Introduction
An EHR system is the backbone of clinical operations. It centralizes the patient record, supports ordering and documentation, connects teams and external systems, and powers reporting. This guide explains EHR systems in plain language, shows the most common EHR systems in hospitals, lists common ambulatory options, and gives a practical checklist to evaluate vendors.
What is an EHR system
An electronic health record (EHR) is an electronic version of a patient’s medical history maintained by a provider over time. It typically includes key administrative and clinical data such as demographics, progress notes, problems, medications, and more. For official definitions and context, see CMS and ISO.
Core EHR data objects
- Patient demographics and identity
- Problems, meds, allergies, histories, vitals
- Orders and results (labs, imaging, referrals)
- Notes, documents, encounters
- Billing and reporting data
Core EHR jobs
- Document care
- Place orders and reconcile results
- Support safety checks and decision support
- Exchange data with other systems
- Report quality, operational, and revenue metrics
EHR vs EMR
- EHR: Designed for a longitudinal record and exchange across organizations and apps, often using standards and APIs.
- EMR: Often used to describe the digital chart within one organization or one practice, sometimes narrower in exchange scope.
Types of EHR systems
By care setting
- Inpatient (hospital) EHR: Multi-department workflows, inpatient order sets, higher integration intensity.
- Ambulatory (outpatient) EHR: Clinic workflows, scheduling and follow-ups, specialty templates.
- Specialty EHR: Behavioral health, therapy, home health, long-term care, and other domain-specific workflows.
By deployment model
- Cloud / SaaS: Vendor-hosted, accessed via browser, typically faster rollout and lower infrastructure burden.
- On-premise: Hosted by the organization, more control, higher internal IT requirements.
Must-have features of EHR systems
- Clinical documentation: fast charting, templates, smart phrases, structured fields
- Orders and results: labs, imaging, referrals, and clear result reconciliation
- Medication workflows: med list, allergy checks, interaction flags, e-prescribing support where applicable
- Patient access: portal, messaging, visit summaries, proxy access
- Reporting: quality, operational reporting, and billing visibility
- Interoperability: standards-based exchange and API access for your key workflows
- Security: role-based access, audit logs, MFA, encryption, and incident response readiness
Top 3 EHR systems in U.S. hospitals
For inpatient hospital settings, the “top 3” are typically discussed in terms of market share. As of May 2025, a commonly cited inpatient market share view places Epic, Oracle Cerner, and MEDITECH as the top three.
Source: Definitive Healthcare inpatient market share overview
Top inpatient hospital EHR vendors
If you are evaluating an EHR for a hospital, start by understanding the most common inpatient vendors, then validate fit against your workflows, interfaces, and implementation capacity.
Epic (large health systems, academic medical centers)
Oracle Cerner (enterprise hospitals, health networks)
MEDITECH (community hospitals, health systems)
TruBridge (often seen in smaller and rural settings)
WellSky (varies by product line and setting)
MEDHOST (hospital-focused workflows)
Netsmart (strong presence in certain specialized settings)
VistA (public sector legacy footprint)
Altera Digital Health (Sunrise and related product lines)
athenahealth (smaller inpatient footprint, strong ambulatory presence)
Note: This list is intended as a discovery starting point. Always validate based on the workflows you run, the interfaces you need, and your timeline.
Common ambulatory EHR systems
Ambulatory EHR evaluations are usually driven by specialty fit, usability, patient experience, billing alignment, and how quickly teams can adopt. These are common ambulatory platforms frequently evaluated in the U.S. market:
- athenahealth (cloud-first ambulatory workflows)
eClinicalWorks (broad ambulatory footprint)
NextGen Healthcare (specialty and ambulatory focus)
AdvancedMD (practice workflows and revenue alignment)
Practice Fusion (smaller practices and cost sensitivity)
Modernizing Medicine (specialty-oriented EHR suites)
Greenway Health (ambulatory focus)
Quick comparison checklist
| Criterion | What to verify | Where to check |
|---|---|---|
| ONC certification status | Certified modules and current version | Vendor compliance pages and ONC program resources |
| FHIR API access | Read and write support for the resources you need | API documentation and technical demo |
| Interfaces | Labs, imaging, claims, registries, HIE participation | Interface catalog and implementation SOW |
| Migration plan | Extract approach, timeline, validation process | Migration playbook and references |
| Security controls | MFA, RBAC, audit logs, encryption, IR plan | Security documentation and security review |
Selection playbook
- Define outcomes
Pick 5 measurable outcomes (example: reduce time to close charts, reduce denials, improve follow-up completion). - Map 10 workflows
Use your real workflows: intake, visit, referral, refill, lab, imaging, discharge, portal requests, prior auth, billing handoff. - Scripted demos
Give vendors the same scenarios and sample data. Require hands-on validation, not slides. - Interoperability due diligence
Confirm certification posture, API support, and your exact integration needs (not generic “we support FHIR”). - Security due diligence
Validate role design, audit trails, MFA, encryption, and incident response process. - Scope and TCO
Include licenses, implementation, interfaces, migration, training, optimization, and ongoing support.
Implementation blueprint
- Governance: executive sponsor, clinical champions, super-users
- Build: templates, structured fields, roles, decision support policies
- Interfaces: labs, imaging, claims, registries, HIE
- Testing: unit, integration, performance, dress rehearsal
- Training: role-based training, sandbox time, at-elbow support
- Go-live: command center and hyper-care
- Stabilize: backlog and quick wins
- Optimize: reduce clicks, improve templates, tune alerts and reporting
Interoperability, FHIR, TEFCA, information blocking
- Certification: Start with ONC’s Health IT Certification Program resources and understand what certified health IT means for data capture and exchange.
- Standards: FHIR is a widely used modern standard for exchange. See HL7’s overview: HL7 FHIR overview.
- Information blocking: U.S. policy generally aims to reduce practices that interfere with access, exchange, or use of electronic health information.
- TEFCA: A national framework intended to support network-to-network exchange under a common approach.
References: ONC Health IT Certification Program, Information blocking, TEFCA
Privacy and security
EHR systems handle electronic protected health information (ePHI). Expect MFA, encryption in transit and at rest, audit logs, role-based access, and an incident response plan. Review HHS summaries for the HIPAA Privacy Rule and Security Rule.
Where Tadabase fits around an EHR
Most teams do not replace their EHR with a custom build. Instead, they keep the EHR as the system of record and build workflow apps around it: intake, internal operations, portals, referral coordination, tasking, and reporting layers that match how the organization actually runs. This is typically done by integrating via APIs, exports, or middleware, and enforcing strict permissions and audit trails for any PHI workflows.
If you are building around an EHR, prioritize three things:
- Permissioning: role-based access and least-privilege design
- Auditability: log access and changes
- Integration clarity: define which system is the source of truth for each data object
Frequently asked questions
What is an EHR system in one sentence
An EHR system is a digital patient record maintained by a provider over time that supports documentation, ordering, coordination, and reporting.
What are the top 3 EHR systems
For U.S. hospitals, the top three are commonly discussed as Epic, Oracle Cerner, and MEDITECH based on inpatient market share views.
What are the types of EHR systems
Common categories include inpatient hospital EHRs, ambulatory clinic EHRs, specialty EHRs, and deployment models like cloud-based and on-premise.
Do I need a certified EHR
If you participate in federal programs or need standardized connectivity, understanding ONC certification and certified health IT requirements is strongly recommended.
What drives EHR cost and timeline
Licenses, implementation, interfaces, migration, training, and post-go-live optimization are usually the biggest drivers. Always budget for optimization, not just go-live.
