October 9, 2026

Before signing an EHR contract, a healthcare practice should understand much more than the software's features and monthly price. It should ask 10 technology questions covering data ownership and export, migration, integrations, hardware and connectivity, security and HIPAA responsibilities, backups and recovery, support, system availability, implementation responsibilities, and contract termination.

These questions help uncover costs, technical dependencies, and responsibilities that may not be obvious during a software demonstration. For an independent practice, the goal is to know what the vendor provides, what the practice remains responsible for, and what happens if the relationship eventually ends before committing to the system.

Why Should Technology Questions Be Answered Before the EHR Contract Is Signed?

An EHR demonstration usually focuses on what the application can do.

The contract determines much more.

It can affect how the practice accesses its information, which integrations are available, who handles security responsibilities, how support works, what happens during an outage, what additional services cost, and how the practice retrieves its data if it eventually changes systems.

Those details can be difficult or expensive to change after the agreement is signed.

The federal SAFER Guides also emphasize that safely implementing health IT involves more than the application itself. Current guidance addresses system configuration, hardware and software, APIs, contingency planning, patient identification, organizational responsibilities, and testing.

Before signing, the Practice Administrator should therefore get clear answers to these 10 questions.

What 10 Technology Questions Should You Ask an EHR Vendor?

1. Who Owns Our Data, and How Can We Get It Back?

Start with one of the most important questions:

What happens to our information if we eventually leave?

Ask the vendor:

• Does the contract clearly state who owns the practice's data?
• What information can be exported?
• In what formats can it be exported?
• Is the export structured data, documents, images, or a combination?
• Can the practice perform an export itself?
• Does the vendor charge for an export?
• How long does an export take?
• What happens to information that cannot be exported in a usable format?
• How long can the practice access the system after termination?
• When and how does the vendor delete remaining information?

Do not settle for "Yes, you can get your data."

Ask the vendor to explain exactly how.

For cloud services involving ePHI, HHS specifically identifies the manner in which data will be returned after termination as an issue that can be addressed in service agreements.

This matters because changing EHRs later can become much more difficult if the practice discovers only then that extracting historical information is complicated, expensive, or limited.

2. What Is Included in Data Migration?

If the practice is replacing an existing EHR, determine exactly what the new vendor will migrate.

Ask:

• What data types are included?
• How much historical information can be migrated?
• Will clinical data remain structured?
• What happens to scanned documents?
• Will appointments migrate?
• Will billing information migrate?
• What happens to historical messages?
• Who extracts the data from the old EHR?
• Who maps it into the new system?
• Who validates the migrated information?
• How are migration errors corrected?
• How many test migrations are included?

The phrase "data migration included" is not specific enough.

A vendor might migrate patient demographics and documents while other historical information remains in the old system.

The practice should know what the completed migration is expected to look like before agreeing to the project.

3. Which Integrations Are Included, and Which Cost Extra?

An EHR rarely operates alone.

Depending on the practice, it may need to exchange information with:

• Laboratories
• Imaging providers
• Pharmacies
• Clearinghouses
• Patient communication platforms
• Payment systems
• Medical devices
• Health information exchanges
• Scheduling tools
• Billing systems
• Other clinical applications

For each required connection, ask whether it is:

Already included, available for an additional fee, dependent on another vendor, custom-built, or unsupported.

Then ask about both initial and recurring costs.

A $0 implementation fee does not help much if a critical interface carries an unexpected monthly charge for the life of the agreement.

Also determine who is responsible when an integration stops working.

The EHR vendor may own one side of the connection while another vendor owns the other. The practice needs to know who coordinates troubleshooting rather than discovering after go-live that each vendor expects the other to solve the problem.

Federal health IT safety guidance specifically recommends addressing potential integration issues during implementation and emphasizes configuration, validation, and maintenance of system-to-system APIs.

4. What Computers, Devices, Network, and Internet Connection Do We Need?

Ask for the vendor's current technical requirements in writing.

Those requirements may cover:

• Supported operating systems
• Supported browsers
• Processor and memory requirements
• Monitor recommendations
• Scanners
• Printers
• Label printers
• Signature devices
• Mobile devices
• Internet bandwidth
• Firewall configuration
• Wireless connectivity
• Remote access
• Other peripherals

Then have the practice's IT provider compare those requirements against the actual environment.

A system being "cloud-based" does not mean the practice has no local technology requirements.

Employees still need computers and devices capable of running the application reliably, and the practice still depends on its local network and internet connection to reach a cloud EHR.

If upgrades are necessary, they should be identified before signing so they can be included in the true implementation budget.

5. How Do You Protect Our Data, and What Are Our Security Responsibilities?

Do not ask only:

"Are you HIPAA compliant?"

Ask the vendor to explain how responsibility is divided.

Questions should include:

• Will you sign a Business Associate Agreement when required?
• How is ePHI encrypted?
• What authentication options are supported?
• Is multifactor authentication available or required?
• How are administrative accounts protected?
• What audit logs are available?
• How is vendor access controlled?
• How are security vulnerabilities addressed?
• How are security incidents communicated?
• What security settings must the practice configure?
• Which security responsibilities remain with us?

HHS states that an EHR vendor that creates, receives, maintains, or transmits PHI on behalf of a covered entity can be a business associate. HHS specifically gives EHR vendors that access patient information for hosting, maintenance, or support as examples where a BAA may be required.

A BAA is important, but it does not transfer every cybersecurity responsibility to the vendor.

The practice still needs to understand and secure its own computers, user accounts, network, email environment, connected systems, and other technology outside the vendor's responsibility.

6. How Are Backups, Recovery, and Data Availability Handled?

Do not assume "cloud-based" automatically answers the backup question.

Ask:

• What data is backed up?
• How frequently?
• Where are backup copies maintained?
• How long are they retained?
• How are backups protected?
• How is recovery tested?
• What happens if data is corrupted?
• What recovery capabilities are included?
• Can individual records or data be restored?
• What happens during a ransomware incident?
• Which recovery responsibilities belong to the vendor?
• Which remain with the practice?

HHS notes that service-level agreements for cloud services can address system availability, reliability, backup and data recovery, security responsibilities, and data return after termination.

The practice should understand the distinction between the vendor's responsibility for its hosted EHR environment and the practice's responsibility for everything else.

7. What Support Is Included, and How Does Escalation Work?

Ask what happens after the salesperson hands the practice to implementation and support.

Clarify:

• Support hours
• Support channels
• Expected response process
• Emergency support
• After-hours availability
• Escalation procedures
• Implementation support
• Ongoing training
• Account management
• Support for integrations
• Support for third-party vendors
• Charges for additional assistance

Then ask a practical question:

If the EHR is unavailable while patients are waiting, whom do we call and what happens next?

Also clarify where the EHR vendor's responsibility ends and the IT provider's begins.

For example, the EHR vendor may troubleshoot its application while the practice's IT provider handles the workstation, network, firewall, internet connection, or other local technology.

Knowing those boundaries beforehand can reduce finger-pointing when something goes wrong.

How Should Healthcare Practices Manage IT Vendors Without Getting Caught in the Middle? A 7-Step Process provides a broader framework for defining vendor responsibilities and escalation before a problem occurs.

8. What Happens When the EHR Is Unavailable?

Every EHR can experience planned or unplanned unavailability.

Ask:

• What availability commitment is in the contract?
• How is availability measured?
• What is excluded from that calculation?
• How are planned maintenance periods handled?
• How will the practice be notified about outages?
• Is there a downtime or read-only capability?
• What information remains available during an outage?
• How does the vendor communicate recovery status?
• What happens if the internet connection fails?
• How are transactions or documentation reconciled afterward?
• Are service credits or other remedies defined?

The current federal SAFER Contingency Planning Guide specifically addresses planned and unplanned EHR unavailability and recommends preparation to reduce its impact on clinicians and staff.

The vendor's recovery plan and the practice's business continuity plan are not the same thing.

The vendor needs to restore its service.

The practice needs to know how it will continue operating while that service is unavailable.

What Should a Healthcare Practice Business Continuity Plan Include? A 7-Part Checklist explains the broader planning needed to keep essential operations functioning during technology disruptions.

9. Who Is Responsible for Each Part of Implementation?

Before signing, make the vendor explain what "implementation" actually includes.

Responsibility may need to be assigned for:

• Project management
• System configuration
• Data migration
• Data validation
• User setup
• Permissions
• Interfaces
• Hardware preparation
• Network preparation
• Security configuration
• Staff training
• Workflow configuration
• Testing
• Go-live support
• Post-go-live troubleshooting

A simple responsibility table can expose gaps:

Implementation Task	EHR Vendor	Practice	IT Provider	Other Vendor
EHR configuration	✓
Data migration	[VERIFY]	[VERIFY]		[VERIFY]
Computer readiness			[VERIFY]
Network readiness			[VERIFY]
User setup	[VERIFY]	[VERIFY]	[VERIFY]
Interfaces	[VERIFY]			[VERIFY]
Training	[VERIFY]	[VERIFY]
Testing	[VERIFY]	[VERIFY]	[VERIFY]	[VERIFY]

The table intentionally uses [VERIFY] because responsibilities vary by vendor and implementation.

Do not assume responsibility based on what is typical.

Put it in writing.

10. What Happens If We Want to Leave?

The final question brings several of the others together.

Ask what happens when the contract ends because the practice:

• Changes EHR systems
• Is acquired
• Closes a location
• Changes ownership
• Is dissatisfied with the service
• No longer needs the platform

Review:

• Initial contract term
• Automatic renewal
• Renewal notice requirements
• Termination rights
• Early termination fees
• Data-export charges
• Migration assistance
• Continued access after termination
• Data-retention period
• Data-deletion process
• Access to historical records
• Responsibilities for integrations
• Final billing
• Assistance transitioning to another vendor

This is one area where the contract deserves appropriate legal review.

Your IT provider can help evaluate technical requirements and dependencies, but it should not replace qualified legal counsel when interpreting contractual obligations.

A good technology relationship should have an understandable exit path before the practice enters it.

What Should a Practice Get in Writing Before Signing?

A salesperson's explanation can be useful, but important commitments should be reflected in the appropriate contractual documents.

Depending on the arrangement, those may include the:

• Master agreement
• Order form
• Statement of work
• Implementation agreement
• Service-level agreement
• Business Associate Agreement
• Data-migration scope
• Support terms
• Security documentation
• Pricing schedule

For cloud services involving ePHI, HHS notes that an SLA can address issues such as availability and reliability, backup and recovery, security responsibilities, data-return procedures, and limitations on use and retention. HHS also cautions that SLA terms should remain consistent with the BAA and HIPAA requirements.

If something materially affects the practice's cost, access to information, implementation responsibilities, security, or ability to leave the vendor, do not rely solely on a verbal assurance.

How Can a Practice Compare EHR Vendor Answers?

Create a simple comparison sheet before making the final decision.

Area	Vendor A	Vendor B	Vendor C
Data export
Migration included
Integration costs
Technical requirements
BAA/security
Backup/recovery
Support
Availability/downtime
Implementation responsibilities
Contract exit

Avoid reducing every answer to Yes/No.

For example, three vendors may all say they support data export while offering very different export formats, costs, turnaround times, and termination procedures.

Capture the details that could materially affect the practice.

Example: What Can These Questions Uncover Before Signing?

Consider a hypothetical 20-employee Houston specialty practice comparing two cloud EHR systems.

Both vendors appear capable during demonstrations, and their base subscription prices are reasonably close.

The Practice Administrator then works through the 10 technology questions.

The review identifies several differences that were not obvious from the demonstrations:

• One vendor includes two required interfaces while the other charges separately.
• One proposed migration includes only selected historical information.
• Several existing workstations need to be checked against the new system's requirements.
• The practice needs clarification about access to historical information after termination.
• Responsibility for configuring one third-party connection has not been assigned.
• The support escalation process differs between the two vendors.

None of those findings automatically determines which EHR the practice should choose.

They give leadership better information about the complete implementation and ongoing relationship before signing a contract.

That is the purpose of the review.

When Should Your IT Provider Review the Proposed EHR?

Ideally, involve the IT provider before the contract is signed, not a few weeks before go-live.

The IT provider can help review areas such as:

• Hardware requirements
• Network requirements
• Internet dependencies
• Security requirements
• Authentication
• Device compatibility
• Interfaces
• Third-party technology dependencies
• Backup responsibilities
• Technical implementation responsibilities

The EHR vendor remains the authority on its application. The practice's attorney should address legal interpretation of the contract, and appropriate compliance advisors should address compliance questions within their scope.

The IT provider's role is to help identify technical assumptions, dependencies, costs, and responsibilities that the Practice Administrator may not know to ask about.

Frequently Asked Questions

Should a Healthcare Practice Have an Attorney Review an EHR Contract?

Yes, appropriate legal review can help the practice understand contractual terms, obligations, liability, termination provisions, data rights, and other legal issues before signing.

An IT provider can review technical requirements and responsibilities, but that is not a substitute for legal advice.

Is a Business Associate Agreement Enough to Make an EHR Vendor HIPAA Compliant?

No, a BAA is an important contractual requirement when the vendor is acting as a business associate, but signing one does not by itself resolve every HIPAA or cybersecurity responsibility.

HHS explains that BAAs establish permitted and required uses and disclosures and require business associates to appropriately safeguard PHI. Regulated organizations still have their own obligations under the HIPAA Rules.

The practice should evaluate both the agreement and how the technology will actually be used and secured.

Should We Choose the EHR With the Lowest Monthly Price?

No, the subscription price is only one component of the financial decision.

Implementation, data migration, interfaces, hardware, training, support, additional modules, transaction fees, and eventual exit costs can all affect the total cost.

The practice should compare the complete cost and responsibilities, not simply the advertised monthly subscription.

What If the Vendor Will Not Answer One of These Questions Clearly?

Treat the unanswered question as unresolved rather than filling in the answer yourself.

Ask for clarification in writing and involve the appropriate technical, legal, or compliance advisor when necessary.

If the question affects a critical requirement, cost, security responsibility, or the practice's ability to access its information, resolve it before signing rather than assuming it will be addressed during implementation.

Should the Practice Administrator Handle the EHR Evaluation Alone?

No, the Practice Administrator may coordinate the evaluation, but EHR selection affects clinical, operational, financial, technical, security, and contractual issues.

Depending on the practice, the evaluation team may include physician leadership, employees who use key workflows, billing personnel, the IT Service Provider, legal counsel, and other appropriate advisors.

The objective is not to make the group unnecessarily large. It is to make sure important decisions are reviewed by people who understand their consequences.

Final Thoughts

An EHR contract can shape a healthcare practice's technology environment for years.

Before signing, understand how your data can be retrieved, what will migrate, which integrations are included, what technology is required, how security responsibilities are divided, how backup and recovery work, what support is available, what happens during downtime, who owns each implementation task, and how you eventually leave the vendor.

A strong EHR evaluation does not stop at, "Does the software have the features we want?"

It also asks, "Do we understand what we are agreeing to?"

About ResTech Solutions

ResTech Solutions helps independent healthcare practices throughout the Houston area manage the technology surrounding critical healthcare applications, including computers, networks, Microsoft 365, cybersecurity, backups, user access, vendor coordination, and long-term technology planning.

When a practice evaluates a new EHR, our role is not to select the clinical system or provide legal advice. We can help evaluate the technical requirements, identify dependencies in the existing environment, clarify technology responsibilities, and coordinate with the EHR vendor and other technology providers.

If your practice is evaluating a new EHR and wants another set of eyes on the technology requirements before signing, book a 10-minute discovery call and we'll help you identify what deserves a closer look.