Selection 11 min read

Best EHR for Oncology Practices (2026 Buyer Guide)

Oncology workflows are high-acuity, multi-disciplinary, and operationally complex. EHR selection must prioritize chemotherapy protocol management, tumor staging fidelity, clinical trial eligibility screening, and infusion documentation -- because mistakes in oncology charting carry patient safety consequences that most specialties never face.

What Oncology Groups Need That General EHR Buyers Miss

  • Chemotherapy regimen management with protocol-based ordering, dose-calculation verification (BSA, AUC), cycle tracking, and automatic hold/modification workflows when labs fall outside treatment thresholds
  • Tumor staging and restaging documentation using AJCC/TNM classifications with structured fields that update as disease status changes and feed into treatment-plan decision support
  • Clinical trial eligibility screening that matches patient demographics, diagnosis, staging, and prior treatment history against active trial criteria without requiring manual cross-referencing
  • Infusion center documentation including chair scheduling, pre-medication protocols, chemotherapy administration times, adverse reaction monitoring, and drug-waste calculation for buy-and-bill compliance
  • Multi-disciplinary care coordination with structured tumor-board documentation, radiation oncology handoffs, surgical referral tracking, and survivorship care-plan generation

Procurement Criteria for Oncology Practices

1. Chemotherapy protocol management and safety

During the demo, build a multi-agent chemotherapy regimen from an NCCN-recognized protocol. The system should auto-calculate doses based on patient BSA or renal function (carboplatin AUC), enforce cumulative dose limits (doxorubicin lifetime maximum), and generate automatic treatment holds when pre-chemotherapy labs (ANC, platelets, creatinine) fall below protocol thresholds. Test dose-modification workflows: when a cycle is reduced, the system should document the reason, adjust subsequent cycle doses, and update the treatment timeline. Any platform that treats chemotherapy ordering like standard medication prescribing is a patient safety risk.

2. Tumor staging and treatment-plan documentation

Validate structured AJCC/TNM staging entry with automatic stage-group calculation. The system should support restaging documentation that preserves the original staging while recording disease progression or response. Test that staging data flows into treatment-plan templates and is accessible to the tumor board, referring physicians, and clinical trial screening modules without requiring providers to re-enter staging information in multiple locations.

3. Clinical trial integration and eligibility screening

For practices participating in clinical trials, test how the EHR identifies potentially eligible patients. The system should match structured patient data (diagnosis, stage, biomarkers, prior treatments) against trial inclusion/exclusion criteria and surface candidates during clinical review. Validate that trial-enrolled patients have separate research documentation workflows that do not contaminate standard-of-care charting, and that protocol-mandated assessments generate reminders at correct intervals.

4. Revenue cycle controls for high-cost oncology services

Oncology revenue depends on accurate buy-and-bill drug reimbursement, infusion administration coding, and prior authorization for targeted therapies and immunotherapies. Test J-code assignment for chemotherapy drugs, drug-waste documentation and reporting, administration-time capture for complex infusion billing, and prior auth tracking for high-cost agents. Request denial-rate data from reference clients specifically for chemotherapy and immunotherapy codes -- a 2% denial rate on $10,000+ drug claims creates massive revenue exposure.

Red Flags in Oncology EHR Selection

  • Chemotherapy ordering that does not enforce protocol-based dosing, cumulative dose limits, or automatic lab-threshold treatment holds
  • Tumor staging stored as free-text rather than structured AJCC/TNM fields with automatic stage-group calculation
  • No clinical trial eligibility screening capability, requiring manual cross-referencing of patient charts against trial criteria
  • Infusion documentation that does not capture start/stop times, drug-waste volumes, or adverse reaction details required for billing compliance and safety reporting

Implementation Guardrails

  • Build and validate your top 20 chemotherapy regimens in the system before go-live, with oncology pharmacist sign-off on dose calculations and safety checks
  • Pilot in one infusion suite first, measuring chair utilization, documentation completion time, and billing accuracy from week one
  • Establish tumor-board documentation workflows and multi-disciplinary care-plan templates during implementation, not as a post-go-live phase
  • Track drug-claim denial rates, average days to reimbursement, and prior authorization turnaround at 30/60/90 days against pre-migration baselines

Bottom Line

Oncology buyers should demand real workflow proof, not generic feature lists. A system that protects both clinical safety and revenue-cycle reliability will outperform on long-term value. Run chemotherapy protocol scenarios, test staging workflows, and verify infusion billing accuracy with live data before signing any contract.

Next Steps