How to Choose an EHR for a Small Practice: A US Buyer's Guide

The JenPulse team · 5 October 2026 · 3 min read

A doctor typing on a desktop computer in a bright office
Photo: Vitaly Gariev on Unsplash

Switching EHRs is one of the most disruptive projects a small practice ever takes on, which is why it pays to choose carefully. The right system fades into the background. The wrong one adds clicks to every visit for years.

This guide walks through what a small US practice should check, in roughly the order it matters.

1. Decide whether you need a certified EHR

The federal Health IT Certification Program certifies EHRs against national standards. Whether you need a certified system depends on your situation:

  • If you participate in Medicare's Merit-based Incentive Payment System (MIPS) and report the Promoting Interoperability category, you need certified EHR technology
  • Some payer programs, health systems and value-based contracts also expect it
  • Many cash-pay, direct primary care and specialty practices outside MIPS have more flexibility

Ask each vendor for their certification details and check them on the official certified health IT product list. Don't rely on a logo.

2. Map your workflow before you see a demo

List what really happens in your practice: check-in, intake forms, vitals, documentation, orders, prescriptions, billing and follow-up. Note who does each step. Then ask vendors to demonstrate your workflow with a patient like yours, rather than their prepared tour. Time the common tasks: registering a patient, writing a note, sending a prescription.

3. Check the clinical essentials

  • Documentation that fits your specialty, with templates you can edit yourself
  • E-prescribing, including electronic prescribing of controlled substances (EPCS) if you prescribe them; Medicare Part D and many states now require it
  • Lab integration for orders and results with the labs you actually use
  • Problem lists, medications and allergies that stay accurate without duplicate entry

4. Look hard at billing

For most practices, billing is where software pays for itself or quietly loses money:

  • Real-time insurance eligibility checks
  • Claim scrubbing before submission and a connection to your clearinghouse
  • Clear tracking of denials and the reasons behind them
  • Patient statements and online payments
  • Reports on days in accounts receivable and collections

If you use an outside billing company, confirm the EHR works smoothly with them.

5. Patient access and the Cures Act

Under the 21st Century Cures Act, patients have the right to access their electronic health information, and practices must avoid "information blocking". In practice, you need a patient portal or app access that lets patients see results and notes in a timely way. Ask how the vendor supports this.

6. Understand the real cost

Ask for a written, all-in price for three years, including:

  • Subscription per provider (and whether staff users cost extra)
  • Implementation, training and data migration fees
  • Clearinghouse, e-prescribing, EPCS and text-reminder add-ons
  • Interface fees for labs or imaging
  • Price increases at renewal, and early termination fees

7. Read the contract for your exit

Your data belongs to your practice. Before signing, confirm in writing:

  • You can export all your data in a usable format at any time
  • What happens to your data, and for how long, if you leave
  • That the vendor will sign a business associate agreement

8. Test support before you need it

Ask about support hours, response times and whether you reach a person. Call two practices of your size and specialty that use the system, and ask what they would change.

A simple scoring sheet

Score each finalist from one to five on: clinical workflow, billing, patient access, ease of use for front-desk staff, three-year cost, data export and support. Give extra weight to the areas your team will feel every day. When it's close, choose the one your staff found easier.

A note on JenPulse

JenPulse is designed for small clinics that want straightforward scheduling, records, billing and telehealth with published per-provider pricing and full data export. It isn't ONC-certified today, so if your practice reports MIPS Promoting Interoperability, you will need a certified system. If that doesn't apply to you, you're welcome to try the live demo and judge the workflow for yourself.