EHR Technology Evaluation Checklist
Use this form to evaluate an EHR technology solution against operational, workflow, integration, support, and usability criteria.
Evaluator and Organization Details
Evaluator Name
*
First Name
Last Name
Organization or Practice Name
*
Evaluator Role or Department
*
Please Select
Physician
Nurse
Practice Manager
IT
Billing
Operations
Other
Email Address
*
example@example.com
EHR Solution Being Evaluated
Vendor/Product Name
*
Deployment Type
*
Cloud
On-premises
Hybrid
Primary Use Setting
*
Clinic
Hospital
Specialty Practice
Urgent Care
Other
Workflow and Integration Fit
Systems or interfaces to connect with
*
Workflow fit rating
*
1
2
3
4
5
Implementation constraints or compatibility notes
Support, Training, and Cost Considerations
Desired Training and Support Level
*
Basic
Standard
Premium
Dedicated
Other
Preferred Implementation Timeline
Overall Budget Fit / Cost Concern Level
*
Low concern / strong fit
1
2
3
4
5
6
7
8
9
High concern / poor fit
10
1 is Low concern / strong fit, 10 is High concern / poor fit
Overall Decision
Overall recommendation
*
Recommend
Consider with changes
Do not recommend
Final comments
Follow-up questions or next steps
Submit Evaluation
Should be Empty: