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2025 Snapshot: What CIOs Love (and Don’t) About an EHR-First Approach

Kara Bodner

Insights from CHIME Fall Forum Focus Group show common trends

Ask two different CIOs what they’re focused on for 2025, and you might get very different answers. But when we asked in the context of an “EHR-first” approach that many CIOs say they adopt, we uncovered several similarities. 

A group of CIOs came to our CHIME Fall Forum focus group specifically focused on maximizing their EHR investments and the rest of their tech stack. They were asked what they loved – and what they didn’t. From academic medical centers to regional health systems to behavioral health, from the Midwest to the coasts, they pinpointed three similar themes. Here’s what they said:

  1. An EHR-First Approach is Working – Mostly

It’s no secret that Epic is much beloved among its customers, especially CIOs. Several CIOs using Epic said it was a great investment. Epic’s integration and interoperability capabilities in particular got shout-outs:

  • An academic medical center loves Epic’s Care Everywhere interoperability to inform care for patients who travel in from around the state.
  • Epic’s ability to integrate with payers was cited as a big efficiency improvement.

But Epic wasn’t the only EHR with devoted customer advocates – MEDITECH received high marks for its collaboration and ability to support co-development with its customers. 

Investing in the EHR was consistently highlighted as a priority, with the EHR driving many strategic investments and programs. But these pain points were common, even among EHR advocates:

  • Training and maintenance are a challenge.
  • Problem-solving and solutions that have worked for others could be more broadly shared among fellow EHR customers.
  • It can be difficult to understand how changes to the EHR might affect other decisions or workflows later on.
  1. The Brightest Spots: Co-Creating Clinical Innovations

Focus group attendees often called out clinical workflow improvements co-created with their EHR vendor as a source of pride. Examples included:

  • Using genomic data in MEDITECH for precision medicine.
  • Adoption of the Epic physician builder framework, in some cases with 20+ physician builders at an organization.
  • An updated care team-to-clinician calling workflow.

However, these workflows might not be perceived as bright spots for the EHR vendor as much as organizational points of pride. Several attendees called out their organization’s own reputation for high-quality clinical care as a driving factor in their technology strategy, and many of the same clinical workflows that were highlighted as co-innovations came with their own EHR challenges like speed of deployment. 

  1. No-Shows Remain a Persistent Challenge

When asked what they’d most like to change, or what would be their top priority for improvement, the leaders were unanimous. No-shows and related schedule utilization challenges, like filling the open slots and getting patients who missed appointments back on the schedule, were the top answer across the board. 

Even CIOs at organizations with robust EHR tools for schedule management and patient self-service called out no-shows as the biggest challenge that technology could solve. Some highlighted the significant revenue losses when slots aren’t filled or the heavy staff lift to fill last-minute openings.

The no-show challenge fit into the larger theme of CIOs’ EHR wish lists: they wanted less maintenance, less manual work, and less starting from scratch to solve the same problems as peers – with great results for basic workflows, plus the opportunity to innovate.

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At the 2024 CHIME Fall Forum, attendees had begun looking ahead. They looked to 2025 and to ways to solve pain points while remaining EHR-first (or, in some cases, switching EHRs to begin building an EHR-first strategy). 


For the most part, they felt they were on the right track. An EHR-first strategy unified the technology stack, enabled innovation, and facilitated core workflows well for the majority of attendees. Efficiency was the main pain point, with maintenance, training, and support coming up frequently. No-shows united the entire group as a common and persistent challenge. 

Based on the feedback, in 2025, we can expect to see leaders like these focusing on efficiency. Innovative clinical care is a bright spot, but enterprise-wide efficiency and access will likely drive strategy.