How to Choose the Right EHR in the Age of AI
The EHR you're in right now might be the single biggest thing slowing your practice down, and you may not even know it yet.
That's not said to alarm you. Most providers chose their EHR for completely reasonable reasons: it was designed for their specialty, it fit the budget, a colleague recommended it, or it was simply what the billing company supported at the time. Those were valid decisions. But the landscape has shifted in ways that make it worth taking a hard look at whether the system you're in is actually positioned to grow with you, or quietly holding you back.
This is a conversation worth having now, before the next wave of healthcare technology lands and you find yourself on the wrong side of it.
The Moment We're In
Artificial intelligence is no longer a future-state concept in healthcare. It's here, it's being adopted rapidly, and it is fundamentally changing what's possible inside a practice. AI tools that handle clinical documentation, streamline prior authorization, automate patient communication, and surface clinical insights are available today, and the numbers tell the story. In 2023, 38% of U.S. physicians reported using AI tools in clinical practice. By 2024, that number had jumped to 66%. That's not a trend. That's a shift.
The question for any provider evaluating or re-evaluating their EHR is no longer whether AI will change how you operate. It's whether your EHR will give you access to it when you need it.
And that distinction, access, is everything.
Why Your EHR Choice Is Actually a Technology Strategy Decision
Here's a perspective that comes from working inside more than ten different EHR systems across mental health, psychiatry, medication management, primary care, and surgical practices: every platform has strengths and weaknesses, and no single EHR is perfect for every practice. That's expected. What matters more than any individual feature is the underlying question of how open the system is, specifically whether it allows outside companies to build tools that connect to it.
That capability has a name: an open API. And in today's environment, it may be the single most important criterion a provider can evaluate when selecting an EHR.
An API (Application Programming Interface) is essentially a set of rules that allows two software systems to talk to each other. When an EHR has an open API, it means that developers and technology companies can build tools that integrate directly into that system. Think AI note-taking software, patient engagement platforms, advanced analytics dashboards, or prior authorization automation. When an EHR has a closed or restricted API, those doors are largely shut and you are dependent on that one company to build everything you'll ever need.
That dependency is a much bigger problem than most providers realize.
The Vendor-Built Problem
EHR companies have a significant incentive to keep their ecosystems closed. When providers can't easily integrate outside tools, they stay put. They buy add-ons from the same vendor. They accept what's available rather than shopping for what's best. This isn't speculation. It's reflected in research, in user complaints, and increasingly in federal antitrust enforcement.
The deeper issue is that EHR vendors are not, by nature, innovation companies. They are infrastructure companies. And when they attempt to build AI tools, patient engagement platforms, or communication systems in-house, the results have consistently lagged behind what specialized companies build when that is their only focus.
The best AI documentation tools on the market right now were not built by EHR companies. They were built by teams whose entire mission is solving that one problem. The same is true for scheduling automation, billing intelligence, and patient-facing engagement tools. The companies winning in those spaces are moving fast, iterating constantly, and competing hard for provider trust. EHR vendors building internal versions of those tools rarely match that pace, and providers end up with something that technically exists but isn't what they actually need.
When your EHR is closed, you can't access those best-in-class tools. You get what your vendor built, on their timeline, according to their priorities.
What's at Stake: Your Speed to Evolve
This is the part that doesn't get talked about enough. When you sign on with an EHR that has a closed ecosystem, you're not just choosing a software platform. You're handing over the pace of your own innovation to that company. Every new capability you want, every efficiency you're hoping to gain, every technology shift you're trying to keep up with, becomes contingent on whether that vendor prioritizes it, builds it well, and releases it on a timeline that works for you.
The data on what this looks like in practice is sobering. A 2024 MGMA report found that 77% of providers who are dissatisfied with their EHR stay anyway. Not because the system is working for them, but because the cost and disruption of leaving exceeds the pain of staying. Vendors know this. It shapes how they price, how they prioritize development, and how aggressively they pursue lock-in at the contract level.
Two major federal antitrust lawsuits filed between 2024 and 2025 allege that at least one dominant EHR vendor engaged in practices specifically designed to prevent competitors from accessing patient records within their system, effectively making it "commercially impossible" for outside companies to build integrations and compete. Whether or not those lawsuits ultimately succeed, they illuminate something that providers who work across multiple platforms have observed for years: some of this is not accidental. Closed ecosystems are a business strategy, not a technical limitation.
The Open API Advantage: What It Actually Gives You
Choosing an EHR with a strong, open API doesn't mean you're committing to a more complicated system. It means you're preserving your right to choose.
Consider what that looks like in practice. A platform like Athenahealth, which has invested in an open integration ecosystem, allows third-party companies to build and certify apps that connect directly to the EHR. As a provider, you can browse those options, evaluate which one fits your workflow and patient population, and make a choice based on performance, not on what your EHR decided to build. A psychiatric practice and a pediatric practice have genuinely different needs. An open API is what makes it possible for the market to serve both of them well, rather than forcing both into a one-size-fits-all solution from a single vendor.
This matters especially right now, as a new generation of AI tools continues to emerge. The AI documentation space alone grew to approximately $600 million in market revenue in 2025, a 2.4x increase over the prior year. Providers who are on open platforms can access and evaluate those tools as they mature. Providers on closed platforms are waiting for permission.
It's also worth knowing that this isn't just a market trend. It's becoming regulatory baseline. Federal mandates under the 21st Century Cures Act and CMS interoperability rules now require certified EHRs to support FHIR-based APIs, the modern standard for health data exchange. The direction of policy is clearly toward openness. EHRs that have been building in that direction are ahead. Those that have resisted it are being pushed, but implementation quality varies significantly.
A Fair Counterpoint
It's worth addressing something honestly: having an open API doesn't automatically mean a seamless integration experience. KLAS Research, one of the most respected independent voices in healthcare IT, noted in their 2025 interoperability report that increased API availability does not equate to high customer satisfaction. Different vendors implement APIs differently, and "FHIR-compliant" on paper doesn't always mean smooth in practice.
That's a legitimate point. The argument here isn't that open API is a perfect solution. It's that it's a prerequisite for optionality. A closed system removes choice entirely. An open system, even an imperfect one, keeps the door available. And as standards like FHIR mature and regulatory pressure increases, the integration experience across open platforms will continue to improve. You want to be positioned on the right side of that improvement curve.
Five Questions to Ask Before You Choose (or Stay)
Whether you're evaluating an EHR for the first time or questioning whether the one you're in is still the right fit, these questions cut through the marketing language:
Does this EHR have a published, open API? Can third-party companies access it without going through a costly, proprietary approval process, or is integration effectively gatekept?
Is there an app marketplace or integration directory? Platforms that take interoperability seriously tend to have ecosystems of certified third-party tools. If you can't find one, that tells you something.
What is this EHR's FHIR compliance status? Are they meeting current CMS interoperability mandates, or are they dragging their feet?
What happens to your data if you leave? Before you sign anything, understand the data export process, what it costs, and what format your records come out in. This is the exit clause that most providers don't read until it's too late.
Who chose the AI tools available on this platform, the vendor or the market? If the only AI tools available are ones the EHR built internally, that's a sign of a closed ecosystem, regardless of what the sales team says.
A Word on EHR Migration
One of the reasons providers stay in systems that aren't working for them is the fear of switching, and that fear isn't unfounded. EHR migration is genuinely complex. These systems are not built on the same architecture, which means data does not transfer cleanly from one to another. Appointment structures differ. Where clinical information lives differs. A meaningful portion of the transition requires manual work, careful reconciliation, and thoughtful planning to avoid gaps in care continuity.
But here's what consistently comes up in conversations with providers who have made the switch: they wish they had started sooner. The disruption is real and finite. The cost of staying in the wrong system compounds quietly, year over year, in the form of workarounds, limitations, and opportunities missed.
If migration feels too big to contemplate, the first step isn't switching. It's understanding. Know what your current system actually allows. Know what your contract says about data portability. Know what the process looks like before you decide it's not worth it.
The Bottom Line
You cannot control how fast AI develops in healthcare. You cannot control which breakthrough tool gets built next, or who builds it. What you can control is whether your EHR gives you the infrastructure to access what's coming, or keeps that door locked while you wait for your vendor to catch up.
The practices that will thrive over the next five to ten years won't necessarily be the ones with the most features today. They'll be the ones that built on platforms flexible enough to evolve. Open APIs are not a technical detail. They are a strategic foundation.
Choose accordingly.
My Extended Team (MET) works alongside healthcare practices of all sizes, from solo providers to multi-location organizations, supporting operations, transitions, and the systems that keep practices running well. If you're navigating an EHR decision or considering a migration, we're happy to share what we've seen.
