A vendor-neutral decision workbook for healthcare organizations
50 Questions for a Better EHR Decision
An EHR decision can reshape clinical work, technology, staffing, finances, data access, vendor relationships, and organizational independence for years.
Before You Choose an EHR helps healthcare organizations ask the questions that deserve answers before the hardest decisions become difficult to reverse.
Evaluate the evidence. Expose important unknowns. Understand the tradeoffs. Make a decision you can defend.
This workbook is not designed to persuade you toward—or away from—Epic or any other EHR. It is designed to help your organization determine whether the best-supported decision is to retain, improve, or replace its current environment—and, if replacement is appropriate, to make that choice with its eyes open.
- 50 carefully developed decision questions spanning clinical workflow, technology, interoperability, data, security, implementation, economics, contracts, governance, vendor dependence, and exit strategy.
- Follow-the-answer prompts and red flags that help teams investigate beyond superficial answers and vendor demonstrations.
- A practical team workbook designed to record evidence, ownership, unresolved questions, next actions, and decision impact.
Digital PDF · 59 pages · First Edition · Version 1.0
A Better EHR Decision Starts Before the Demo
EHR decisions are extraordinarily complex. Clinical needs, workflow, technology, interoperability, cybersecurity, privacy, implementation, staffing, contracts, cost, governance, and long-term flexibility can all affect whether a decision succeeds.
Yet organizations can become focused on products and demonstrations before some of the most important questions have been clearly answered.
What problem are we actually trying to solve? Is replacement really better than improving what we already have? Which workflows must be demonstrated end-to-end? What happens when an interface fails? Have backups actually been restored? Which vendor promises belong in the contract? What happens to our data and operational freedom if we eventually want to leave?
Before You Choose an EHR brings these questions into one structured decision process.
Designed for the People Who Actually Have to Make the Decision
The workbook is designed to be used across the organization—not handed to one person to complete from beginning to end. Different questions belong with the people closest to the evidence.
- Executive and governing leadership
- CIOs, CTOs, CMIOs, and IT leadership
- Physicians, nurses, and other clinical leaders
- Security, privacy, and compliance professionals
- Finance, procurement, and contracting teams
- Implementation and operational leaders
- Analysts, architects, interface teams, and technical staff
- Independent advisors and consultants supporting EHR decisions
Participants can investigate the questions relevant to their expertise, record evidence and unresolved issues, and bring consequential findings back into the organization’s legitimate decision process.
Prepare individually. Investigate collaboratively. Decide through the organization’s legitimate governance.
50 Questions Across the Entire Decision
An EHR decision is not merely a software selection. The 50 questions examine nine interconnected areas that can determine whether the decision ultimately succeeds.
- Purpose, Need, and the Case for Change
Are we solving the right problem—and is replacement actually necessary? - Clinical Work, Patients, and Real-World Workflow
How will the system affect the way care is actually delivered? - Architecture, Integration, and Technical Fit
Will the technology work reliably within the organization’s real environment? - Data, Access, Interoperability, and Organizational Freedom
Can the organization use, exchange, protect, and retain practical control of its information? - Security, Privacy, Resilience, and Safety
What happens when systems, controls, people, or assumptions fail? - Implementation, People, Training, and Operational Change
Can the organization successfully move from selection to competent everyday use? - Economics, Contracts, and Vendor Relationship
What will the decision really cost—and how will the relationship change after commitment? - Governance, Influence, and Decision Integrity
Can important evidence and legitimate dissent reach the people responsible for the decision? - Future Flexibility, Exit, and the Long View
What happens if today’s good decision becomes tomorrow’s wrong one?
Some of the Questions You May Be Glad You Asked
What evidence shows that replacing the current EHR is better than improving it?
Which workflows and handoffs must be demonstrated end-to-end before selection?
What systems must the EHR communicate with on day one—and what happens if any one of those connections fails?
What does the ransomware and cyber-recovery strategy actually require?
Which costs can the vendor change after the organization becomes dependent on the platform?
Can knowledgeable participants present evidence against a favored solution without reasonably fearing retaliation?
What evidence would cause us to reconsider this decision before signing?
Can we explain this decision simply and defensibly?
The objective is not to produce fifty perfect answers before anyone can act. The objective is to identify which answers matter most, what evidence is sufficient, what remains unknown, who owns the next action, and what could change the decision.
Ask enough to know when you are ready to move—and then move.
See What’s Inside
You don’t have to take my word for what the workbook contains. Take a look at several representative pages and see whether the questions would improve a real EHR decision in your organization.
Question 2 — What evidence shows that replacing the current EHR is better than improving it?
This immediately demonstrates neutrality. It tells an executive that we’re not assuming a multimillion-dollar replacement is necessary.
Question 25 — What does the ransomware and cyber-recovery strategy actually require?
This is one of my favorites because it demonstrates the workbook’s follow the answer philosophy. “We have backups” isn’t enough; have you actually demonstrated that you can restore a realistic environment?
Question 35 — Which costs can the vendor change after the organization becomes dependent on the platform?
This demonstrates that we’re thinking beyond purchase price and into long-term economics and negotiating leverage.
These aren’t checklist questions intended to produce a quick yes or no. Each question includes why it matters, follow-the-answer prompts, a red flag or reason to investigate, and structured space for evidence, ownership, next actions, and decision impact.