Executive Summary
Ask each vendor for its Certified Health IT Product List entry, its route to TEFCA, and its API fee schedule. All three are public.
For an EHR purchase focused on interoperability, compare vendors on three public records before the demo: the product’s certification listing, the way it connects to TEFCA, and what it charges for API access. The Certified Health IT Product List (CHPL) is a comprehensive and authoritative listing of all certified health information technology that have been successfully tested and certified by the ONC Health IT Certification program. ONC states that the § 170.315(g)(10) certification criterion requires Health IT Modules to support API-enabled “read” services for single and multiple patients, and that these services exclude “write” capabilities. The Certified Health IT Product List shows whether a product version holds that certification; the vendor’s own pages show the rest.
On TEFCA, the eight EHRs in this guide take different routes. Two vendors run their own QHIN. One connects its customers through another organization’s QHIN. Two more state that they participate in TEFCA or offer a network connected to it. The interoperability section below sets out what each vendor’s own pages say. Whichever route a vendor uses, the question for the buyer is the same: which organizations can you exchange records with on day one, and for which purposes.
This guide explains what ONC certification, FHIR and TEFCA each cover, compares the eight vendors on what their own pages state about interoperability, covers specialty fit for ambulatory practices, and describes how pricing works.
What Do ONC Certification, FHIR and TEFCA Each Cover?
Three separate things sit behind the word interoperability in an EHR sales deck. ONC certification sets what a product must be able to do. FHIR is the data standard behind the certified API. TEFCA is the national framework for exchanging records between networks.
Certification. ONC describes its Health IT Certification Program as a voluntary certification program, launched in 2010, and states that the CMS Promoting Interoperability Programs continue to require the use of certified health IT. The program now carries a second name in vendors’ disclosures. Oracle Health offers health IT products certified under the Assistant Secretary for Technology Policy and the Office of the National Coordinator for Health Information Technology (ASTP/ONC) Health IT Certification Program. Search the product name on the Certified Health IT Product List at https://chpl.healthit.gov/ and confirm that the version you are buying is the version listed. The CHPL page includes a list of all health IT products that have been certified to at least one API criterion.
FHIR. HL7 describes FHIR, Fast Healthcare Interoperability Resources, as a next generation standards framework that combines the best features of its v2, v3 and CDA product lines. FHIR solutions are built from a set of modular components called Resources. HL7 states that the US Core Implementation Guide is based on FHIR Version R4 and defines the minimum constraints on the FHIR resources to create the US Core Profiles. HL7 states that the US Core profiles have become the foundation for US Realm FHIR implementation guides, and that its annual release reflects changes to the U.S. Core Data for Interoperability (USCDI). The SMART App Launch implementation guide describes foundational patterns based on OAuth 2.0 for client applications to authorize, authenticate, and integrate with FHIR-based data systems.
The certified API. The criterion buyers ask about is § 170.315(g)(10), the standardized API for patient and population services. A health IT developer must document which US Core IG Choices and References are supported by their Health IT Module via public technical documentation. ONC lists HL7 FHIR US Core Implementation Guide STU 8.0.1 as effective for testing on August 13, 2026, with a surveillance compliance date of November 15, 2027. A Health IT Module’s authorization server must issue a refresh token valid for no less than three months to applications using the “confidential app” profile. Ask each vendor which US Core version its certified API supports today and when it will support the next one.
TEFCA. TEFCA operates in the United States as a nationwide framework for health information sharing. QHINs are the individual networks that make up the backbone of TEFCA. Participants are organizations that connect to QHINs, such as hospitals, health systems and public health agencies. To become a QHIN, a network must be a U.S. entity, complete the QHIN application, onboarding, and designation process, and sign the Common Agreement, which typically takes about 12 months. The Sequoia Project serves as RCE under a 5-year contract with ONC awarded in August 2023. In November 2024, the Common Agreement Version 2.1 was released.
How Do EHR Vendors Compare on Interoperability?
The comparison below covers only what each vendor’s own pages state about exchange, APIs and TEFCA. TEFCA is designed to support exchange for any purpose, but that purpose must be indicated in each request for data. The RCE lists the exchange purposes as treatment, individual access services, public health, benefits determination, a subset of the HIPAA-defined payment activities (utilization review), and a subset of the HIPAA-defined health care operations.
Running a QHIN. Two of the eight run one. Epic customers connect to the TEFCA network through Epic Nexus, the Epic Community’s QHIN, which is currently only for Epic community members. Epic states that more than 1,000 hospitals and 22,000 clinics using Epic are live on TEFCA. Epic states that organizations use Care Everywhere to exchange over 30 million patient records daily, and that around half of those exchanges are with organizations that use a different interoperable EHR. Oracle states that Oracle Health Information Network provides unified health data connectivity for all Oracle Health provider customers and is a Designated Qualified Health Information Network (QHIN) under TEFCA.
Reaching TEFCA through a network. MEDITECH states that Traverse Exchange enables customers to connect to Commonwell, Carequality, and QHINs under TEFCA utilizing the Health Gorilla QHIN. athenahealth’s site invites readers to join a network that’s automatically connected to the Trusted Exchange Framework and Common Agreement (TEFCA). athenahealth states that it maintains connections for data exchange with labs and imaging centers, other EHRs through CommonWell and Carequality, pharmacies and payers. eClinicalWorks states that it participates in the Trusted Exchange Framework and Common Agreement (TEFCA) framework.
Carequality, integration engines and standards. NextGen Healthcare states that NextGen Share, supported by Carequality, plugs you into a national data exchange and provider network. NextGen Healthcare lists the Mirth Connect Integration Engine among its Mirth family of solutions, for connecting systems using HL7. Greenway states that its interoperability platform unifies patient information to improve care decisions and reduce manual work. Greenway lists standards-based exchange using HL7, FHIR, and C-CDA to support secure, reliable healthcare data exchange.
Published APIs. Epic states that over 1,000 API and interface specifications are freely and publicly available for integrating software with Epic on open.epic.com. Oracle states that Oracle Health FHIR APIs enable you to build custom applications and connect to third-party independent software vendors. eClinicalWorks states that its certified FHIR APIs, including APIs certified to the Standardized API for Patient and Population Services criterion, are available to third-party application developers and eClinicalWorks customers at no cost at this time. Veradigm states that its certified Health IT products are listed on the Certified Health IT Product List (CHPL). Greenway describes its EHR as ONC-certified. API fees are covered in the pricing section below.
Your right to choose a network. ASTP/ONC states that it would likely be considered an interference with the access, exchange, or use of EHI if an actor restricts or impedes a customer or user from obtaining or using the QHIN connectivity services of their choice. If a contract limits which QHIN you may use, ask the vendor to explain the clause in writing.
| Route | What it gives you | What to ask |
|---|---|---|
| The vendor’s own QHIN | TEFCA exchange through a network the EHR vendor runs | Which exchange purposes are live, and who can join besides the vendor’s customers |
| Another organization’s QHIN | TEFCA exchange through a network the vendor connects to | Who holds the QHIN contract, and what it costs per site |
| Carequality and CommonWell | Record exchange with other EHRs through national frameworks | Which partners in your referral area are live, and how outside records reach the chart |
| Certified FHIR API, (g)(10) | Read access for patient apps and population exports | Which US Core version is supported, and what developers pay |
| Integration engine, HL7 v2 | Interfaces to labs, imaging, pharmacy and devices | Who builds and maintains each interface, and at what rate |
Which EHR Systems Fit Specialty Practices, and What Else Should You Test?
Hospitals buy one platform for many departments; a dermatology, cardiology or behavioral health group needs templates, orders and billing rules built for its own work.
The ambulatory vendors describe specialty coverage and practice size on their own pages. eClinicalWorks states that it offers solutions for ambulatory practices, urgent care facilities, health centers, hospitals, and more than 50 specialties. Greenway supports ambulatory practices across more than 40 specialties. athenahealth states that athenaOne’s specialty solutions combine tailored workflows with medical billing software and services, and patient engagement tools. NextGen Healthcare lists NextGen Enterprise (10+ Providers) as its enterprise-level EHR and patient health data platform, and NextGen Office (Under 10 Providers) as its fully-integrated EHR and PM for independent practices. Veradigm offers two electronic health record solutions: Veradigm EHR, for multi-location, multi-specialty organizations, and Practice Fusion EHR, for small, independent practices.
Ask each finalist for three customers in your specialty and size, and have your own clinicians run a full visit in the demo system with your templates and order sets.
Test exchange the same way. Bring a real referral from a partner on another EHR, and watch where the outside record appears and how many clicks it takes to reconcile.
| Capability | What it covers | How to test it |
|---|---|---|
| Certification | The product version listed for each criterion you need | Match the version on the Certified Health IT Product List to the version in the contract |
| FHIR API | Patient and population read access under (g)(10) | Have one app developer connect to the sandbox and pull a bulk export |
| Network exchange | TEFCA, Carequality, CommonWell and Direct messaging | Exchange one real referral with a partner on a different EHR |
| Specialty content | Templates, order sets and billing rules for your specialties | Run a full visit for your busiest specialty with your own clinicians |
| Revenue cycle | Claims, denials and payer rules | Submit test claims for your payer mix and review the denials |
| Data export | Electronic health information export for one patient or all patients | Ask for the export format and a sample file |
| Patient access | Portal, messaging and apps patients choose | Connect a patient-chosen app through the certified API |
Vendors in Electronic Health Records (EHR)
Representative vendors include athenahealth, eClinicalWorks, Epic Systems, Greenway Health, MEDITECH, NextGen Healthcare, Oracle Health / Cerner and Veradigm, formerly Allscripts. The list is alphabetical, is not a ranking, and is not for sale. How we choose vendors
The approaches below follow two questions: which care settings the product is built for, and how the vendor sells and runs it.
An integrated enterprise EHR runs one record across hospitals, clinics and affiliates. Epic describes itself as a software factory with no acquisitions, and as employee-owned and developer-led. Community Connect offers independent providers and healthcare organizations a unified and integrated patient record by extending the EHR from an organization that uses Epic.
A cloud infrastructure vendor now owns one of the hospital platforms. Oracle and Cerner announced an agreement for Oracle to acquire Cerner on December 20, 2021, and Oracle states that the deal closed on June 8, 2022. Oracle states that Oracle Health Foundation EHR provides an enterprisewide view of clinical information, integrated directly into the workflow.
A single platform built for community hospitals is the third hospital approach. MEDITECH states that over 2,000 healthcare organizations across 28 countries and territories have chosen MEDITECH. MEDITECH states that it provides the same core EHR platform to every customer, regardless of organization size. MEDITECH states that MEDITECH as a Service (MaaS), a subscription version maintained in a Google Cloud environment, delivers the full Expanse platform.
All-in-one ambulatory suites combine the EHR with practice management, revenue cycle and patient engagement. Since 1997, athenahealth has served ambulatory healthcare practices. athenahealth states that athenaOne integrates electronic health records (EHR), practice & revenue cycle management (RCM), and patient engagement capabilities. Greenway Health helps ambulatory healthcare organizations through an AI-enabled unified platform that includes EHR, practice management, revenue cycle management, and patient engagement solutions. Greenway states that Intergy has long supported ambulatory practices with integrated clinical, financial, and operational workflows.
One ambulatory-first vendor publishes its prices. eClinicalWorks states that it is privately held. Its prices are in the pricing section below.
A specialty ambulatory EHR comes with an integration engine; both are covered above. NextGen Healthcare states that Madison Dearborn Partners acquired a significant ownership position in the company alongside Thoma Bravo in June 2025.
The last approach pairs two ambulatory EHRs for different practice sizes under one company. Veradigm states that Allscripts transitioned its solutions to the Veradigm brand, including electronic health records, practice management systems, and patient engagement platforms, in 2022. Veradigm EHR was formerly Allscripts Professional EHR.
| Vendor | Approach | Where it fits |
|---|---|---|
| athenahealth | All-in-one ambulatory suite | athenaOne EHR, revenue cycle and patient engagement; CommonWell and Carequality |
| Greenway Health | All-in-one ambulatory suite | Intergy; more than 40 specialties; HL7, FHIR and C-CDA exchange |
| eClinicalWorks | Ambulatory EHR with published pricing | Privately held; listed per-provider pricing; certified FHIR APIs at no cost |
| Oracle Health / Cerner | Hospital EHR from a cloud vendor | Cerner acquisition closed June 8, 2022; Oracle Health Information Network is a designated QHIN |
| Epic Systems | Integrated enterprise EHR | Epic Nexus QHIN; Care Everywhere; Community Connect for affiliates |
| MEDITECH | Single platform for community hospitals | Expanse, also as a MaaS subscription on Google Cloud; TEFCA through the Health Gorilla QHIN |
| NextGen Healthcare | Specialty ambulatory EHR with an integration engine | NextGen Enterprise and NextGen Office; Mirth Connect; Madison Dearborn and Thoma Bravo ownership |
| Veradigm, formerly Allscripts | Two ambulatory EHRs by practice size | Veradigm EHR and Practice Fusion EHR; Allscripts brand retired in 2022 |
Eight vendors across seven approaches; athenahealth and Greenway Health share one. The approaches were chosen first, and the eight vendors are the ones the previous edition named. Placement in this table cannot be bought. The roster check for this edition also covered Altera Digital Health, ModMed, Netsmart, PointClickCare, TruBridge and Elation Health, and any of them can make its own case in the Spotlight below.
How much should you budget for Electronic Health Records (EHR)?
On the pages checked for this guide, one vendor publishes an EHR subscription price. eClinicalWorks lists its EHR Only plan at $499/mo per provider, with no start-up costs. eClinicalWorks lists EHR with Practice Management at $599/mo per provider. For the other seven, ask for a quote built from your providers or beds, modules, hosting and services.
Certified API fees are published separately from the EHR price. On its certified API page, Oracle separates standard (standalone environment) healthcare provider implementations into tiers of S/M/L/XL based on the volume of patient records in the system, and includes Oracle Health Millennium certified APIs in the Oracle Health Ambulatory Suites for no additional fees. NextGen Healthcare states that costs for its Patient Access API and FHIR API are included in the standard software licensing package and covered by the standard software maintenance fees. Price the interfaces, the integration engine and the staff who maintain them alongside the API.
For a hospital program, ask for the services estimate, the number of vendor and customer staff it assumes, and what happens to the price if go-live moves.
Hosting changes the shape of the bill. A vendor-hosted or subscription EHR moves data center and upgrade costs into the subscription. A self-hosted EHR keeps them on your budget.
| Model | You are charged for | Grows with | Where it goes wrong |
|---|---|---|---|
| Per provider per month | Each licensed provider on the EHR | Provider headcount | Part-time and locum providers counted as full licenses |
| Percentage of collections | A share of what the vendor’s billing service collects | Practice revenue | Costs that rise faster than the work as revenue grows |
| Enterprise license | Modules, beds or encounter volume | Facilities and modules | Modules bought at signing and never switched on |
| Hosted subscription | The EHR with hosting and upgrades | Users and facilities | Exit terms that make leaving the hosting costly |
| API and interface fees | Certified APIs, interfaces and engine licenses | Connections and record volume | Interface fees charged by both sides of one connection |
How long does implementation take for Electronic Health Records (EHR)?
Phase lengths depend on scale: a large health system measures them in years, a single clinic in months. Settle clinical governance, interface testing and downtime procedures before any clinician uses production.
Name physician, nursing and revenue cycle leads. Map current workflows, decide how closely you adopt the vendor’s standard build, and decide which legacy data migrates and which is archived read-only.
Configure the system and build interfaces to labs, imaging, pharmacy and devices. Connect to your TEFCA route and regional exchanges, and test with partners on other EHRs before go-live.
Train by role, run mock go-lives and downtime drills, and staff a command center. Reduce the patient schedule for the first weeks and watch claims daily.
Work the ticket backlog, tune order sets, alerts and templates, and track clinician time in the record. Add analytics and new modules only after productivity recovers.
What should you ask vendors about Electronic Health Records (EHR)?
Ask each finalist to answer in writing and to show each answer in a system configured for your organization.
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Do you run hospitals as well as clinics?Yes Shortlist the hospital platforms and ask how each extends to your affiliated practices.No Shortlist ambulatory suites and weight specialty content and revenue cycle.
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Do most of your referral partners already use one EHR?Yes Test exchange with those partners first, through TEFCA and the vendor’s own network.No Weight TEFCA, Carequality and CommonWell reach over any one vendor’s network.
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Do you have staff to host and upgrade the system?Yes Compare self-hosted and vendor-hosted total cost over the contract.No Shortlist vendor-hosted and subscription options and read their exit terms.
Electronic Health Records (EHR) RFP package: 129 questions, 10 demo scenarios and a vendor scorecard
RFP packages are a separate paid product. Vendors do not pay to appear in buyer guides.