Your EHR is responsible for sensitive data across every area of your practice, and replacing one is a decision most organizations make only a handful of times. Reliable numbers on what that process actually looks like are harder to come by than they should be. How long does selection take? What are practices trying to fix? What should the budget be?

To answer those questions, we analyzed over 17,000 active EHR selection projects recorded between January 2020 and July 2026. 

1. On average, practices spend 11.5 weeks selecting EHR

Practice size remains the clearest predictor of how long a selection takes. Solo practices completed the process in an average of 10.2 weeks in 2025, practices with 2 to 10 physicians took 11.7 weeks, and organizations with 11 or more physicians took 19.6 weeks. The largest practices still take close to twice as long as the smallest.

What has changed is the overall pace. Selection timeframes lengthened to a peak of 14.1 weeks in 2023 and have fallen each year since, reaching 11.5 weeks in 2025 and 11.0 weeks across the first seven months of 2026. Large organizations account for most of that movement. Practices with 11 or more physicians averaged 22.4 weeks in 2021, compared with 15.1 weeks in 2026, the shortest figure recorded for that group in seven years.

Buyers are also compressing their planning windows. Three quarters of projects in 2026 expect to select within three months, up from 62.5% in 2023, while those allowing six months or more have fallen from 13.6% to 6.7%.

A shorter window puts more weight on comparison and pricing information being readily available, which is exactly what buyers have started asking for.

2. The top reason for implementing EHR is to increase efficiency

For the first time in this research, growth is not the leading driver.

Increasing efficiency was the most cited reason in 2025 at 30.14% of all reasons given, with greater functionality close behind at 29.9%. Supporting growth, which led every previous edition of this report, has moved into third at 24.02%.

That's a stark contrast from 2021, where supporting growth accounted for 40.95% of all reasons given, roughly double the share held by efficiency at 18.23%. The two have swapped positions over five years.

Reporting and business intelligence has been the fastest riser, growing from 1.63% of reasons given in 2021 to 10.14% in 2025. Poor support from an existing vendor accounted for 3.64%, its lowest share in seven years.

The three leading drivers are now consistent across every practice size, which was not true in our last report. This points to practices replacing systems to get more out of the organization they already have rather than to add capacity for one that is growing.

3. The modelled budget per user for EHR software is $1,243

Budget figures in this edition are modelled. Benchmark rates are held constant and applied to the mix of practices entering selection in each year, so the series isolates a single question: how much does expected spend move purely because the buyer base has changed? The series is set so that it matches the previously documented average of $1,200 per user.

On that basis, modelled budget per user runs from $1,201 in 2020 to $1,240 in 2026 to date, a rise of about 3.3% across the period. The direction is upward because smaller practices now make up more of the buyer base and expect to pay more per seat. Solo practices grew from 38.92% of the sample in 2021 to 48.58% in 2025, while the 11 or more physician group fell from 20.84% to 13.17%.

Total contract values move the other way. Modelled annual budget per practice falls from $13,263 in 2022 to $8,701 in 2026, a decline of 34% from the peak. Smaller practices expect to pay more per user but buy far fewer seats, and that second effect is much the larger of the two. The median solo practice has reported 2 users in every year since 2020, against 50 for the largest band in 2025.

Hosting is the single biggest lever on expected spend. Modelled annual budget by hosting preference peaks at $4,290 in 2023 and falls to $3,757 in 2026, a drop of 12.4%, as buyers who would previously have kept installed systems in play stop doing so.

What has changed since the 2022 report

1. Cloud has become the default: Cloud-based EHRs were the preference in 93.32% of projects across the first seven months of 2026, up from 76.49% in 2021. On-premise software has fallen to 0.17% of projects, effectively removing it from consideration. The either/or has collapsed from 28.02% of projects in 2023 to 6.51% in 2026.
2. Buyers want a price and a conversation sooner: Comparison content has fallen from 63.46% of content requests in 2021 to 31.76% in 2026, while demo requests have risen from 3.96% to 31.13% and pricing requests from 16.21% to 27.09%. By 2026, comparison and demo requests sit almost level.
3. Requirements have broadened: Health records (naturally) remain the near-universal requirement at 85.33% of projects, almost unchanged from 85.82% in 2021. The growth has been in administrative and revenue functions: billing was required by 73.04% of projects in 2025 against 63.33% in 2021, insurance and claims by 49.88% against 38.37%, and document management by 46.66% against 18.95%.
4. Telemedicine and patient portals are mentioned less often: Telemedicine peaked at 41.32% of projects in 2023 and sits at 29.62% in 2026. Patient portal has fallen from 56.55% in 2021 to 27.23%. An important thing to note is the fact that these figures describe how often buyers name these as selection requirements, not whether the features are part of their criteria.
5. Epic EHR is still the most shortlisted, but the field below it has reshuffled: Epic was the most compared system in 2025 at 24.29% of all system comparisons, a similar share to the 26.71% recorded in 2022, and has been the most compared system in every year of this dataset. Below it, Practice Fusion at 4.47%, eClinicalWorks at 4.12% and AdvancedEHR at 3.18% now occupy positions held by other vendors four years ago, with SimplePractice, TherapyNotes and ICANotes completing the top eight.

About this research

The figures above come from 17,674 EHR selection projects recorded between 1 January 2020 and 31 July 2026. The sample comprises almost entirely U.S. based healthcare organizations, at 99.74% of records, and is weighted toward outpatient practices at 96.26%. Headline figures quote 2025, the most recent complete calendar year. 

Full methodology, including how the budget model is constructed and how multivalued fields are handled, is set out in the appendices of the full report.

Download the 2026 EHR Software Report for the complete findings, including specialty breakdowns, feature requirements by practice size and the full set of trend charts.