per state.

### 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

<Steps>
  <Step title="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.
  </Step>

  <Step title="Shortlist three specialty-appropriate systems" />

  <Step title="Demo with your own scenarios">
    Your specialty's common encounter. Your multi-entity structure. A messy 835. Your reporting questions.
  </Step>

  <Step title="Ask the contract questions in writing">
    Clearinghouse flexibility, data export, price escalation, term, termination.
  </Step>

  <Step title="Talk to reference customers in your specialty and at your scale">
    Ask specifically about support responsiveness and about anything that broke during implementation.
  </Step>

  <Step title="Negotiate">
    Term length, price escalation caps, implementation fees, and data export terms are all negotiable.
  </Step>
</Steps>

## 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

## Common failure modes

| Failure                                    | Consequence                                        |
| ------------------------------------------ | -------------------------------------------------- |
| Choosing on demo polish                    | Daily friction for years                           |
| Not confirming clearinghouse flexibility   | Locked into an embedded one                        |
| No data export rights                      | Cannot migrate or analyze                          |
| Not testing multi-entity                   | Discover it needs an instance per PC after signing |
| Not testing ERA posting with a real 835    | Manual posting forever                             |
| Percentage-of-collections software pricing | Cost scales with success; unbenchmarkable          |
| Long term with automatic escalation        | Locked in at rising cost                           |


## Related topics

- [Step 9: Pick your billing stack](/start/zero-to-paid/pick-billing-stack.md)
- [Choose a clearinghouse](/guides/billing/choose-a-clearinghouse.md)
- [Decide: in-house billing vs outsourced RCM](/guides/billing/in-house-vs-outsourced-billing.md)
- [Clearinghouse vs RCM vs EHR (vs biller)](/concepts/payments/clearinghouse-vs-rcm-vs-ehr.md)
- [When platforms bundle payroll and card processing](/concepts/banking/bundled-payroll-and-processing.md)
- [EHR/PM directory by segment](/reference/vendors/ehr-directory.md)
- [All-in-one platforms (payments/payroll bundling) reference](/reference/vendors/all-in-one-platforms.md)