EHR software selection involves specific criteria that shift compared to previous years. Six that matter most in 2026.
1. FHIR API completeness. Verify against Inferno, not marketing.
**2. SMART on FHIR support.** Universal expectation.
**3. US Core conformance.** Baseline for US deployments.
**4. Bulk data export.** Required for CMS-0057.
5. Terminology depth. SNOMED CT, LOINC, RxNorm coverage.
6. Vendor roadmap alignment. Ability to keep pace with regulatory changes.
Evaluation framework
| Criterion | Weight | Verification |
|---|---|---|
| FHIR completeness | High | Inferno |
| SMART support | High | Live launch demo |
| US Core | High | Inferno |
| Bulk data | Medium | Load test |
| Terminology | Medium | Update cadence |
| Roadmap | Medium | Reference customers |
Red flags
1. Custom auth vs. SMART. 2. Unversioned US Core. 3. Sync-only bulk export. 4. Manual terminology. 5. Custom profile requirements.
Reference-check questions
1. Time from purchase to production? 2. CMS-0057 compliance level? 3. Inferno test failures? 4. Vendor profile update handling? 5. Support quality?
Common selection mistakes
1. Feature-list purchasing. 2. Ignoring conformance testing. 3. Custom auth acceptance. 4. No bulk data verification. 5. Weak terminology governance.
Vendor state (mid-2026)
| EHR | FHIR completeness | SMART | Bulk data | Terminology |
|---|---|---|---|---|
| Epic | Full | Full | Full | Full |
| Cerner | Full | Full | Full | Full |
| Athenaclinicals | Full | Full | Full | Partial |
| Meditech | Growing | Full | Partial | Growing |
| Aidbox-based | Full | Full | Full | Full |
EHR selection is a five-year commitment. The six criteria above cover most decision factors.
