Switching EHR Systems: When to Do It, How to Plan It, and What It Really Costs

The Scale of EHR Switching

If you are unhappy with your EHR, you are not alone — and the data says you are in the majority. Survey after survey shows a striking disconnect between how providers feel about their EHR systems and how many actually do something about it.

According to Black Book Research, over 60% of physicians say they would readily switch their EHR if the transition were painless. A separate study from the Medical Economics Physician Report found that roughly 60% of providers either actively dislike their EHR or feel neutral about it — meaning only 4 in 10 are genuinely satisfied. The Harris Poll and Stanford Medicine survey data echoes this: most physicians view their EHR as a source of frustration rather than a clinical asset.

Yet actual switching rates remain comparatively low. Only about 15% of practices are actively considering a switch in the next 12 months (KLAS Research). That gap — between widespread dissatisfaction and limited action — is explained by three factors: the perceived cost of switching, fear of data loss and workflow disruption, and the sheer inertia of "the devil you know."

This guide is designed to help you close that gap with clear information. If your EHR is genuinely holding your practice back, switching may be the right move. If your frustrations are minor and addressable, switching could create more problems than it solves. The key is knowing the difference.

Top Reasons Practices Switch EHRs

When practices do make the leap, their reasons tend to cluster around a handful of recurring themes. Here is what the survey data shows:

Let's unpack the top drivers:

Cost: The Dominant Factor

At 65%, cost is the number one reason practices switch. But the cost problem is rarely just the sticker price of the software. It is the total cost picture: rising annual maintenance fees, expensive add-on modules for features that should be standard (e-prescribing, patient portal, telehealth), and the hidden IT labor costs of maintaining on-premise infrastructure. Many practices that signed contracts five or more years ago find that their annual costs have crept up 30-50% through incremental fee increases. If your current vendor's pricing is no longer competitive, see our complete EHR cost guide for current market benchmarks.

Functionality Gaps

At 60%, functionality is nearly as important as cost. The most commonly cited gaps include lack of integrated telehealth, poor clinical decision support, missing specialty-specific templates, inadequate reporting and analytics, and weak revenue cycle management tools. If your EHR cannot support the way you practice medicine today — not the way you practiced five years ago — that is a legitimate reason to switch.

User Experience

Over half (54%) of switching practices cite a poor user interface as a driver. This is not vanity. Poor EHR usability is directly linked to physician burnout, documentation errors, and longer patient encounters. The AMA's research on EHR usability shows that physicians spend nearly two hours on EHR tasks for every one hour of direct patient care. A system with better UX does not just feel nicer — it gives you time back.

Vendor Unresponsiveness

At 44%, this is more common than most people expect. The warning signs: support tickets take days or weeks to resolve, your account manager changes every six months, feature requests disappear into a backlog with no timeline, and critical bugs persist across multiple updates. When your vendor treats your practice as an afterthought, it is time to explore alternatives.

Interoperability

Some 45% of practices that switched cited information sharing problems as a key factor. In an era where cloud-based EHRs offer FHIR APIs, TEFCA-compliant data exchange, and pre-built integrations with labs and pharmacies, being stuck on a system that cannot share data with referring providers or health information exchanges is a genuine competitive disadvantage.

Health System Consolidation

This one is less about choice and more about organizational mandate. When health systems acquire physician practices or merge with other systems, standardizing on a single EHR platform is almost always required. If you are being acquired and told to switch to Epic or Oracle Health, much of this guide still applies — but your "vendor selection" phase is already decided for you.

Signs It Is Time to Switch

General dissatisfaction is not sufficient reason to undertake a six-figure, year-long project. Here are the specific red flags that indicate your EHR has moved from "annoying" to "actively harming your practice":

• Vendor support is declining or nonexistent. Response times are getting worse, not better. Your issues go unresolved for weeks. The vendor has been acquired and the new parent company is deprioritizing your product line.
• The system cannot meet current regulatory requirements. Your EHR cannot generate MIPS/MACRA quality reports, lacks ONC-certified functionality for the current program year, or fails to support the latest ICD-10 or CPT code updates without expensive manual workarounds.
• The product is approaching end-of-life. The vendor has announced sunsetting your version with no viable upgrade path, or the vendor itself is being absorbed into a larger company that plans to retire the platform. This is more common than you think — the EHR market has consolidated significantly, and several products popular a decade ago are now on borrowed time.
• Critical capabilities are missing and will not be added. You need integrated telehealth, FHIR-based interoperability, a patient portal that patients actually use, or AI-assisted documentation — and the vendor's roadmap shows no plans to deliver these within 12 months.
• The system is causing patient safety concerns. Alerts are unreliable, medication interaction checking is outdated, or the interface leads to documentation errors. If your EHR has become a patient safety liability, the urgency to switch overrides cost considerations.
• Your staff retention is suffering because of the EHR. If exit interviews consistently mention the EHR as a factor in clinician departures, the cost of replacing physicians ($500,000-$1,000,000 per physician, depending on specialty) far exceeds the cost of switching systems.
• You are paying for workarounds. If you have built a patchwork of supplementary tools — separate billing software, a standalone patient portal, an external fax server, manual spreadsheets for reporting — the total cost of these band-aids may already exceed the cost of a modern, integrated EHR.

When NOT to Switch

Switching EHR systems is disruptive, expensive, and stressful. Before committing, honestly assess whether your problems truly require a new system or can be resolved within your current one.

Do not switch if:

• Your complaints are about training, not the system. Many EHR dissatisfaction issues trace back to inadequate initial training or failure to learn features that already exist. Before switching, invest in a thorough retraining initiative. You may discover your current system can do far more than your team realizes.
• You switched within the last 2-3 years. "Switching fatigue" is real. Staff who have recently endured one EHR transition will resist another, and the productivity recovery period from the first switch may not yet be complete. Unless there is a critical safety or regulatory issue, give your current system at least 24 months before reassessing.
• The new system will not solve your actual problem. If your revenue cycle is struggling because of coding issues or payer denials, a new EHR might not fix that. If patient satisfaction is low because of wait times, the EHR is probably not the root cause. Be specific about what problem the switch will solve and verify that the new system actually solves it.
• You do not have organizational bandwidth for the project. An EHR switch requires sustained leadership attention, dedicated project management time, and staff participation in training and testing. If your organization is already in the middle of a major initiative — a new facility, an acquisition, a Joint Commission survey — adding an EHR migration may overextend your team.
• Your vendor is willing to negotiate. Before committing to a switch, tell your current vendor you are evaluating alternatives. Many vendors will offer significant discounts, free training, or expedited feature development to retain customers. If the core platform is sound and the vendor is willing to address your concerns, a renegotiated contract may be a far better investment than a full switch.

The Switching Process: Step by Step

If you have determined that switching is the right decision, here is how to execute it methodically. Rushing this process is the single most common cause of failed EHR migrations.

Phase 1: Build the Business Case (2-4 Weeks)

Before selecting a vendor, you need internal alignment on why you are switching and what success looks like.

• Quantify the pain points. Attach dollar figures wherever possible. How much time are physicians losing to workarounds? What is your claim denial rate, and how much of that is EHR-related? How much are you spending on supplementary tools that a new EHR would replace?
• Estimate the switching costs. Include the new system license, data migration, training, temporary productivity loss, and consultant fees. Use the cost estimates in our EHR cost guide as a starting point.
• Compare switching costs to the cost of staying. Project your current vendor's costs forward 5 years, including fee increases, workaround tools, and IT labor. Compare that to the 5-year TCO of the new system. The business case should show a clear financial advantage or a non-negotiable quality/safety justification.
• Get stakeholder buy-in. Physicians, office managers, billing staff, and IT all need to be aligned before you start evaluating vendors. An EHR switch imposed top-down without clinical input will face resistance at every stage.

Phase 2: Select the New Vendor (1-3 Months)

Vendor selection is a project in itself. We have a dedicated guide to this process: see our EHR selection process for a structured framework covering requirements gathering, RFP development, vendor demos, reference checks, and contract negotiation.

Key considerations specific to switching (vs. first-time purchase):

• Ask every vendor about their data migration experience from your current system. Some vendors have established migration tooling for common systems (e.g., from eClinicalWorks to athenahealth). Others will require custom extract-transform-load work.
• Verify the vendor's parallel running support. Will they help you run both systems simultaneously during the transition?
• Negotiate performance guarantees tied to go-live milestones. If the vendor is late or the migration introduces data quality issues, there should be contractual remedies.
• If you are a behavioral health or substance abuse treatment practice, prioritize vendors with specialty-specific workflows including 42 CFR Part 2 compliance, group therapy scheduling, and outcome tracking.

Phase 3: Plan the Migration (2-4 Weeks)

Once you have selected a vendor and signed the contract, the real work begins. Develop a detailed project plan using our EHR implementation checklist as your starting framework.

• Assign a dedicated project manager — either internal or from the vendor. This role is non-negotiable. EHR migrations that lack dedicated project management consistently run over budget and over schedule.
• Create a detailed timeline with dependencies mapped. Data migration cannot start until data mapping is complete. Training cannot start until the system is configured. Go-live cannot happen until training is complete.
• Identify your super-users — 1-2 staff members per department who will receive advanced training and serve as first-line support for their colleagues.
• Plan your go-live date strategically. Avoid the last week of the month (billing cycle pressure), holiday weeks, and your busiest seasonal period. Many practices choose a Monday go-live so they have a full week to stabilize before the weekend.

Phase 4: Data Migration Strategy (2 Weeks - 2 Months)

Data migration is where EHR switches most commonly go wrong. The central decision: what to bring forward and what to leave behind.

What to migrate (active data):

• Active patient demographics and insurance information
• Current medication lists, allergy lists, and active problem lists
• Recent encounter notes (last 12-24 months of visit documentation)
• Open orders, pending referrals, and scheduled appointments
• Outstanding claims and accounts receivable data

What to archive (leave in old system):

• Historical encounter notes older than 24 months
• Scanned documents and legacy image files
• Historical billing records for closed accounts
• Inactive patient records (no visit in 3+ years)

Critical migration practices:

• Run at least two test migrations before the final cutover. Compare record counts, verify data integrity, and have clinicians spot-check patient charts.
• Build a data mapping document that maps every field from the old system to the new system. Fields that do not have a 1:1 mapping need explicit decisions — will you transform the data, store it in a notes field, or discard it?
• Establish a data freeze window. At some point, you must stop entering data into the old system so the final migration captures a complete snapshot. Keep this window as short as possible (ideally a weekend).

Phase 5: Training and Go-Live (2-4 Weeks)

Training is where most practices underinvest. The research is consistent: organizations that invest more in training experience faster productivity recovery, fewer errors, and higher staff satisfaction post-migration.

• Role-based training. Physicians, nurses, front desk staff, and billing staff all use the EHR differently. One-size-fits-all training sessions waste everyone's time.
• Hands-on practice, not just demos. Staff should complete realistic scenarios in a training environment using actual (de-identified) patient data — not watch a vendor-led slideshow.
• At-the-elbow support for go-live week. Have vendor trainers or your super-users physically present in each department during the first week on the new system. This is the single most effective go-live support strategy.
• Reduce patient volume during go-live. Most practices cut schedules by 25-50% during the first week to give staff time to learn in a lower-pressure environment. The lost revenue is real, but it is a fraction of the cost of a botched go-live.

Phase 6: Decommission the Old System (1-3 Months Post Go-Live)

Do not rush to decommission your old EHR. Keep it running in read-only mode for at least 6-12 months after go-live. There will be situations where clinicians need to reference historical data that did not migrate, and having the old system accessible (even if inconvenient) is far better than discovering that critical records are inaccessible.

• Confirm all active data has been successfully migrated and validated
• Verify all open claims and accounts receivable have been transitioned
• Export a final complete database backup in a standard format for long-term archival
• Review state medical record retention requirements (typically 7-10 years for adults, longer for minors) before destroying any data
• Formally notify your old vendor of contract termination per your agreement terms

The Real Cost of Switching

Here is what an EHR switch actually costs, broken down by practice size. These figures include costs that vendor quotes often omit — particularly lost productivity, consultant fees, and the time cost of running parallel systems.

Timeline Realities

Beyond dollars, the time cost is significant:

• Vendor selection: 1-3 months. Includes requirements gathering, RFP, demos, reference checks, and contract negotiation.
• Implementation and configuration: 1-3 months depending on complexity and whether you are moving to cloud or on-premise.
• Data migration: 2 weeks to 2 months. Heavily dependent on the volume of data, the quality of your export from the old system, and the number of test migrations needed.
• Training: 2-4 weeks of formal training, plus 4-8 weeks of informal learning on the job.
• Stabilization: 1-3 months post go-live before the practice returns to normal operating rhythm.
• Total project timeline: 6-12 months for small to mid-size practices; 12-24 months for large organizations.

Data Portability: Your Rights Under the Law

The 21st Century Cures Act (signed into law in 2016, with the ONC Information Blocking Rule taking effect in April 2021) fundamentally changed the data portability landscape in healthcare. Here is what it means for practices switching EHRs:

• Information blocking is prohibited. Your current EHR vendor cannot engage in practices that are likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information. This includes refusing data exports, charging unreasonable fees for data extraction, or providing data in deliberately proprietary formats.
• Standard export formats are required. ONC-certified EHR systems must support data export in United States Core Data for Interoperability (USCDI) format using the FHIR R4 standard. In practice, most vendors also support C-CDA document exports and CSV/flat file data dumps.
• Penalties are real. The OIG can impose civil monetary penalties of up to $1 million per violation for information blocking by health IT developers. While enforcement has been gradual, several investigations are underway as of 2026.
• Reasonable fees are permitted. The law does not require vendors to export data for free. They can charge reasonable, cost-based fees for the labor of preparing and transmitting the data. What they cannot do is use fees as a barrier — charging $50,000 for a data extract that should cost $5,000 would likely be considered information blocking.

Practical advice: Before you sign a contract with any EHR vendor, read the data export and contract termination clauses carefully. Specifically confirm the format your data will be exported in, the timeline for data release after termination, any fees for data extraction, and your rights to data retained after contract end. If the vendor is vague on any of these points, get it in writing before you sign.

Running Parallel Systems During the Transition

Most experienced implementation consultants recommend running your old and new EHR systems simultaneously for a defined period — typically 1-2 weeks, though some organizations extend this to 4-6 weeks for complex migrations.

How Parallel Running Works

• All new clinical documentation is entered into the new system from go-live day.
• The old system remains accessible in read-only mode for reference — checking historical notes, verifying medication histories, reviewing past lab results.
• During the parallel period, your team validates that migrated data is accurate by comparing key patient records between both systems.
• Billing may continue in the old system for encounters documented before go-live, while new encounters are billed through the new system.

Common Pitfalls

• Staff entering data into the wrong system. Make this operationally difficult — remove the old system's shortcut from desktops and change the wallpaper on computers to show which system is the new default.
• Extending parallel running indefinitely. Set a firm end date. Every week you run parallel systems, you are paying double licensing costs and splitting your staff's attention. Two weeks is usually sufficient for small practices; four weeks for larger organizations.
• Not having a rollback plan. In rare but real scenarios, a go-live goes badly enough that you need to revert to the old system temporarily. Have a documented rollback procedure that your team has reviewed before go-live day.

Managing Staff Through the Change

Technology projects fail because of people, not software. An EHR switch affects every person in your organization, and managing the human side of this transition is at least as important as managing the technical side.

Communication Strategy

• Announce the decision early. Staff will find out anyway. Controlling the narrative — explaining the why, the timeline, and what it means for them — is far better than letting rumors fill the void.
• Be honest about the disruption. Do not promise that the switch will be painless. Acknowledge that there will be a learning curve, that the first few weeks will be frustrating, and that productivity will temporarily drop. Credibility now pays dividends later when you need staff cooperation.
• Create a feedback channel. Designate a way for staff to report issues, ask questions, and suggest improvements during the transition. Whether it is a dedicated Slack channel, a shared inbox, or a weekly huddle, staff need to feel heard.

Super-User Strategy

The super-user model is the most proven approach for EHR transitions:

• Identify 1-2 people per department who are tech-savvy and well-respected by their peers.
• Train them 2-4 weeks ahead of everyone else so they are proficient before go-live.
• During go-live, their primary role is supporting colleagues — not their normal clinical or administrative duties. Backfill their regular work.
• After stabilization, super-users become the ongoing first-line support for EHR questions, reducing vendor support dependency.

Protecting Against Burnout

EHR transitions are a known driver of staff burnout, particularly for physicians. Proactive steps to mitigate this:

• Reduce patient schedules by 25-50% during the first week post go-live.
• Provide extra documentation time — many practices add 15-30 minutes to each encounter slot for the first 2 weeks.
• Acknowledge frustration publicly and normalize the learning curve. Physicians who feel supported through the transition recover faster.
• Celebrate milestones. When the first clean claim goes through the new system or when schedule volume returns to normal, recognize the achievement.

Frequently Asked Questions

The Final Word

Switching EHR systems is one of the most disruptive projects a healthcare organization will undertake. It is expensive, time-consuming, and stressful for everyone involved. It is also, sometimes, the right thing to do.

The practices that execute EHR switches successfully share common traits: they build a clear business case before they start, they invest heavily in change management and training, they plan for data migration as the most technically complex phase, and they set realistic expectations about the productivity dip that follows go-live.

The practices that struggle are the ones that rush vendor selection, underinvest in training, attempt to migrate every piece of historical data, or fail to get clinical staff buy-in before the project begins.

If your current EHR is costing you more than it should, missing critical functionality, losing vendor support, or causing patient safety concerns, the evidence supports switching. If your frustrations are real but manageable — and your vendor is willing to work with you — renegotiating may be the smarter move.

Either way, do the analysis. Quantify the pain, estimate the costs, and make a decision based on data rather than emotion. That is how you get this right.