Building a robust RFI process and RFP for a new EHR system

Selecting and implementing a new EHR system is as complex and high-stakes as it ever was — choose wisely, and it can be the backbone of an efficient, financially sound and patient-centered practice. Choose poorly, and it becomes a costly, frustrating albatross around the neck of your organization.

Therefore, a well-constructed request for proposal (RFP) is vital to ensure the chosen solution aligns with the clinical, operational, and financial needs of the practice.

A March 18, 2025, MGMA Stat poll finds that 23% of medical group practice leaders expect to switch or significantly update their EHR(s) in the next 12 months, while 70% do not and 7% were unsure. The poll had 455 applicable responses.

Follow-up responses from practice leaders revealed:

• Many more medical groups planning for a change note they are switching to a new EHR vendor rather than updating/upgrading their existing platform, with many respondents noting they are specifically moving to Epic or otherwise transitioning as part of a merger or acquisition.
• Multiple respondents signaled a mix of strategies, such as having already switched to a new EHR platform in 2024 and adding other new elements in the year ahead, suggesting a phased approach to learning a new system and then enhancing it post-go-live.
• Among the majority of respondents who did not expect a switch or update in the next 12 months, many noted they were happy or satisfied with their current EHR — many of whom noted they recently transitioned to their current platform in the past year or two.
  • Many expressed some reservations but signaled they would maintain their existing systems due to favorable cost structures or physicians’ preference.
  • Relatively few said they would not consider a change due to contractual obligations with their current vendor.
  • Many indicated they would be open to adding additional features or integrations (especially for AI scribe/documentation services) without doing a complete shift away from their current system.

To assist practice leaders thinking about a change soon, MGMA has updated its guidance on developing an RFP that reflects the latest regulatory requirements and addresses evolving technology offerings, while accounting for the varying needs of different types of ambulatory practices.

Why the RFP matters

A well-crafted RFP is the first step in identifying and selecting a new EHR system, helping guide vendors to demonstrate how their product meets your organization’s clinical, operational, and regulatory needs.

Because the EHR marketplace has matured in recent years, practices should scrutinize emerging technologies (e.g., cloud-based systems, AI, and advanced analytics), while ensuring compliance with new regulations such as the 21st Century Cures Act’s interoperability and information-blocking rules.

Smaller organizations usually benefit from simpler, turnkey solutions, whereas larger systems require more robust data exchange, advanced analytics, and multi-site interoperability. Tailoring your RFP to these needs improves the quality of vendor responses.

Why switch EHRs?

Several circumstances might prompt your practice to switch to a new EHR, including:

• Decertification: Your current EHR has been decertified by regulatory bodies (e.g., it is no longer ONC-certified for mandated quality reporting).
• Upgrades and costs: Your EHR has fallen multiple versions behind, and the cost of upgrading is prohibitive.
• Legal/compliance concerns: Your vendor has faced legal actions (e.g., Department of Justice oversight) that could jeopardize the platform’s stability.
• Vendor acquisition: Your EHR provider is bought out, creating uncertainty about future support or product direction.
• Changing relationships: Your current EHR is tied to another entity (e.g., hospital system) that is severing or altering the relationship.
• Staff expertise turnover: Your key staff who are proficient in the existing EHR have left, while new staff are experts in a different system.
• Vendor support issues: Your vendor’s support and development pace have become inadequate.
• Usability and workflow limitations: Your providers find the interface clunky or unsuited to specialty-specific tasks, causing inefficiencies and dissatisfaction.
• Value-based care and reporting needs: You need advanced features to support population health, value-based reimbursement models, and expanded data analytics.

Setting a realistic timeline

Many industry experts recommend allotting at least six to 12 months for evaluating new systems, but larger or more complex implementations can easily stretch to 12 to 18 months. Proper planning and timelines reduce the risk of rushed decisions, overlooked requirements, and unanticipated costs. Consider the following:

1. Internal needs assessment (one to two months): Document existing workflows and identify where the current EHR falls short. Conduct stakeholder interviews (physicians, staff, administrators) and map out must-have vs. nice-to-have features.
2. RFI process (one to two months, optional): Before issuing an RFP, many practices opt to release an RFI (Request for Information). This preliminary document gathers high-level details, such as technology stacks (cloud vs. on-premise), interoperability capabilities (FHIR vs. traditional HL7 v2), and vendor experience with similar practices. The RFI process allows you to eliminate solutions that clearly do not meet your core needs or compliance mandates. Once the vendor list is trimmed, move forward with a more detailed RFP.
3. Draft and issue RFP (one to two months): Finalize the RFP by detailing your practice profile, technical and functional requirements, compliance needs, and evaluation criteria.
4. Vendor evaluation (two to three months): Compare proposals using a weighted scorecard, arrange demonstrations, and conduct reference checks or site visits.
5. Selection and contracting (one to two months): Engage in negotiations around pricing, contract terms, data migration, and go-live plans.
6. Implementation (three to 6+ months): Plan and execute data migration, training, and any workflow redesign or optimization. Larger, multi-site rollouts may require a phased approach.

Key RFP elements

While the final RFP can easily exceed a dozen pages, it should thoroughly address the items below to help you differentiate among potential EHR vendors.

Your practice profile

• Number of facilities/locations
• Practice demographics: Share your specialty (e.g., cardiology, behavioral health, dermatology) and patient population. Include data on annual patient visits, payer mix, and any sub-specialty service lines.
• Number of users and roles: Clearly specify the number of physicians, advanced practice providers, other clinical staff (MAs, techs), back-office staff, and administrative users.

Project scope and timeline

• Anticipated project start date and go-live: Specify if you plan a rapid go-live or a staggered, site-by-site rollout.
• Upgrade/replacement plans: Indicate whether this is a full replacement or if certain modules (e.g., billing, scheduling) will be kept from your existing system.

Functional and technical requirements

• Interoperability and data sharing: Compliance with the 21st Century Cures Act’s information blocking provisions. Ability to support HL7 standards and FHIR-based APIs for streamlined data exchange. Readiness or roadmap to participate in the Trusted Exchange Framework and Common Agreement (TEFCA).
• Usability and workflow: Request demos or screenshots illustrating simplified clinical documentation and minimized “click burden.” Inquire about AI-powered documentation or speech recognition to reduce physician burnout.
• Data migration and conversion: Require a detailed plan for migrating legacy data, including clinical notes, scheduling data, and revenue cycle information. Request references from practices of similar size/specialty who have successfully navigated data conversion with this vendor.
• Reporting and analytics: Confirm that the EHR can generate robust reports for MIPS/QPP or other quality programs, as well as specialty registries. Ask about integrated or third-party business intelligence (BI) tools for deeper analytics, population health management, and performance dashboards.
• Security and compliance: Outline HIPAA/HITECH security requirements, including encryption standards, multi-factor authentication, and vendor security certifications (e.g., SOC 2). Understand the vendor’s cybersecurity measures (e.g., zero-trust framework, intrusion detection, disaster recovery) to protect against ransomware.
• Training and ongoing support: Clarify the number of training hours (onsite vs. remote) included, helpdesk availability, and how ongoing updates/upgrades are handled. Smaller practices often need more “hands-on” implementation support. Larger systems may require advanced project management for phased rollouts.
• Scalability and future-readiness: For organizations anticipating growth, confirm the EHR can scale to accommodate additional sites, providers, and advanced modules (e.g., chronic care management, remote patient monitoring). Request the vendor’s product roadmap to ensure alignment with emerging regulatory requirements and interoperability initiatives.
• Patient engagement and telehealth: Look for robust patient portals/mobile apps (appointment scheduling, secure messaging, test results). Include integrated telehealth functionality: video visits, virtual monitoring, and integrated e-visit billing workflows.
• Revenue cycle management (RCM): Determine whether the vendor also provides fully integrated practice management/billing modules or easily interfaces with existing RCM solutions. Confirm real-time eligibility checks, automated claims processing, and denial management capabilities if RCM is a requirement.

Financial expectations and RFP formatting

Providing vendors with clear instructions on costs and proposal structure reduces confusion and allows an apples-to-apples comparison:

• Comprehensive cost breakdown: This would include upfront costs (licensing, implementation, training, data migration), ongoing costs (support/maintenance fees, subscription fees, upgrade charges), and third-party integrations (e.g., e-prescribing for controlled substances, additional interfaces for labs or PACS, telehealth modules).
• Contractual clarity: Spell out annual price increase caps or multi-year pricing structures. Consider future expansion to avoid expensive “surprise” fees if your practice grows or adds new specialties.
• Weighted scorecard: Develop a rating system (e.g., 0–5 or 0–10) for each requirement, weighting categories such as interoperability, usability, cost, security, and specialty functionality.
• Submission guidelines: Encourage uniform proposal formats so you can easily compare solutions. Require references from practices similar in size and specialty. Where possible, request site visits or demo access to see the solution in action.

Conclusion

By clarifying your clinical and operational needs, detailing modern interoperability and compliance standards, and outlining robust evaluation criteria, you enable vendors to craft proposals that truly address your challenges.

The goal is to choose an EHR that not only meets your current needs but also positions you for evolving data exchange, advanced clinical decision support, and value-based payment models. A well-structured, up-to-date RFP is key to making that decision with confidence.

Do you have any best practices or success stories to share on this topic? Please let us know by emailing us at connection@mgma.com. 

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Additional resources

• Health IT Resources from MGMA including podcasts, articles, upcoming webinars, and more.
• RFP Template (Word document) from the Office of the National Coordinator for Health Information Technology (ONC).
• Information Blocking Toolkit for Medical Groups is an MGMA member-benefit summary of the regulatory provisions of the 21^st Century Cures Act information-blocking rule.
• Intelligent Automation in Healthcare is an MGMA-Laserfiche whitepaper exploring what motivates investments in the next generation of EHR integrations.