A few years ago, I led an evaluation of 14 EHRs before we chose one. Here's what I wish I'd known going in.
The number that matters most isn't the licensing fee. It's the engineering tax — the hours per sprint your team will spend maintaining the integration instead of building product.
We built a scorecard: clinical workflow fit, API flexibility, billing compatibility, support responsiveness, and cost. But also the questions that don't show up on a pricing sheet — how much custom front-end work will this require? What's the migration risk if we outgrow it?
We selected Healthie. We ran the full cutover across 12 clinics and nationwide telehealth in a single weekend: zero business downtime, ahead of our own best-case timeline.
The old platform's licensing fee was never the real cost. The maintenance tax was — the engineering hours it consumed every sprint. Healthie eliminated both: a few hundred thousand dollars a year in direct platform costs, and a team that could finally get back to shipping product instead of babysitting an integration.
With AI tooling now, the speed delta between a good and bad architecture decision is larger than it's ever been.
The evaluation methodology is the part most teams skip because they don't have a template for it. Full scorecard here →