Choosing an AI-native EHR: a checklist
Evaluating a new EHR? The questions to ask about AI, interoperability, billing, and support.
"AI-powered" now appears in every EHR's marketing. The useful question is not whether a system mentions AI but where the AI actually sits in your workflow — and what happens when it is wrong. Here is a checklist for cutting through demos.
The AI questions
- Does AI draft the note from the visit itself (ambient), or just autocomplete text?
- Does every AI output require clinician review before it enters the record?
- Does the AI show its sources — which chart data or evidence produced a suggestion?
- What does the vendor do with your clinical data? Is it used to train models? Covered by a BAA?
The plumbing questions
- Is the record FHIR-native, and can you export all of it, structured, if you leave?
- Does eligibility checking run in real time, inside the workflow?
- Does billing live in the same system as the chart, so charges reconcile against documentation?
- Can records from other health systems be imported as structured data?
The operational questions
- What does implementation actually involve, week by week, and who does the data migration?
- What is the real all-in monthly cost — licenses, claims fees, support tiers, add-ons?
- Talk to a reference practice your size, in your specialty, that switched in the last year.
A vendor comfortable with every question on this list is telling you about their product. A vendor who redirects to the demo is also telling you about their product.