EHR Integration Checklist: Questions to Ask Before You Sign
Integration costs and limitations are where EHR business cases quietly fall apart. These are the questions that surface them before the contract, not after.
Healthcare SBC Integration Team
Interoperability Engineering ·
EHR selection usually focuses on clinical workflow demos. The costs that actually derail the business case are almost always integration-related, and they surface after signature.
Interfaces and fees
- What does each interface cost to build, and what is the recurring monthly fee?
- Are lab, imaging, HIE and pharmacy interfaces included or priced separately?
- What is the typical timeline to build and certify a new interface?
- Who pays when a trading partner changes their specification?
- Is there a charge to connect a third-party application via the FHIR API?
Standards support
- Which HL7v2 message types are supported, and in which direction?
- Is the FHIR API complete for the certified resources, or partial?
- Can the system both generate and consume CCDA documents?
- Is bulk data export supported for analytics and population health?
- Which HIEs and national networks are already connected?
Data ownership and exit
Get explicit contract language stating you own your clinical and financial data. Then ask the harder question: in what format can you export it, at what cost, and how long does it take?
Many practices discover at renewal that a complete export including documents and images is a five-figure professional services engagement. That's the moment your negotiating leverage disappears, so settle it before you sign.
Migration reality
- What data is migrated by default: demographics, schedules, charts, documents, images, open A/R?
- What is discrete versus what arrives as a flat PDF?
- How is migrated data reconciled and validated, and by whom?
- How long is legacy system access retained after go-live?
- Who works legacy A/R during the transition?
The question that reveals the most
Ask for a reference from a client who left the platform, or one who completed a complex integration in the last year.
Vendors are prepared for happy-reference calls. They are rarely prepared for that request, and the response, including a refusal, tells you a great deal.