Choosing the “Host” of Your EHR Extension in the Acute Setting

Beautiful female doctor working with computer in medical consult
Apr 26, 2018

Choosing the “Host” of Your EHR Extension in the Acute Setting

Written by Impact Advisors

Category: EHR

EHR extension – using someone else’s implemented EHR – is not a new practice among healthcare providers. In the EHR Extension Model, the “recipient” (a healthcare provider) uses the EHR of the “host” (typically another healthcare provider), and the host provides not only the software but also services and support associated to that use.

Why use someone else’s EHR?

Some healthcare providers simply can’t afford their own implementation. Others are within a market where using a specific vendor is strategically important due to partnership with another organization, ease of integration for patient information sharing, or provider preference.

The typically known host is a healthcare provider. However, it is interesting to note that some EHR vendors started to offer “vendor hosted shared install” services, in which the vendor hosts the system with a standard build/shared instance among recipients. The choice between using the vendor and using another healthcare provider as the host depends on the initial reason, “why use someone else’s EHR,” e.g., if it is purely because of cost, using a vendor as the host would be a viable option; if clinical integration/partnership is the play, using another healthcare provider might be preferable. This blog is primarily focused on the pursuit of an EHR extension partnership with another healthcare provider.

How does this work?

The host essentially assumes the role of service provider for the software and specified support; the recipient organization is the customer. Both parties are on the same system. The recipient adopts the system build of the host but with certain freedom to configure the system for itself. How to separate information is determined by regulatory obligation and agreement between the two organizations (although the decision is typically driven by the host). The following graph describes an example of information separation and sharing.

Sample EHR Extension Model

A Possible Way to Handle Information Sharing in an EHR Extension Model

What are the criteria to consider during a host selection?

EHRs touch patient care in the most vital way. Even if the recipient has the new EHR vendor preference in mind (this typically is the case), to find the best EHR extension host is still no picnic. This is essentially another vendor selection! If an organization is thinking about becoming the recipient of an EHR extension, what criteria does it need to consider? The following questions should help you initiate and drive the conversation.

Note, though there are a lot of shared attributes between EHR extensions to acute providers and independent ambulatory providers, the following questions are primarily focused on acute extension.

Sample Questions to Ask

Why Ask the Question

Similarity & Shared Connections

Do we have/want to strengthen our strategic relationship with host?

This is typically one of the top reasons (if not #1) why an EHR extension host is selected.

Enhancing and tightening the patient flow between the host and recipient would benefit both organizations. Moreover, as patient experience is streamlined and clinical information is shared, the lives of patients and providers will be easier as well.

What are the products currently implemented at the potential host’s organization? Will that scope meet our needs?

If the recipient needs a specific application that host currently does not have (e.g., recipient needs a transplant solution, and the host does not have that in place today), the host would need to implement an application for the first time for the recipient (if the partnership were to happen). This poses significant risk to a success implementation and could potentially jeopardize the recipient’s service provision.

Is the potential host similar to us?
– Strategic Vision/Culture
– Business Focus & Constraints (e.g., practice state, payer mix)|
– Operating Model (e.g., for-profit/not-for-profit, academic/community, general/specialty)


If host has significant differences from the recipient, it’s likely that the host will have differences in decision-making that will not align to the recipient’s operational needs.

Has the potential host already implemented various best practices that work for our organization?

EHR transformation is typically leveraged as an opportunity to improve an organization’s way to operate. If the host already has best practices built into the system, it would save the recipient time and resources in getting to the right place.

Decision-Making Autonomy

What decisions are we empowered to make during the implementation?

No two organizations are exactly the same. To simply adopt another organization’s setup (for example, work flow) might not be appropriate
all the time. If the recipient has no freedom to configure some key items that fundamentally impact the operation, it can be a major issue.

What is our role in the EHR governance process at the potential host site after the implementation?

In an extreme scenario, the recipient has no say on upgrades and changes to workflow. It would have to comply with any EHR decisions made by the host. Even if the recipient has the system perfectly configured at implementation, those new decisions could create new problems.

When appropriate level of consideration is placed on recipient’s input during decision making (e.g., upgrades, enhancements), recipient can leverage these decisions to enhance its own business.

IT Service Organization

Has the potential host done this before?

If the host has done EHR extension before, they are more likely to have an established methodology and experienced talent in place. In this way, no one has to explore the path to success in the dark.

Is the potential host mature enough to be an IT service organization to others?

Lack of host maturity is a risk for both implementation and ongoing maintenance. Can the host handle the workload? Will the implementation be delivered on time, on budget, and on target? Will the issue reported during system operation be addressed properly?

What is the potential host’s existing/envisioned service model (e.g., issue resolution process, SLAs, etc.)?

Just like selecting a service provider, how the support is provided and what the SLAs look like is crucial.

This can be a topic subject to negotiation later in the partnership setup.


What are the costs and resource requirements? (Ask all the typical cost-related questions.)

No further explanation needed – this is a business process. Moreover, financial consideration is one of the most common drivers for adopting an EHR extension model for a recipient. Clarity on roles/responsibilities will enable the recipient to understand its total cost of ownership, including what it will pay to the host as well as what staff it will need for support internally.

How much is the potential host willing to subsidize the cost?

Certain hosts are willing to subsidize software services to keep the offering attractive and enhance the business relationship with the community. In some scenarios, the final price could be a notable

Before having the conversation with a potential host, engage in an internal discussion to understand how you want these questions to be answered by potential hosts and what the acceptable range of answers are for each.

Co-authored by DJ Skalsky