The 5-dimension framework we used to evaluate 14 EHRs — built for digital health companies at Series A who need more than a vendor demo to make the right call.
Score each criterion from 1 to 4: 1 = major concern, 2 = significant gaps, 3 = acceptable with workarounds, 4 = strong fit. Complete a separate scorecard for each vendor you're evaluating. The score boxes are interactive — enter your numbers and the totals calculate automatically. Print or save to PDF when you're done.
Does the EHR actually match how your clinical team delivers care — or will your providers be working around it forever?
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The EHR supports your primary care delivery model (in-person, telehealth, hybrid) without significant workarounds
What workarounds is your clinical team running today?
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Clinicians can complete a standard visit note within the time normally available during a visit
Ask to see this live in a demo using your own patient scenario — not theirs
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Required documentation templates (SOAP, DAP, H&P, care plans, clinical assessments) exist natively or are configurable without custom dev
"Configurable" should mean clicks, not code
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The EHR accommodates your specialty-specific workflows (PT, behavioral health, concierge, fertility, etc.)
Generic EHRs often have a flagship specialty — make sure it's yours
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Can you build product on top of this EHR — or will you be locked into their UI forever?
| Criterion | Score |
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The EHR has a documented, publicly available REST or FHIR API
Ask for the API docs URL in the first demo — not just a yes/no
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API credentials are available at no additional cost and without special contract negotiation
"We can make that work" during sales is not the same as standard access
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You can build a fully custom patient-facing front-end on top of the API without architectural constraints
Test this with a real developer — not a sales demo
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The API supports webhooks or real-time events for critical workflow triggers
Polling is a workaround; webhooks are infrastructure
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Your EHR and your revenue cycle need to be designed for each other. Misalignment here creates invisible revenue leakage that compounds at scale.
| Criterion | Score |
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The EHR natively supports your primary billing model (fee-for-service, cash-pay, membership, value-based, or hybrid)
Retrofitting a billing model that isn't in the core product is expensive and fragile
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It handles all claim types, modifiers, and payer rules your practice requires
Ask about your top 5 payers specifically — not "do you support insurance billing" in the abstract
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ERA/EOB reconciliation and denial management are supported without third-party add-ons
"We integrate with X" adds cost, another contract, and another vendor dependency
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Your revenue cycle team can generate the financial reports they need without manual data exports
Export-to-spreadsheet as a standard workflow is a red flag for where you're going
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What happens when you outgrow this EHR? Build this into your evaluation — not your regret.
| Criterion | Score |
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You can export a complete, structured patient data dump in a standard format (FHIR, C-CDA, or structured CSV)
Don't take this on faith — test it with a sample record during due diligence
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The vendor has a documented migration guide and an established implementation partner ecosystem
"We'll work with you" is not a migration plan
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You have validated the completeness of the data export with actual patient records — not just API schema documentation
The delta between documented and actual is where migrations go wrong
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The vendor has a verifiable track record of successful migrations at your scale
Ask for two customer references who have migrated away from this EHR, not just onto it
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At 3am when your on-call clinician can't access a chart, who answers? "Submit a ticket" is not an answer in healthcare.
| Criterion | Score |
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There is a tested escalation path for clinical-blocking issues — not just a general ticket queue
This means you've actually called it. Not that it exists in the contract language.
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A dedicated CSM or implementation manager is assigned and personally accountable to your account
"Our support team" is not accountability — ask for a name
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You can speak to references at companies with a similar clinical model and comparable scale
Self-selected references still reveal patterns under probing — ask the uncomfortable questions
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Average P1 resolution time has been validated through customer references — not just SLA language in a contract
SLA commitments describe what they owe you. References describe what you'll actually experience.
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We didn't start with this scorecard — we built it during the process. After the first three vendor demos, it was clear that every vendor's sales deck covered the same ground in the same order. Clinical features. Billing. Integrations. Support. Pricing. The differences that actually matter — API accessibility, template flexibility, how the support team behaves when something breaks — only surfaced when we put a real workflow in front of the product.
We ran the same demo scenario across all 14 vendors: a real patient case, our actual clinical workflow, our actual documentation requirements. Same questions, same order. Same person running the demo wherever possible. The vendors that scored well on clinical workflow fit were obvious within 20 minutes. The ones that surfaced API limitations or support red flags usually didn't volunteer that information — we had to probe.
Migration Risk was the dimension most vendors hoped we'd skip. We didn't. We asked every finalist to demonstrate a structured data export with a test patient record. Two vendors couldn't. That alone removed them from consideration.
We selected Healthie. It wasn't the cheapest or the flashiest — it was the one that fit our clinical model, had the most flexible API, and had a migration path we could trust. We ran the full cutover across 19 clinics in a single weekend. Zero business downtime. Ahead of our own best-case timeline. And we eliminated $319K per year in platform costs in the process.
If you're navigating an EHR decision or suspect your current platform is costing you sprint capacity, I'm happy to walk through the scorecard together.