Electronic health records (EHRs) are a given in healthcare. And yet physicians rate them “with a median System Usability Scale (SUS) score of just 45.9/100, placing them in the bottom 9% of all software systems.” Not exactly a ringing endorsement.
I have found that dissatisfaction rarely comes from one issue. There are usually a whole host of reasons why clinicians, staff and organizations are unhappy, typically related to administrative burdens that distract from patient care or hidden costs that make systems less palatable. These concerns can lead to EHR jumping, which is not without its own headaches and costs. This begs the question: Where are healthcare organizations going wrong?
EHRs are traditionally chosen based on feature lists and license fees, which seems straight forward enough. But the true cost of switching EHRs extends well beyond license fees, and this fact tends to come to light only after a contract is signed. The reality is that when transitioning from one EHR to another, costs and frustrations can quickly balloon.
The real costs of switching are rarely visible upfront
Exporting, cleansing, mapping and validating years of patient records when migrating EHR systems is a massive technical, clinical and operational undertaking. For multiprovider organizations with complex histories, even small inconsistencies can ripple into documentation gaps, billing errors, or compliance risks. And integration costs can vary significantly.
Workflow disruption is also often underestimated. Even when systems are configured to mirror existing processes, I have seen the real world test these limits. Edge cases translate to ongoing system refinement, as what looked efficient during a vendor demo could feel very different during a busy clinic day.
Then there is the human factor. Staff capacity, training, communication, and leadership alignment all play a role in successful adoption of a new EHR. Without clear expectations and support from the onset, productivity dips can linger longer than anticipated, which costs the practice time, money and frustration.
On top of this, long-term cost structures are frequently misunderstood. Aside from the quoted subscription pricing, organizations must consider integrations, support tiers, API usage, maintenance, and scaling costs. These can materially change the total cost of ownership; the system that seemed quite affordable at signing looks very different three years into the engagement.
Another often overlooked expense is the cost of separation, should they decide to go with another vendor later. Many charge thousands of dollars for structured data exports and compliance handoffs at contract termination. So, when you negotiate for your next EHR, you can’t just think about the relationship you’re entering; you must consider what that looks like if or when you leave.
A weighty decision
Many of these challenges are not new. What is new is how consequential they’ve become. Choosing the right EHR is about more than just a documentation system. Healthcare organizations have to think bigger. They need platforms that support AI-driven workflows, interoperability requirements, and new care delivery models to keep up with the radical transformation taking place in healthcare today. If an EHR can’t adapt, the cost isn’t just financial — it’s strategic.
I see many organizations still treating EHR selection as an IT project, which is a mistake. When this happens, clinicians are required to use a tool they did not choose. It likely doesn’t meet their needs, so engagement drops and workarounds crop up. Staff fight the system. Training gets pushed, then shortened, then ultimately quietly abandoned when everyone moves on to the next operational priority. It all adds up to wasted time, money and trust in the system itself.
EHR migration is an opportunity — with the right planning
Even with all of these challenges, changing EHRs is not a bad move. In fact, it can really help a practice differentiate its care and aid in the satisfaction of clinicians and staff when done right. Making a change just requires forethought.
The organizations that navigate EHR transitions successfully tend to approach them differently from the outset. They not only have a “people plan” pertaining to who they involve in EHR selection, training, deployment and onboarding, but they also think about what specific commitments they need to lock into their contracts.
For example, data ownership and export terms should be explicit. You want defined support formats, clear timelines, and predictable exit fees documented in the agreement. Skip this step and you might pay the price later.
Also, API access matters more than it did five years ago. AI tools, remote monitoring platforms, and patient engagement applications are becoming core infrastructure. Systems that are difficult to integrate, extend or adapt could become a stranglehold. You want a partner that emphasizes openness and flexibility. Standards-based interoperability, transparent pricing models, and predictable access to data are increasingly seen as prerequisites to innovation. Without them, even the most advanced tools — AI copilots, remote monitoring solutions, patient engagement platforms, and so on — remain difficult to deploy at scale.
From technical change to strategic advantage
EHR switching involves risk. But practices that take a life cycle view, considering data migration, workflow configuration, training, downtime, ongoing fees and eventual exit terms, can put an end to their EHR pain. These organizations realign workflows, empower clinicians, and create a foundation for future innovation rather than optimize for the initial contract. This is good business on every level.
So, the features list matters, and license fees matter. Let’s not pretend they don’t. But taking a longer-term view and carefully considering your vendor partnership along with the terms you negotiate before you sign matters more.
In the end, the question isn’t which EHR you choose. It’s whether the system you choose will evolve with you or quietly hold you back.
Image: metamorworks, Getty Images
Venky Chellappa is a founding team member and vice president, strategic partnerships at CharmHealth, a leader in healthcare technology solutions for providers. In this capacity, he has grown CharmHealth from a startup venture to one of the leading EHR vendors, offering fully integrated solutions to the ambulatory and healthcare industries. In addition, Venky serves as one of the managing partners of the CharmHealth+Bioverge Digital Health Transformation Fund. His goal is to bring innovative ideas to the point of care along with CharmHealth. He received a Ph.D. in engineering from Auburn University and an MBA from Kellogg Graduate School of Management at Northwestern University.
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