NextGen vs eClinicalWorks for 2027: Which EHR to Pick

Key Takeaways

• Neither vendor publishes a list price, so the only fair cost comparison is two written quotes with the same provider count, integrations and contract length.

• Both vendors have federal settlement histories. Read them before the quote arrives, not after.

• The most recent independent score this guide could verify for either vendor is the 2025 KLAS listing for practices with 11 to 75 physicians. It does not cover the smallest practices.

• The integration deadline is the hard date. NextGen's DSTU2 API for Enterprise sunsets at the end of 2026, and eClinicalWorks requires an activation step before a practice's apps go live.

• Treat the quote as the decision document. Ask both vendors to price the same API scopes, data-export terms and support levels.

The short answer for a small practice

An electronic health record (EHR) is the software where a practice keeps patient charts, orders and visit notes, and most other systems have to connect to it. Public information does not show a clear default between NextGen and eClinicalWorks. Your choice turns on three checks you can run before the sales call: whether any integration still depends on NextGen's DSTU2 API, whether your compliance review accepts each vendor's settlement history, and which written quote matches your provider count and integration list.

If you already run NextGen and an integration still uses DSTU2, put that deadline first in your plan whichever vendor you pick. If you are starting fresh and your integrations all use FHIR R4, quote eClinicalWorks first, provided its settlement history clears your review.

Who should choose each vendor

NextGen fits a practice that already runs NextGen software, or whose integration partners already support NextGen's FHIR routes, and that can complete the Enterprise onboarding form before its developers need the full technical documentation.

Red flags: your integration depends on DSTU2 with no one assigned to migrate it; you need Enterprise technical documentation before you can scope the project; your compliance review will not accept a 2023 settlement that the company denies.

eClinicalWorks fits a practice whose integrations are provider-facing FHIR R4 apps, and that wants a developer path it can read before it signs.

Red flags: your integration needs contract-required scopes and you have no budget for the pricing agreement those scopes trigger; you need a published price list to budget; the 2017 settlement fails your vendor-risk policy.

Ownership and the history you inherit

Thoma Bravo took NextGen private in a 2023 take-private transaction. According to Thoma Bravo (2025), Madison Dearborn Partners acquired a significant ownership position in June 2025 while Thoma Bravo kept its own significant stake. Both firms plan to jointly fund a material increase in annual R&D over three years, but the release gives no dollar figure. NextGen's 2025 release also said the board named President and COO Srinivas Velamoor as CEO, effective after a planned transition period.

Public profiles describe eClinicalWorks as privately held, and the searches for this guide found no 2025 or 2026 ownership change. That is a search result, not a filing, so confirm ownership in writing.

Our read: an ownership change matters for two things, the product roadmap and the contract terms. Ask NextGen whether your contract survives a change of control, and ask eClinicalWorks the same question.

Compliance history: two settlements to read side by side

Both cases are settlements of allegations, and each vendor handled its settlement differently in public. NextGen's settlement includes no admission of wrongdoing, and eClinicalWorks's includes no determination of liability.

Settlement: $31 million, July 2023 according to Healthcare Dive (2023). The Justice Department alleged that NextGen obtained federal certification using an auxiliary product built only to run the certification tests, which hid missing functionality. It also alleged that NextGen gave customers tickets to sporting events and credits worth up to $10,000 to encourage purchases and referrals. NextGen denies that its conduct violated the law and says the settlement relates to claims from more than a decade ago.

Settlement: $155 million, May 31, 2017 according to Bass Berry (2017). The government alleged that eClinicalWorks hardcoded 16 drug codes instead of building access to a full drug database, that its audit logs and drug-interaction checks fell short, and that it falsely represented to its certifying bodies that its software met certification requirements. The settlement carried a five-year corporate integrity agreement with HHS's Office of Inspector General. That agreement required customers to receive updated software versions free of charge and to move their data to another EHR without penalties or service charges, according to Bass Berry (2017). eClinicalWorks says it settled to avoid litigation costs and does not accept that its software was unlawful, according to AJMC (2017).

Our read: the two cases differ in age and in the type of conduct alleged, but both belong in your diligence file. Ask each vendor, in writing, whether any integrity agreement or corrective-action reporting still applies to it. The eClinicalWorks data-transfer and free-update terms are the most specific contract points in either history, so ask for equivalent language from NextGen too.

How we evaluated these two EHRs

This comparison weights six criteria against the decisions a small practice makes when it switches or renews. The weights are our judgment, not vendor data. Each cell in the feature matrix uses only what the public pages confirm, and where a fact is not public, the cell says so. Readers also weighing athenahealth can read a separate Tebra and athenahealth comparison, which covers a different buying decision.

Weights are a starting point. If your integration list is short, or your compliance review is already finished, shift weight toward price and product fit.

Feature matrix: what the public pages confirm

The matrix is descriptive. Where a cell says a fact is not public, the vendor's pages reviewed here do not answer it, and the written quote should.

Independent satisfaction: the KLAS numbers

KLAS Research publishes customer-satisfaction rankings by practice segment. The 2025 listing for independent ambulatory EHRs with 11 to 75 physicians is the most recent independent score this guide could verify for either vendor.

KLAS 2025 scores: eClinicalWorks 64.7, NextGen Enterprise 62.5 according to KLAS Research (2025).

Every figure in the table comes from the KLAS listing cited above. NextGen Enterprise is the ranked product, and eClinicalWorks appears in the not-ranked section of the same segment, so the two scores are not formally comparable. Read the table as a directional signal. The segment covers larger practices than the smallest offices, and KLAS scores reflect customer feedback in that segment, not the experience of a practice at the low end of the range.

Integration and API access, with a worked example

NextGen's API page lists more than 800 routes in its Enterprise APIs, which support reads and writes, according to NextGen Healthcare (current page). Full Enterprise technical documentation is withheld until a developer submits the API Developer Program onboarding form. Clients must also grant access to the API Client Portal, which requires permission from a main community user on the client's account.

FHIR DSTU2 sunset: December 31, 2026 according to NextGen Healthcare (current page). The same page says R4 routes for USCDI v3 data elements need NextGen Enterprise 8.3.1 or higher, and otherwise default to USCDI v1 routes. An integration still on DSTU2 needs a migration owner before that date.

eClinicalWorks's developer portal targets provider-facing SMART on FHIR apps and backend service apps on FHIR R4, with USCDI v3 listed. For apps without contract-required scopes, the path has 5 steps: sign up, register the app, test in the sandbox, publish to production and share an activation code with clients, according to eClinicalWorks (current page). Patient-facing and scheduling apps are directed to a separate patient platform, healow.

The worked example below is illustrative, not a measured result. Assume a practice receives 140 referral intake forms a month and staff spend 12 minutes per form copying patient details into the EHR and CRM, which is 140 × 12 = 1,680 minutes, or 28 hours. A proposed workflow starts when a new referral contact is associated with a record in HubSpot, which HubSpot's webhook documentation describes as the ASSOCIATION_ADDED action, according to HubSpot (current page), and reading that contact needs the crm.contacts.read scope. Assume a 4-minute review per form, so the same 140 forms take 140 × 4 = 560 minutes, about 9.3 hours, saving 1,120 minutes, or about 18.7 hours a month, with no EHR write until a staff member approves it.

Either EHR requires onboarding or contract work before any automation can read or write chart data. For NextGen, that means the Enterprise onboarding form and the NextGen team's session-key arrangement. For eClinicalWorks, it means a scope review and a pricing agreement if the integration needs contract-required scopes. Neither vendor's public pages describe how long these steps take, so ask for that timing in the quote.

Pricing and total cost of ownership

Neither vendor publishes a list price. NextGen's pricing page sends buyers to a custom quote and says, "Tell us about your practice and we'll prepare a tailored proposal." Its footer links to a "Certifications & Cost Disclosures" page, which the pricing page does not display. eClinicalWorks's pricing page publishes no prices or plan costs. Its only pricing language is a claim that its revenue cycle service offers "better RCM service at a lower price than your current provider." Third-party listing sites publish per-user and per-practice figures that conflict with each other, and none of them is a vendor price, so this guide does not reproduce them.

Pricing checked October 26, 2026.

Build the two quotes on the same template. Require each vendor to list the same provider count, integrations, support hours and contract length, so the totals can be compared line by line.

NextGen: best fit, limits and implementation

What the public record shows

• Thoma Bravo took NextGen private in 2023, and Madison Dearborn Partners acquired a significant stake in 2025.

• The 2023 Justice Department settlement was $31 million, and NextGen denies wrongdoing.

• In the 2025 KLAS listing for 11–75 physicians, NextGen Enterprise scored 62.5 with a −6% trend.

• Enterprise technical documentation is gated behind an onboarding form, and the Enterprise DSTU2 API sunsets at the end of 2026.

Our read

NextGen is the stronger first call when your practice already runs NextGen software or your integrations already use its routes. In that case, the migration plan and the DSTU2 deadline are the work to scope, and the existing relationship lowers the number of unknowns.

The limits are the gated Enterprise documentation, the DSTU2 deadline and the ownership change. A practice that needs to read full API documentation before signing will have to get it through onboarding first. Implementation starts with the onboarding form, the API Client Portal permissions and the session-key process, so put those steps on the project plan before the contract is signed.

eClinicalWorks: best fit, limits and implementation

What the public record shows

• The developer portal lists FHIR R4, USCDI v3 and SMART on FHIR support, and it describes a five-step path to production for apps without contract-required scopes.

• Contract-required scopes trigger a scope review and a pricing agreement with eClinicalWorks.

• The 2017 settlement was $155 million, and the five-year corporate integrity agreement that followed required free software updates and data transfer without penalties.

• In the 2025 KLAS listing for 11–75 physicians, eClinicalWorks scored 64.7 with 12 organizations, but it is shown in the not-ranked section.

Our read

eClinicalWorks is the stronger first quote when your integration list is provider-facing FHIR R4 and you want a developer path you can read before signing. Its published sandbox steps are concrete, and the activation step gives your team a clear go-live gate.

The limits are that the portal does not specify its SMART launch flows, the public pages do not show a product-line breakdown, and the settlement history needs your review. Implementation requires a scope review for any contract-gated feature and an activation code for each client, so ask who at eClinicalWorks owns that process and how long it takes.

Where US Tech Automations fits next to either EHR

An EHR decision does not settle the work between the EHR and the rest of the practice, such as referral intake, balance follow-up and reporting. US Tech Automations describes itself as a managed service that builds, runs and supports custom AI workflows, with named integrations that include HubSpot, QuickBooks, Gmail and Google Sheets. Its customer-support sample puts a person in the loop with an approval queue: "You approve, edit or reject each draft before it sends." The public pages reviewed do not describe an EHR connector for either NextGen or eClinicalWorks, so any EHR connection is a prerequisite to confirm, not a feature to assume.

Proposed, configurable workflow: referral intake. The trigger is a new referral contact associated with a record in HubSpot. The action is a read of the matching patient fields through the EHR API you have activated, followed by a drafted match. The output is that draft in an approval queue. Prerequisites are a HubSpot app with the crm.contacts.read scope, an EHR API activation, and a business associate agreement where your counsel requires one. Human review: front-desk staff verify identity and approve any chart write, and nothing writes to the chart without that approval.

Proposed, configurable workflow: balance follow-up. The trigger is a nightly export of open patient balances from the billing system. The action drafts a reminder for each balance over a threshold the practice sets. The output is a queue of drafts in Gmail. Prerequisites are export or API access to balances and a check of your state and payer rules on patient communication. Human review: staff approve, edit or reject each draft before it sends, the same pattern the company's support sample describes.

Zapier, Make and n8n can handle much of this work. When configured, they keep run histories, retry failed steps, branch on errors and record audit evidence. The buyer still owns idempotency, so a retried step does not post a duplicate, along with escalation paths, access controls, credential rotation and maintenance when the EHR API changes. A proposed US Tech Automations design would configure the approval queue, name the person who receives escalations and list the API scopes as prerequisites, but your team would still own the EHR-side access and change control.

When NOT to use US Tech Automations

Skip a workflow layer if your need is the EHR's own charting, scheduling and billing, because the EHR vendor already covers that work and an extra system is one more thing to maintain. Skip it if you need only two or three simple app-to-app steps, such as a form submission into a spreadsheet, where a no-code tool you already pay for is enough. Skip it if no one on staff can review drafts before they reach a patient or payer, because the approval step is the design, and without it the automation should not run.

Decision checklist

1. Confirm which NextGen product line (Office or Enterprise) and which eClinicalWorks product your quote covers.

2. List every integration with its FHIR version or export format, and flag any DSTU2 dependency before NextGen's sunset date.

3. Ask for the API scopes each integration needs and mark which ones are contract-required.

4. Get written answers on settlement follow-up, change-of-control terms and data-transfer terms.

5. Request an itemized quote for implementation, data migration, training and support.

6. Ask for reference customers of your practice size, not only the vendor's preferred references.

7. Decide which work stays inside the EHR and which needs a workflow layer, and name the person who approves each outbound action.

Frequently asked questions

Is NextGen or eClinicalWorks cheaper?

Neither publishes a list price, so no public source ranks them on cost, and a written quote for the same scope is the only evidence that answers the question. Ask both for the same provider count, integrations and contract length, then compare the totals line by line.

Which vendor gives developers API access faster?

Neither can be called faster from public information, because the paths differ. NextGen's Enterprise technical documentation sits behind an onboarding form, while eClinicalWorks lists a 5-step path from sandbox to production for apps without contract-required scopes.

Do the settlements rule out either vendor?

Neither should be an automatic disqualifier, because both are settlements of allegations. NextGen's settlement includes no admission of wrongdoing, and eClinicalWorks's includes no determination of liability, so treat both as a diligence item to resolve in writing.

Who owns NextGen now?

Thoma Bravo took NextGen private in 2023, and Madison Dearborn Partners acquired a significant ownership position in June 2025, so two private equity firms hold significant stakes. Ask for change-of-control terms in writing before signing.

Do I need a workflow tool if I buy one of these EHRs?

Not always. An EHR's built-in charting and billing may cover the work, and a workflow tool earns its place where manual copying between systems is the costly step, as the worked example above shows.

Can I rely on KLAS data for a practice with 1 to 10 physicians?

Not from the data this guide could verify, because the 2025 KLAS listing it opened covers 11 to 75 physicians. Ask both vendors for reference customers in your size band before you decide.

Conclusion

The decision is narrower than the brand comparison suggests. Choose the vendor whose written quote matches your provider count, your integration list and your compliance review, and put the DSTU2 deadline and the settlement follow-up questions at the top of the contract checklist. If you want to see how the approval-first intake and follow-up flows above would be configured once those prerequisites are confirmed, see how US Tech Automations configures this.