EHR Frequently Asked Questions — Expert Answers for 2026

An EHR is a comprehensive digital record of a patient's health information — including medical history, diagnoses, medications, lab results, immunizations, and treatment plans — that is designed to be accessed and shared across multiple healthcare organizations. Unlike paper charts, EHRs enable real-time clinical decision support, electronic prescribing, automated billing, and secure data exchange between providers. Modern EHR systems also include practice management tools, patient portals, and telehealth capabilities.

An EMR (Electronic Medical Record) is a digital version of a patient's chart within a single practice — it replaces paper records but is not designed for external data sharing. An EHR (Electronic Health Record) is broader and interoperable, meaning it follows the patient across multiple providers, specialists, hospitals, and care settings. In practice, nearly all systems marketed today function as EHRs with data sharing capabilities, even if the vendor uses the term "EMR." When evaluating systems, focus on interoperability features rather than the label. See our glossary entry on EHR vs. EMR for more detail.

Any healthcare provider who documents patient encounters, submits insurance claims, or prescribes medications benefits from an EHR system. Federal regulations under the 21st Century Cures Act and CMS programs like Promoting Interoperability effectively require certified EHR use for practices that accept Medicare or Medicaid. Beyond compliance, EHRs improve clinical efficiency, reduce documentation errors, and enable data-driven care. Even small solo practices and behavioral health providers increasingly adopt EHRs to remain competitive and meet payer requirements.

Cloud-based EHR systems typically cost $150 to $700 per provider per month, with behavioral health and solo-practice platforms starting as low as $49 to $79 per month. Beyond the subscription, expect one-time implementation fees ($5,000 to $50,000), data migration costs ($2,000 to $15,000), and training expenses ($1,000 to $3,000 per provider). On-premise systems carry higher upfront licensing costs ($10,000 to $50,000+ per provider) plus ongoing maintenance. For a detailed breakdown by vendor and practice size, see our complete EHR cost guide.

Start by defining your clinical specialty, practice size, budget, and must-have features (e.g., e-prescribing, telehealth, billing). Then research vendors through independent sources like KLAS ratings, peer recommendations, and comparison guides. Request demos from at least three vendors, involve clinical staff in the evaluation, and check references from practices similar to yours. Finally, evaluate total cost of ownership rather than just the monthly subscription. Our step-by-step EHR selection guide walks through the entire process.

A behavioral health EHR should include specialty-specific features that general medical EHRs lack: treatment planning with goal tracking, progress note formats like DAP, BIRP, and SOAP, group therapy documentation and scheduling, 42 CFR Part 2 consent management for substance use disorder records, ASAM assessment tools, and support for multiple levels of care. Telehealth integration and a patient portal are also essential. See our behavioral health EHR comparison for vendor-by-vendor analysis.

The best EHR for a small practice depends on your specialty and workflow priorities. For general medical practices, athenahealth offers strong revenue cycle management, while DrChrono provides an affordable, mobile-first platform. For behavioral health solo practitioners, SimplePractice and TherapyNotes offer intuitive interfaces at accessible price points. Key factors for small practices include ease of use, total cost (not just subscription), quality of support, and how quickly you can go live. Read our best EHR for small practices guide for detailed recommendations.

SUD treatment programs need EHR systems with ASAM Criteria assessments, 42 CFR Part 2 compliant consent management, MAT workflows with PDMP integration, EPCS for controlled substances, bed management for residential programs, and state regulatory reporting. Leading vendors in this space include Netsmart (enterprise-scale), AZZLY Rize (mid-market), and PIMSY (smaller programs). Your choice depends on program size, levels of care offered, and whether you need integrated billing.

Implementation timelines vary significantly by practice size and complexity. A solo behavioral health practice using a cloud-based platform like SimplePractice or TherapyNotes can go live in 2 to 4 weeks. A mid-sized medical practice implementing a system like athenahealth or AdvancedMD typically needs 8 to 16 weeks. Large multi-site organizations deploying enterprise systems like Epic or Netsmart often require 6 to 18 months. Key variables include data migration scope, number of interfaces, customization requirements, and staff training needs. See our EHR implementation checklist for a phase-by-phase timeline.

Data migration is the process of transferring patient records, clinical data, billing history, and documents from your old system to your new EHR. It is challenging because source and destination systems rarely use the same data structures, field names, or coding standards. Common pitfalls include incomplete demographic data, unmapped diagnosis codes, lost document attachments, and duplicate patient records. Thorough data validation, field-by-field mapping, and test migrations are essential. Budget 4 to 12 weeks and $2,000 to $15,000 depending on volume. Our switching EHR systems guide covers the process in detail.

The most frequent mistakes include: underestimating the total cost and timeline, failing to involve clinical staff in vendor evaluation and workflow design, skipping thorough data migration testing, providing insufficient training (especially for older staff), trying to replicate paper-based workflows digitally instead of optimizing for the new system, and not designating internal "super users" to support colleagues post-go-live. Another critical error is going live on all modules simultaneously rather than phasing the rollout. Our implementation checklist helps you avoid these pitfalls.

ONC certification confirms that an EHR system meets federal standards for functionality, security, and interoperability as verified by an ONC-Authorized Certification Body. If your practice participates in Medicare, Medicaid, or CMS quality programs like MIPS, you are required to use Certified EHR Technology (CEHRT). Even if you do not participate in these programs, ONC-certified systems provide assurance of data security standards, FHIR API support, and compliance with information blocking rules. You can verify any vendor's certification on the ONC CHPL website.

Meaningful Use was a CMS incentive program (2011-2018) that established requirements for how providers should use certified EHR technology. It has been replaced by the Promoting Interoperability (PI) program, which shifts focus toward health information exchange, patient access via FHIR APIs, and electronic prescribing. While the term "Meaningful Use" is still widely used colloquially, the current requirements under PI are what matter for compliance. PI performance is scored as part of MIPS and directly affects Medicare payment adjustments.

42 CFR Part 2 is a federal regulation that provides extra privacy protections for patient records related to substance use disorder treatment, going beyond standard HIPAA requirements. Under Part 2, SUD treatment records cannot be disclosed without explicit written patient consent, even for treatment, payment, or healthcare operations. If your practice provides any SUD services, your EHR must support Part 2 compliant consent management, segmented data sharing to prevent unauthorized disclosures, and robust audit trails. Recent regulatory updates are aligning Part 2 more closely with HIPAA, but significant restrictions remain.

HIPAA requires EHR systems to implement administrative safeguards (role-based access controls, workforce training, security policies), physical safeguards (workstation security, device controls), and technical safeguards (encryption at rest and in transit, audit logging, automatic session timeouts, unique user identification). Your EHR vendor must sign a Business Associate Agreement (BAA) and maintain compliance with the Security Rule, Privacy Rule, and Breach Notification Rule. When evaluating vendors, verify that they conduct regular third-party security audits and maintain SOC 2 Type II certification.

e-Prescribing is the electronic generation and transmission of prescriptions directly from your EHR to the patient's pharmacy through the Surescripts network. It eliminates handwritten prescriptions, reduces medication errors through automatic drug interaction and allergy checking, and verifies insurance formulary coverage in real time. For controlled substances (Schedule II-V), EPCS adds DEA-mandated identity proofing and two-factor authentication. Most modern EHR systems include e-prescribing as a standard feature, though EPCS may require an additional module or fee.

A patient portal is a secure web application integrated with your EHR that gives patients 24/7 access to their health records, appointment scheduling, secure messaging, prescription refill requests, lab results, and billing statements. Patient portals are required under the Promoting Interoperability program and improve patient engagement, reduce phone call volume, and decrease no-show rates through automated appointment reminders. High portal adoption is also linked to better medication adherence and patient satisfaction scores.

Telehealth integration means your EHR system includes built-in or tightly connected video conferencing capabilities that allow providers to conduct virtual visits while maintaining full access to the patient's chart, documentation templates, and billing workflows. Integrated telehealth ensures that virtual encounters generate the same structured clinical notes and billing codes as in-person visits, eliminating the need for separate platforms. Following permanent post-pandemic telehealth policy expansions, most EHR vendors now offer native telehealth at no additional cost or for a modest per-visit fee.

A cloud EHR is hosted by the vendor on remote servers and accessed via a web browser, with the vendor handling maintenance, security, and updates. An on-premise EHR is installed on servers at your facility, giving you direct control but requiring in-house IT staff for maintenance, backups, and security. Cloud systems offer lower upfront costs, automatic updates, and anywhere access, while on-premise systems offer more customization control and data locality. As of 2026, the vast majority of new EHR deployments are cloud-based. Read our detailed cloud vs. on-premise comparison for a full analysis.