25 Questions to Ask an EHR Vendor Before Signing a Contract

A polished demo shows what an EHR can do. The contract determines what is included, what costs extra, who handles implementation, how support works, and what happens if you eventually leave.

Before signing an EHR contract, ask detailed questions about workflow, implementation, data migration, interoperability, security, pricing, support, and data portability. Use the following 25 questions as a practical EHR vendor checklist for solo, small, and midsize ambulatory practices.

Product Fit and Workflow

1. What types of medical practices is your EHR designed for?
Confirm that the system fits your specialty, practice size, care setting, and workflow. Specialty practices may need templates, orders, reports, or device integrations that are unnecessary in a general medical practice.

2. Which capabilities are native, and which depend on third parties?
Ask whether scheduling, billing, e-prescribing, telehealth, patient engagement, document management, AI documentation, and reporting are native modules or connected products. Also clarify who supports each component when problems occur.

3. How customizable are templates, forms, and workflows?
Ask what administrators can configure themselves and which changes require vendor assistance, custom development, or additional fees. Flexible software can reduce the need to redesign established clinical processes.

4. Can you demonstrate our real workflow?
Give the vendor common scenarios—such as a new patient visit, refill, referral, or telehealth encounter—and ask them to show the complete process from scheduling through documentation, billing, and follow-up.

Implementation and Data Migration

5. Who will manage implementation?
Identify who is responsible for configuration, training, data conversion, interfaces, testing, and go-live support. Ask whether your practice receives a dedicated implementation specialist or account manager.

6. What is the expected implementation timeline?
Request milestones and dependencies, not just a go-live date. The timeline should account for practice size, locations, customization, interfaces, migration, training, and the work expected from your staff.

7. What training is included?
Clarify whether training is live, recorded, role-based, or self-service; how many sessions are included; whether new employees can be trained later; and what additional training costs.

8. Exactly what data will you migrate from our current EHR?
Do not assume “data migration” means the complete record. Complete record migration may not be possible due to technical as well as cost reasons. Decide what information is must have for you. Ask about demographics, insurance, allergies, medications, problems, notes, documents, etc. Request the migration scope in writing.

9. What will migration cost, and how will accuracy be validated?
Ask about migration costs, how records will be validated. Ask about formats supported for data migration as the data export cost from current EHR may depend on format that is requested. Define how missing, duplicated, or incorrectly mapped data will be corrected before go-live.

10. Which interfaces and integrations will we need?
List your labs, imaging centers, clearinghouse, pharmacies, HIEs, medical devices, registries, and payment tools. Ask which connections already exist, which must be built, who pays, and how long activation takes.
Certification, Interoperability, and Data Access

11. Is the EHR ONC-certified, and which certification criteria apply?
Ask for the exact product version and its Certified Health IT Product List (CHPL) listing. The CHPL is ONC’s authoritative listing of certified health IT products.
Certification demonstrates conformance with specific certification criteria; it should not be interpreted as a general rating that one EHR is automatically “better” than another.

12. What FHIR and API capabilities are available?
Ask which standardized APIs are supported, what data is accessible, who can connect, and what fees or terms apply.
For certified API technology, ONC requires participating developers to publish API documentation, applicable terms and conditions, and material information about API fees.

13. How does the EHR exchange data with other organizations?
Ask about FHIR, C-CDA, Direct messaging, laboratory interfaces, HIE connectivity, and referral workflows. Instead of accepting “interoperable” as a feature, ask how staff will actually send, receive, reconcile, and use outside information.

14. How can patients access and share their records?
Review portal access, downloadable records, secure messaging, app access, and other patient-facing tools. Ask what information patients can access, when it becomes available, and whether any access features cost extra.

15. If we leave, how do we export our complete data?
Discuss this before signing.
Certified Health IT Modules that store electronic health information (EHI) are subject to ONC’s EHI-export certification criterion. The criterion includes electronic, computable exports covering individual-patient EHI as well as patient-population EHI.
Ask the vendor to demonstrate its export process and explain the formats, timing, included documents, and any fees or professional services required for a transition.

Security and Reliability

16. Will you sign a Business Associate Agreement?
If an EHR vendor creates, receives, maintains, or transmits protected health information on behalf of a HIPAA-covered practice, an appropriate Business Associate Agreement (BAA) is generally required.

HHS guidance explains that BAAs establish permitted uses and disclosures of PHI and include requirements related to safeguards, incident reporting, subcontractors, and other responsibilities.

Review the BAA during contract evaluation—not after the commercial agreement has already been signed.

17. What security controls protect our information?
Ask about encryption, multifactor authentication, role-based access, audit logs, backups, security monitoring, vulnerability management, and incident response.

Also ask an important follow-up question: Which controls are enabled by default, and which require configuration by our practice?

18. Where is our data hosted, and which subcontractors may handle it?
Understand the cloud environment, data locations, backup architecture, and important downstream service providers.

HHS advises healthcare organizations using cloud services to understand the cloud environment so they can conduct appropriate risk analysis and risk-management activities.

19. How do you handle security incidents and breach notifications?
Ask the vendor to explain its process for detecting, investigating, containing, and responding to security incidents involving patient or practice data.
Clarify how quickly your practice will be notified of a suspected or confirmed breach, what information will be provided, who is responsible for investigation and remediation, and how the vendor coordinates with your practice to meet applicable HIPAA breach-notification requirements.

Pricing, Support, and Contract Terms

20. What is the total cost—not just the subscription fee?
Request all recurring and one-time charges.
These may include implementation, interfaces, e-prescribing, EPCS, eligibility checks, claims, clearinghouse services, text reminders, telehealth, AI tools, support tiers, storage, additional locations, migration, and API services.

Compare vendors using the expected total cost of ownership over several years, not just the advertised monthly license.

21. How can pricing change?
Ask about price increases during the initial term, renewal pricing, notice requirements, and how providers or users are counted.
Define how part-time providers, locum providers, inactive accounts, additional staff, and new locations affect your fees.

22. What support is included?
Clarify support hours, phone availability, live chat, email, emergency procedures, escalation paths, and whether you receive an account manager.
Ask whether response targets are documented and whether faster or premium support requires an additional subscription.

23. Are updates and upgrades included?
Ask whether security patches, routine upgrades, certification-related changes, code updates, and major versions are included.
Also ask how much notice the practice receives before changes that could affect clinical or administrative workflows.

24. Who owns the data, and what rights does the vendor have to use it?
Review contract language covering practice information, PHI, de-identified or aggregated information, analytics, AI-related uses, subcontractors, data retention, and deletion.
Consider legal review when provisions affecting data ownership or data-use rights are unclear.

25. What happens when the contract ends?
Clarify the initial contract term, automatic renewal, cancellation notice requirements, early-termination fees, post-termination access, final invoices, data-export costs, transition assistance, and how long records remain available.

The agreement and BAA should also address what happens to PHI following termination. HHS’s sample BAA provisions include return or destruction of PHI at termination when feasible.

Red Flags During EHR Contract Negotiations

Potential warning signs include unclear data-export procedures, important fees disclosed late in the sales process, no written data-migration scope, uncertain support responsibilities, or sales promises that do not appear in the final contract.

Any commitment affecting cost, implementation, interoperability, data access, or your ability to leave the EHR should be documented in writing.

How Should a Medical Practice Compare EHR Vendors?

Start with your own requirements rather than the vendor’s feature list.

Define your must-have clinical workflows, billing requirements, integrations, reporting, patient engagement, interoperability, security expectations, implementation constraints, and budget. Then ask each shortlisted EHR vendor substantially the same 25 questions.

This produces a more meaningful comparison than selecting an EHR based only on price, brand recognition, or the appearance of a polished demo.

Nexus EHR is an ONC-certified, cloud-based platform designed for ambulatory and outpatient practices. It combines EHR, practice management, medical billing, telehealth, patient engagement, e-prescribing, interoperability, and AI-assisted clinical documentation in an integrated environment.

Practices evaluating Nexus—or any other EHR—should still use a structured evaluation process and make sure written contractual commitments match their clinical, operational, and financial requirements.

Frequently Asked Questions

What is the most important question to ask an EHR vendor?
There is no single answer for every practice, but data portability deserves special attention. Ask exactly how you can retrieve complete patient and practice data if you switch systems. Total cost, implementation responsibility, security, interoperability, and support are also critical.

Does an EHR have to be ONC-certified?
Not every medical practice is required simply because it uses an EHR to purchase an ONC-certified product. Certification may be important for specific regulatory programs, interoperability requirements, standardized API capabilities, or data-export needs.
Practices should verify both their own requirements and the exact certification status and criteria applicable to the product they are considering.

What should an EHR contract include?
An EHR contract should clearly address pricing, contract term and renewal, implementation responsibilities, support, service commitments, security and privacy obligations, data rights, termination provisions, and data-export procedures.

Material promises made during sales discussions should be reflected in the written agreement.

Final Takeaway

The best time to understand an EHR contract is before your practice becomes dependent on the system.

A strong EHR evaluation looks beyond screenshots and feature lists to implementation, interoperability, security, total cost, service commitments, data portability, and the ability to transition to another system in the future.

Asking these 25 questions before signing an EHR contract can help a medical practice reduce unexpected costs, identify important limitations earlier, and better understand the long-term relationship it is establishing with its EHR vendor.