EHR implementations are among the most capital‑intensive and disruptive investments health systems make. Yet, many fail to deliver expected return on investment (ROI). Rather than basing decisions on a platform’s quality or features, health systems in the process of selecting an EHR can better define the problem and desired outcomes by aligning their business goals, decision governance, and selection criteria.

This article outlines a business‑first framework for assessing readiness and selecting an EHR that supports long‑term financial, clinical, and operational performance.