Five Criteria to Use When Evaluating ASC EHRs

There’s an old saying among healthcare administrators: there are two ways to make a career-ending move. Change a physician’s compensation plan, or implement a new Practice Management (PM) and Electronic Health Records (EHR) solution. I’ve heard it for years, and I’ve watched enough nightmare installs and embarrassing uninstalls to understand exactly where it comes from. When a system fails, it fails loudly, in front of your physicians, your staff, and your board.

So I’m not going to pretend EHR selection is anything other than what it is: one of the highest-stakes decisions an ASC administrator will ever make. Get it right and the center hums. Get it wrong, and you’ll spend years and a small fortune digging out.

Here’s the part that gives me some comfort, though. As a former ASC administrator, I’ve been through this process four separate times across my career, so I genuinely appreciate how daunting it feels. The most recent time was in 2020, when I set out to choose a PM and an EHR for the last surgery center I helped develop. I knew technology would make or break that center, so I gave myself more than a year to find the right fit. A full year of an EHR search. That’s how seriously I took it, and that’s how seriously I’d encourage you to take it too.

What I came away with was a framework. Before I evaluated a single vendor, I wrote down five criteria, and I held every option up against them. I’ll walk you through all five, in the order of importance I’d assign them, and I’ll tell you what I actually found. I hope that this gives you a usable EHR evaluation checklist of your own, so your selection and decision-making process is methodical instead of driven by whichever sales deck dazzled you most recently.

My five criteria were:

1. Customer Support
2. Company Stability and Trustworthiness
3. Software Performance
4. Number of ASCs Using the Software Successfully
5. Price

We narrowed the field to four contenders: EPIC, Cerner, SIS, and HST Pathways. Two of those came off the list fast. EPIC and Cerner are excellent systems, but they weren’t built for an ambulatory surgery center environment, and that mismatch matters more than their brand names suggest. That left SIS and HST. I’ll be honest: the SIS PowerPoint presentation impressed me, and their pricing looked attractive. But as I worked through my criteria, the presentation and the price turned out to be the only two things that looked better at first glance. After ample research, my board and I chose HST Pathways.

Let me take you through each criterion in detail, because the reasoning behind the choice is more useful to you than the choice itself.

Criterion 1: Customer Support

I put this first on purpose, and I’d encourage you to do the same. The day after go-live, the slick sales relationship is over, and the support relationship begins, and that relationship is the one you’ll live inside for the next decade.

Hands down, HST had the better reviews, which honestly didn’t surprise me, since they consistently win awards from KLAS (KLAS is a respected third-party software rating company). But reviews only tell you so much. What moved me was talking to real customers. HST gave me references to call, and every single one told me the same thing: they’d been assigned a dedicated support rep who calls them periodically just to check in. Not to upsell. Just to make sure things are running. And when an issue did come up, they’d email or call that rep, and the problem got handled.

That kind of relationship is rare, and it shows up in the numbers. HST has a 98% retention rate, and over the past four years, they’ve converted more than 400 SIS systems onto their platform. When you’re choosing an EHR system, those two statistics tell you something a feature list never will. People don’t leave software that takes care of them, and they don’t migrate toward software that doesn’t.

Here’s my advice on evaluating support: don’t just collect the vendor’s reference list. Use it, absolutely, but also find your own references (more on that at the end). And when you talk to anyone, ask specifically about how problems get resolved, not whether the software is good. Everyone says the software is good. Few can describe a support experience that actually saved them on a bad day.

Criterion 2: Company Stability and Trustworthiness

The second thing I looked at was the company behind the product, because you’re not buying software so much as entering a long-term partnership. If the vendor wobbles, your center wobbles with it.

What struck me about HST was the people. The team members I met had all been with the company for years, and I later confirmed that HST has very low employee turnover. That continuity matters more than people realize. It means the person who knows your account this year is likely to know it still next year.

I’ll get a little personal here, because it’s relevant. The representative who sold me HST behaved more like an advisor than a sales rep. He was sincere; he helped me with things that had nothing to do with his software, and he later became a friend. Even after we’d signed and the commission was banked, he kept calling to check that our implementation was going smoothly. That almost never happens. In fact, that relationship is a big part of why I’m now employed by HST, which I mention so you know exactly where I’m coming from.

On the financial side, HST’s stability is real and verifiable. Their infusion of capital from Bain Capital has them as strong as they’ve ever been, and they’ve used that footing to add staff and enhance their products toward a true single-system solution. When you’re evaluating EHR systems, dig into the vendor’s financial health and ownership. A great product from a shaky company is still a risk, because the roadmap you’re betting on depends on the company being around to build it.

Criterion 3: Software Performance

Only now, third on the list, do we get to the software itself. That ordering is deliberate, and I’d ask you to resist the urge to flip it. Demos are designed to make performance look effortless. Support and stability are what you discover later, often the hard way.

That said, performance obviously matters enormously. HST’s PM has been around for 16 years, and what I love is that most of its enhancements have come from client recommendations. Clients submit suggestions, the ideas with the most support rise to the top, and they get built into upgraded versions. On top of that, HST ships quarterly software enhancements, so the system keeps improving rather than calcifying.

The ASCs I spoke with were genuinely happy with their revenue cycle management and their accounts receivable balances. The platform is built so that the path from surgery to revenue is as fast as possible, which is the whole point of a PM system in a surgery center. And the end users all said the same thing, almost word for word: the software is intuitive, easy to learn, and easy to use. When that many independent people land on the identical sentence, you should believe them.

One performance evaluation step I cannot recommend strongly enough: do site visits. I went on two, one for SIS Complete and one for HST, and those visits cinched my decision more than any demo could. Seeing real staff use the system in a live center, on a normal day, with normal interruptions, tells you what a controlled presentation never will. If you take one thing from this section, let it be this: a site visit is a critical, non-negotiable part of any serious EHR selection process.

Criterion 4: Number of ASCs Using the Software Successfully

The fourth criterion is about evidence at scale. One happy reference could be luck. Hundreds of happy centers are a pattern.

When I was searching, I wanted to know what my peers were actually running. I’m a member of ASCA, the national ASC association, and at their national meeting, I went around asking people what systems they used. A lot of them were named HST, and, rare for EHR companies, they seemed to like it genuinely. That stuck with me. It’s also telling that the top five ASC management companies all reviewed and selected HST. And the number that really lodged in my mind: HST has roughly 1,400 ASCs on its system.

There’s a specific question I’d add to your EHR selection checklist here, and it’s one people forget to ask. Don’t just ask how many total installs a vendor has. Ask how many successful installs they have of the specific version of the product you’re considering buying. Software changes. A vendor can have a long, proud history while the version they’re trying to sell you today is barely out of the gate. Make them tell you the number that’s actually relevant to your decision.

Criterion 5: Price

I put price last, and I did it on purpose. I know that’s uncomfortable advice in an environment where every dollar is scrutinized, so let me explain.

HST came in about 5% higher than SIS. Not nothing, but not the gulf you might expect. The reason price lands at the bottom of my list is a concept called total cost of ownership. The sticker price is only one line in a much longer equation. Total cost of ownership also includes downtime, the time it takes to resolve issues, how long it takes your staff to document a surgical procedure, and, most important of all, the percentage of claims that get accepted the first time through.

That last factor is where a “cheaper” system can quietly become the expensive one. HST has a 99.1% clean claim rate on the first submission, with claims going out through their Waystar integration. Think about what a lower clean claim rate costs you in reworked claims, delayed cash, and staff hours, every single week, for years. A few percentage points of first-pass acceptance dwarfs a 5% difference in license price.

When I stepped back, I realized there was a reason so many centers were paying a little more for HST and not complaining about it. They’d done the same math. For a decision this critical, price belongs at the bottom of your list, not the top.

One Final Piece of Advice on the Selection Process

I’ll leave you with the single most useful tactic I learned, and it costs nothing.

Call references the vendor did not give you. Every time I called a reference off the vendor’s curated list, the conversation was fine. But every time I tracked down a center the vendor hadn’t handpicked, the call was better, more candid, and far more informative. So seek out peers who already use the system, on your own, outside the vendor’s influence. When I did this through my state ASC association, I couldn’t find a single center running SIS Complete. More than half the ASCs in my state were on HST, and nearly all of that feedback was positive. That told me more than any presentation ever could.

Whether you’re a brand-new center, an existing one finally moving from paper charts to digital, or a center looking to migrate off a legacy PM system to something cloud-based, understand that this is one of the most consequential decisions you’ll make. So take your time. Be methodical about your evaluation. Build yourself a real EHR evaluation checklist and hold every vendor to it. And get genuine buy-in from your team and your physicians before you sign anything, because the best system in the world fails without the people who use it every day standing behind it.

I went through this four times, and I’d still tell you to slow down and do it right. If you have questions as you work through your own search, I’m here as a resource, and if you want to see how HST stacks up against your own criteria, you can always schedule a demo and judge for yourself. Reach out anytime.