Mastering Integration with Multiple EHRs: Strategies and Best Practices

Electronic Health Record (EHR) integration has long been the silent dealbreaker in digital health. You can have a brilliant product, a strong go-to-market strategy, and a talented team behind it—but if your solution doesn’t talk smoothly to the systems providers rely on every day, you’ll hit a wall. A costly, compliance-laden, slow-moving wall.

And that wall only gets taller when your product needs to integrate with not just one EHR, but several—each with its own quirks, standards, and expectations. Whether you're building a clinical decision support tool, scaling a virtual care platform, or just trying to pull patient data into a consumer-facing app, EHR integration isn’t a box you check once. It’s a long-term strategy you have to get right.

So how do you approach it? In this guide, we’ll walk through the major integration paths available today, including off-the-shelf EHR integration providers and direct API integrations with major vendors. Along the way, we’ll unpack real-world challenges like vendor inconsistencies, regulatory shifts, and cost trade-offs—and we’ll end with a practical framework for choosing the right strategy for your business. Let’s start with the reality of the landscape you’re stepping into.

The Fragmented World of EHR Systems

If EHRs were standardized in practice—not just on paper—this would be a very short article. The truth is, despite FHIR becoming the mandated standard, EHR vendors still interpret and implement it differently.

Some of the fragmentation is market-driven. Just five vendors—Epic, Oracle Cerner, Meditech, Allscripts (Veradigm), and Athenahealth—make up around 80% of the U.S. market. That concentration might seem helpful at first, but these systems have deep legacy roots and complex ecosystems that don’t always play nicely with each other—or even with themselves.

Even basic clinical data isn’t always returned the same way. Take blood pressure: Cerner might split the value and the measurement location into two separate Observation resources. Technically valid, but operationally frustrating when you’re trying to normalize data across systems.

This kind of inconsistency isn’t just a technical detail. It affects how you design your product, how much transformation logic you need to build, and how scalable your architecture really is. That’s why the first decision you face isn’t just which EHRs to integrate with—but how you want to integrate in the first place.

The Two Paths: Aggregators or Direct Integration

Most digital health products choose between two broad integration strategies: using an EHR integration provider, or connecting directly to EHR APIs. The right path depends on what you're building, who you're serving, and how much control you need.

Let’s start with the aggregated approach.

Working Through an Integration Provider

Companies like Redox, Health Gorilla, and 1upHealth act as intermediaries between your product and the messy, inconsistent world of EHR systems. They offer standardized APIs, pre-built connections, and a layer of abstraction that handles most of the complexity for you.

This model shines when speed and simplicity matter. You get access to the majority of providers through a single integration. You don’t need a huge dev team to manage multiple EHR relationships. And the provider often handles compliance, data normalization, and support.

But the convenience comes at a cost—literally. These platforms charge per transaction or per user, and those fees add up fast at scale. They may also restrict access depending on your business model. Some only work with provider-facing apps. Others may limit sandbox access or hold back advanced functionality behind premium tiers.

Most importantly, you’re not in control. If an integration provider changes its pricing, deprecates an API, or introduces a bug, your product takes the hit. For early-stage companies or MVPs, that might be an acceptable risk. But if you’re building a critical workflow tool or scaling to thousands of users, that dependency can feel risky.

Going Direct: EHR APIs and Custom Connections

The alternative is to build integrations yourself—one by one, system by system. This approach requires more time and technical expertise, but it gives you full control over the integration logic, error handling, and data mapping.

You also save money in the long run. There are no per-use fees, and you avoid vendor lock-in. You can prioritize specific EHRs that matter most to your customers. You can customize workflows. And when regulations change or FHIR versions evolve, you’re in the driver’s seat.

But direct integration comes with real friction. Some EHRs require manual onboarding and support requests just to access sandbox environments. Others have undocumented limitations. And even when APIs are technically available, they might not expose the data or writeback capabilities you need.

It’s not just about getting connected—it’s about maintaining those connections across updates, vendor changes, and evolving clinical requirements. That’s why many companies take a hybrid approach: direct integration with key systems, plus a fallback to aggregators for broader coverage.

Which Strategy Makes Sense for You?

There’s no one-size-fits-all answer, but a few guiding principles can help:

• If you need speed to market and broad reach, use an integration provider. Great for MVPs, pilots, and early-stage validation.
• If you need cost efficiency and control at scale, invest in direct integrations. Plan for longer implementation but better margins and flexibility down the line.
• If you’re working with high-value providers, consider a hybrid approach. Build custom interfaces where needed, use FHIR APIs when available, and lean on integration partners for everything else.

Just as importantly, your strategy needs to account for how regulations are evolving—and how they might open up new paths.

Regulatory Shifts: HTI-2 and the Rise of Patient-Access APIs

The regulatory landscape is starting to catch up with the vision of true interoperability. Under the Cures Act, certified EHRs must now support patient-access APIs—giving individuals the right to retrieve their own health data via third-party apps. This opens the door to patient-mediated access models that don’t require direct provider integrations at all.

And with the upcoming HTI-2 rule, things will move even further. The new regulations are designed to strengthen interoperability, enforce data sharing, and reduce information blocking. That means EHR vendors will face more pressure to expose clean, consistent APIs—and digital health companies will have more opportunities to build around them.

Smart integration strategies today should anticipate these shifts. Even if you rely on aggregators now, building in support for patient-access APIs and staying close to HTI-2 developments will help future-proof your product.

Integration Is a Long Game—Play It Smart

At Momentum, we’ve seen both sides of this challenge. We’ve helped startups stand up MVPs using integration platforms in weeks. We’ve helped enterprise clients build and maintain their own pipelines into Epic and Cerner. And we’ve navigated the regulatory maze that sits in between.

Our biggest lesson? Integration isn’t a technical hurdle—it’s a strategic one. The method you choose will shape your product’s cost structure, reliability, user experience, and ability to scale.

So choose deliberately. Build for where your business is going—not just where it is today.

If you’re facing a complex integration challenge—or you’re not sure which path makes sense—let’s talk. We’ll help you build a plan that works now and holds up as you grow.