What Is an Electronic Health Record (EHR)? A Practical Guide for Independent Practices

What Is an Electronic Health Record (EHR)?

An electronic health record (EHR) is the digital chart your practice uses to store each patient’s health information and add to it with every visit. It keeps diagnoses, lab results, medications, and doctors’ notes in one running record that only authorized staff can open. 

Nearly every medical office runs on one today.

• In 2008, about 4 in 10 office-based physicians used any EHR. 
• By 2024, 91% used a certified EHR, according to adoption data from the Office of the National Coordinator for Health Information Technology (ONC). 
• Solo physicians had the lowest rate, at 79.9%.
• Only about 32% of solo physicians used a system from the five biggest vendors, while 34% used systems from smaller companies.

If you run an independent practice, you’re choosing from a wider and less predictable field than a hospital-owned group does. Choosing well starts with knowing what an EHR should hold.

What Information Does an EHR Hold?

Every EHR should hold what you need to treat a patient and get paid for the visit.

• Name, contact details, and insurance
• Problem list, diagnoses, and past history
• Medications, allergies, and vaccines
• Visit notes, orders, lab results, and imaging reports
• Referrals, care plans, and patient messages

Your specialty changes the mix. A therapist needs session notes and progress scores, while a cardiologist needs device readings and test images.

How the system saves data matters as much as what it saves. A lab value stored in its own field can trigger an alert, count toward a quality report, or travel to another office in a form that office can use. The same value inside a scanned page can’t do any of that. Federal rules define a standard set of these fields, the United States Core Data for Interoperability (USCDI), so systems across the country label the same information the same way. 

Stored data only becomes useful through the features built on top of it.

What Are the Core Features of an EHR?

The core features of an EHR turn stored data into daily work.

Feature	What it does for your practice
Charting and templates	Structured notes built for your specialty
Computerized provider order entry (CPOE)	Sends lab, imaging, and medication orders electronically
E-prescribing	Sends prescriptions straight to the pharmacy
Clinical decision support	Flags allergies, drug interactions, and care gaps
Lab and imaging connections	Pulls results into the chart
Patient portal	Shares results, messages, and forms with patients
Telehealth	Records video visits in the same chart
Quality and registry reporting	Sends quality measures to Medicare and vaccine data to state registries

How Does an EHR Work During a Patient Visit?

From check-in onward, the EHR moves one patient’s information through each step of the visit.

Step	What happens in the EHR	Outside link it needs
Check-in	Registration, insurance check, intake forms	Insurance eligibility service
Exam room	History review, medication update, note, orders	Lab connection
Checkout	Prescriptions sent, visit codes passed to billing	Pharmacy network, clearinghouse
Afterward	Results arrive, follow-up goes out	Patient portal

When an outside link is missing, your staff fills the gap by phone or fax. The last step, results arriving, now reaches the patient as fast as it reaches you.

Can Patients See Their Test Results Before You Do?

Yes, in most cases. A recent research review notes that federal law requires patients to get immediate access to their lab results through portals once the results are ready. Results can be held back only under a few exceptions.

So a patient can open an abnormal result at home before you’ve called. The same review found many patients liked seeing results right away, but struggled to tell normal values from abnormal ones or to know which results needed action.

Most of your patients already use these portals. ONC’s latest national survey data shows how common they are.

Patient portal measure	Share of individuals
Offered online access by a provider or insurer	77%
Offered access and opened their records	65%
Encouraged by their provider to use the portal, among those offered access	89%
Used an app to reach their records, among those who accessed them	57%
Had more than one portal	59%

Since most patients juggle more than one portal and over half reach their records through an app, a phone-friendly portal fits how they already work.

Results and the portal sit on the clinical side of your software, while scheduling and billing usually sit on the business side.

How Is an EHR Different From Practice Management Software?

Patient care lives in the EHR, while practice management software runs the business side of your office.

Software	What it handles
EHR	Notes, orders, prescriptions, results
Practice management	Scheduling, insurance checks, claims, payments

Some vendors build both on one shared patient database. Others sell them as separate products that sync. With a shared database, a diagnosis typed in the note lands on the claim without anyone retyping it. With two systems, every sync error becomes a billing task.

Vendors mix up two other product names just as often, EHR and EMR.

What Is the Difference Between an EHR and an EMR?

The term electronic medical record (EMR) means a digital chart kept inside one practice. An EHR is built to follow the patient to other doctors, labs, and hospitals. A personal health record (PHR) is a third type, one the patient controls.

Record type	Who controls it	Where it goes
EMR	One practice	Stays in your office
EHR	The care team	Across providers
PHR	The patient	Wherever the patient shares it

The label on a product says nothing about its age or quality, and many products sold as EMRs share data well. Small practices sometimes hear that a basic EMR is all they need. Yet 90.2% of physicians in two- or three-doctor groups used a certified EHR in 2024. 

Beyond the label, what matters is how the system is built and where it runs.

What Are the Main Types of EHR Systems?

EHR systems differ in where they run and who they’re built for.

Type	How it runs	What you take on
Cloud-hosted	Vendor runs the servers, and you log in through a browser or app	Reliable internet and vendor uptime
On-premise	Servers sit in your office	Hardware, updates, and backups
Hybrid	Some parts local, some in the cloud	Two sets of responsibilities
Specialty-specific	Templates and workflows for one field	Less flexibility if you add services
Multispecialty	Broad templates across fields	More setup to fit your specialty

Whichever type you lean toward, certification is the next thing to check.

Does Your Practice Need a Certified EHR?

You need a certified EHR to earn points in the Promoting Interoperability category of the Merit-based Incentive Payment System (MIPS), Medicare’s quality program for clinicians.

• That category makes up 25% of a traditional MIPS score. 
• Practices with 15 or fewer eligible clinicians qualify automatically to have that category reweighted.

For many small practices, MIPS points are a weak reason to buy certified. The stronger reason is the data export that certification guarantees, covered a few sections ahead.

The federal listing doubles as a research tool. You can confirm any product’s status in the Certified Health Information Technology Product List (CHPL) through ONC’s free product list. The listing also includes usability test results, plus any compliance problems found through federal surveillance and how they were corrected. 

Certification isn’t proof of security. ONC has proposed a rule called HTI-5 (Health Data, Technology, and Interoperability) that would remove or revise more than half of the current certification requirements, including the privacy and security ones. It had not been finalized as of the latest federal updates. If it becomes final, a certified label won’t confirm features like multifactor login. 

Separate from certification, controlled substance prescriptions follow their own federal rules.

Can Your EHR Handle Controlled Substance Prescriptions?

Your EHR must meet Drug Enforcement Administration (DEA) rules before you can e-prescribe controlled substances. The Centers for Medicare & Medicaid Services (CMS) says prescribers sending controlled substance prescriptions electronically must use e-prescribing software that meets all DEA requirements.

Medicare adds its own rule on top, explained in the CMS program overview.

• Prescribers must e-prescribe at least 70% of their Schedule II to V controlled substance prescriptions for Medicare Part D patients. 
• Prescribers who issue 100 or fewer qualifying prescriptions in a year are exempt.
• Many states set their own e-prescribing rules for controlled substances, separate from the CMS program. 

Prescriptions move data out of your office one patient at a time. Switching vendors means moving every record at once.

Can You Get Your Data Out of an EHR?

Certified EHRs must let you take your data with you.

• One patient at a time: Certified systems that store electronic health information (EHI) must offer an EHI export. Your staff can export one patient’s full record whenever needed, without the vendor’s help.
• Your whole practice: These systems must also offer an export of every patient’s record for switching to a new system. This export may need some vendor help.

Export fees have limits. Under federal information blocking rules, a fee for using that certified export to switch systems doesn’t qualify for the rules’ fee exception. Neither does an export or conversion fee that wasn’t agreed to in writing when the system was bought. Loading the data into your new system is a separate job, usually part of the new vendor’s migration work.

The same rules apply to your practice, and breaking them costs money. The Department of Health and Human Services (HHS) set Medicare penalties for providers who knowingly block access to patient data without a legal reason or an allowed exception.

• A clinician found to have blocked information gets a zero in the Promoting Interoperability category, which caps the best possible MIPS score at 75 points, even with perfect marks everywhere else.
• A provider in an accountable care organization can be barred from the Medicare Shared Savings Program for at least one year. 
• When a group reports MIPS together, the penalty applies at the group level, so one person’s blocking can hurt every clinician in the group.

The HHS Office of Inspector General says it will focus on blocking that harms patients, seriously disrupts care, continues over time, or causes losses to federal health programs. The Office of Inspector General and ONC have also issued a joint alert signaling coordinated investigations.

Sending data out on request is one side of sharing. Pulling outside data in is the side most offices still struggle with.

How Well Do EHRs Share Data With Labs, Pharmacies, and Hospitals?

EHRs share data through direct connections, health information exchanges, and modern standards like Fast Healthcare Interoperability Resources (FHIR). Even so, ONC’s latest burden data on family physicians shows how much still slips through.

Outside medication lists	Share of family physicians
Often arrive automatically	32%
Also easy to find	21%
Also easy to reconcile	13%

The share of physicians reporting a heavy burden tracking down outside records dropped from 43% to 38% over the past two years. ONC points to wider FHIR-based sharing and the Trusted Exchange Framework and Common Agreement (TEFCA), a nationwide data-sharing network, as the path to easier access.

Every gap in those connections shows up on someone’s schedule as extra work.

What Are the Benefits and Limitations of an EHR?

The biggest benefit of an EHR is having the right information in front of you during the visit. The biggest limitation is the time it can take.

Burden among family physicians	2024	Latest
3+ hours a day charting after work	41%	34%
Heavy prior authorization burden	54%	58%

Source ONC, based on more than 8,400 family physicians.

Prior authorization is the burden still growing, and the American Medical Association (AMA) puts numbers on it.

• Practices complete an average of 40 prior authorization requests per physician each week.
• Those requests take 13 hours of physician and staff time weekly. Over 50 working weeks, that adds up to about 650 hours a year for each physician. 
• 40% of physicians have staff who work only on prior authorization.

ONC’s HTI-4 rule added certification requirements for electronic prior authorization. ONC also found that fixing one burden at a time barely helped, because missing data, paperwork, and slow processes feed each other. 

Two everyday problems can add to the load. Frequent pop-up alerts can train clinicians to click past warnings, and copied-forward notes can carry stale details into today’s visit. Careful setup and training reduce both.

A system that saves time still has to keep patient data safe.

Is a Cloud EHR HIPAA Compliant?

A cloud EHR can help you meet the Health Insurance Portability and Accountability Act (HIPAA), but software alone never makes a practice compliant. HHS guidance says a cloud company that stores your patient data is a business associate even if it holds only encrypted data and has no key to unlock it. You need a signed business associate agreement either way.

Moving to the cloud takes the server out of your office. Your practice still handles devices, login permissions, and a plan for working through an outage. You also owe your own security risk review, and the federal government offers a free tool to help you complete one.

Under the current HIPAA Security Rule, encryption is ‘addressable.’ That means you assess the risk, choose a reasonable safeguard, and document the decision. HHS has proposed an update that would make encryption and multifactor login required, with July 2027 listed as the target date on the federal agenda. The current rule applies until then.

Skipping these steps carries a price. HHS adjusts HIPAA civil penalties for inflation every year. The current amounts are below. 

Penalty tier	Per violation	Yearly cap per identical violation
Did not know	$145 to $73,011	$2,190,294
Reasonable cause	$1,461 to $73,011	$2,190,294
Willful neglect, fixed within 30 days	$14,602 to $73,011	$2,190,294
Willful neglect, not fixed	At least $73,011	$2,190,294

Penalties are only one cost of weak security. A breach brings costs of its own.

How Big Is the Data Breach Risk for Small Practices?

Healthcare data breaches hit practices of every size.

• In the first five months of this year (2026) alone, 319 large breaches reported to the HHS Office for Civil Rights affected at least 21 million people.
• One recent monthly list included small practices with around 500 affected patients each, and every breach that month affecting 10,000 or more people was a hacking incident.
• IBM’s latest Cost of a Data Breach Report puts the worldwide average healthcare breach at $6.64 million, the highest of any industry.
• The same report found phishing was the most common way attackers got in.

With phishing and hacking behind so many breaches, multifactor login, staff training on suspicious emails, and tested backups protect your practice whichever EHR you choose.

New artificial intelligence (AI) tools inside the EHR raise the same questions about who protects the data they capture.

Who Are the Top AI-Powered EHR Vendors?

The leading AI-powered EHRs center on ambient scribes, tools that listen to the visit and draft the note for the clinician to review and sign. Physicians are adopting AI fast.

• The AMA’s latest AI survey found more than 80% of physicians now use AI professionally, double the 2023 rate. 
• 30% use AI to create discharge instructions, care plans, or progress notes.
• 86% say data privacy is critical for wider AI adoption, and 88% want strong safety and efficacy testing.

KLAS Research reports that Epic, Oracle Health, athenahealth, and eClinicalWorks are all rolling out built-in ambient tools, which some organizations prefer for simpler setup and fewer vendors. 

Vendor	Built-in AI tool	Ask about
athenahealth	athenaAmbient	Which ambient model suits your specialty
eClinicalWorks	Sunoh.ai	Whether the scribe is in your price
Epic	AI Charting in Art	Fit for a small practice
OmniMD	AI Medical Scribe, AI Front Desk	References in your specialty
Oracle Health	Clinical AI Agent	Moving from older Oracle systems

athenahealth: athenahealth has rolled out athenaAmbient inside athenaOne. It drafts the note, diagnoses, orders, and prescriptions from the conversation, at no added cost.

eClinicalWorks: Its ambient scribe, Sunoh.ai, is owned by healow, the patient engagement platform eClinicalWorks built. 

Epic: Epic released AI Charting as part of Art, its AI for clinicians. It listens during the visit, drafts the note, and queues orders from what was said. Epic is also the most-used EHR among office-based physicians, at 27.7%. 

OmniMD: We offer more than 25 products, including an EHR, practice management, an AI Front Desk, an AI Medical Scribe, and AI revenue cycle tools. Its EHR is listed on ONC’s CHPL. Clinical, front desk, and billing work can all run through one vendor.

Oracle Health: Oracle’s new AI-powered EHR earned ONC certification for ambulatory providers and includes its clinical AI agent, voice navigation, and conversational search.

Whichever scribe you pick, the results depend on how often your clinicians use it.

What Results Can You Expect From an AI Scribe?

AI scribes save measurable time, and the savings grow with use. A large multisite study published in the Journal of the American Medical Association (JAMA) measured how AI scribes changed clinicians’ time and visit numbers. 

Finding	Result	Over a year of 220 eight-hour clinic days
Documentation time saved per 8 hours of patient care	About 16 minutes	About 59 hours
Time saved by clinicians using the scribe on at least half their visits	27.3 minutes	About 100 hours
Share of users who reached that level of use	32%	Roughly 1 in 3 users
Added revenue from extra visits	About $167 per clinician per month	About $2,000 per clinician

Time spent in the EHR outside work hours didn’t differ meaningfully between scribe users and non-users. A separate study of 263 outpatient clinicians found burnout fell from 51.9% to 38.8% after 30 days of scribe use. 

A clinician who uses the scribe on at least half of visits saves about 41 more hours a year than the average user. That gap makes training and steady use as important as the tool you pick.

The scribe’s price belongs in your total cost alongside everything else.

How Much Does an EHR Cost?

Total EHR cost falls into four groups, and most quotes lead with only the first.

Cost group	What it includes
Ongoing	Subscriptions, support, add-on modules, AI features
One-time	Setup, data migration, connections, testing
Staff	Training, slower launch weeks, project hours
Exit	Export help, cancellation terms, overlap months

For subscriptions, the software directory Software Finder lists typical ranges by practice size.

Practice size	Typical subscription per provider per month
Solo provider	$300 to $900
2 to 5 providers	$250 to $800
6 to 20 providers	$200 to $700

Over a 60-month contract, a three-provider practice at $250 to $800 per provider each month spends $45,000 to $144,000 on subscriptions alone, before setup, migration, connections, training, or AI add-ons.

Ask each vendor for a written quote covering all four cost groups for your exact number of providers, with each lab connection and AI feature priced separately.

When those costs keep climbing on your current system, it may be time to move.

When Is It Time to Switch EHRs?

It’s time to look at a new EHR when the current one creates more work than it saves. Watch for these signs.

• Support tickets sit for days without answers.
• Renewal brings price increases with no new features.
• The vendor stops updating your version or ends support for it.
• Staff track work in spreadsheets because the system can’t.
• Your practice adds a service the templates can’t handle.

If two or more sound familiar, start comparing options well before your contract renews.

How Should You Evaluate an EHR Before You Sign?

The surest way to judge an EHR is to test it against your own visits, staff, and contract. Bring this scorecard to every demo.

Ask the vendor	A strong answer sounds like
Can we run our five most common visits live?	Yes, with your templates, not a canned demo
Which features are built in, and which need another product?	A clear list, including what stays manual
How do new results reach me?	An alert before or as the portal releases them
Which lab and imaging connections are live near us?	Named labs already connected
Do you connect to TEFCA?	Yes, or a firm date
Do you support electronic prior authorization?	Shown working in the demo
Can we e-prescribe controlled substances?	Yes, with DEA identity proofing and two-factor signing
Can you show multifactor login and activity logs?	Shown on screen, not described
What are the full-practice export terms?	A deadline and any fees in writing
How many clinicians use your AI scribe on most visits?	A usage figure from practices like yours
Who signs AI drafts, and where is audio stored?	The clinician signs, with a stated retention period
Does the business associate agreement cover the AI?	Yes, in the contract language
Who supports launch, and for how long?	Named staff for a set number of weeks
How do we see charts during downtime?	A read-only backup or offline access plan
Can we call two practices like ours?	Same specialty and size, provided promptly

A vendor that answers well still needs your team ready on launch day.

How Do You Prepare Your Practice for EHR Implementation?

Getting ready for an EHR launch comes down to mapping your workflows, cleaning your data, and training each role before the first patient arrives.

1. Map your visits: Write down how a visit moves through your office today, from the first call to the paid claim, then match each step to its place in the new system.
2. Clean your data: Close out inactive patients, merge duplicates, and update old medication lists, since every error you skip carries over.
3. Test every connection: Run sample patients through each lab, pharmacy, and billing link before launch day.
4. Train by role: Front desk staff, nurses, clinicians, and billers use different screens, so each group practices its own tasks.
5. Lighten the schedule: Book fewer patients in the first weeks so staff have room to learn.
6. Track problems: Keep a simple issue log and review it with your vendor each week until things settle.

FAQs

How fast must you give patients a copy of their records?

Under HIPAA, you must give patients access within 30 days of their request, with one possible 30-day extension. Many states set faster deadlines, and the stricter state rule applies.

How long must you keep EHR records?

HIPAA doesn’t set how long medical records must be kept, though it does require HIPAA-related paperwork to be kept for six years. States set medical record retention periods, commonly 5 to 10 years for adults and longer for minors. Your EHR contract should cover access to old records after you switch. 

Do substance use disorder records need special handling in an EHR?

Yes, if your practice runs a federally assisted substance use disorder program covered by the federal Part 2 rules. Updated Part 2 rules for these records are now fully in effect. The HHS Office for Civil Rights now accepts complaints and breach reports for these records and can open investigations. Your EHR should be able to tag these records and limit who can share them.