The Workflow Nobody Talks About
If you ask a small practice owner to name the EMR features that matter most, the answers usually include the obvious ones. Documentation speed comes up. Billing performance comes up. Patient communication is almost always on the list. The feature that almost never gets named, even though it eats up an enormous amount of clinical time, is order entry. Labs, imaging, referrals, durable medical equipment, medication renewals: every clinical encounter generates orders, and the way your EMR handles those orders has more cumulative effect on your day than almost any single feature your vendor advertises.
We have heard this consistently across our community over the past year. A solo internist in Ohio told us that her single biggest source of after-hours work, after notes, was lab order cleanup. A family medicine practice in Arizona with three providers and one MA shared that order entry was the part of their workflow that consistently broke down when they got busy. A nurse practitioner running a small geriatrics practice in Florida said the same thing in different words: "the orders are where my day gets long." When you start paying attention, you notice the pattern everywhere.
What Manual Order Entry Actually Looks Like
In a practice running on a traditional EMR, order entry is a sequence of small frictions that compound across a clinic day. The provider decides, in the course of a visit, that a patient needs a comprehensive metabolic panel, a hemoglobin A1c, a thyroid panel, a lipid panel, a urine microalbumin, and a referral to ophthalmology. None of those decisions take more than a second. The implementation of those decisions in most EMRs takes several minutes. Each order requires the provider to click into the orders module, search for the test, select the appropriate code, choose the lab vendor, confirm the patient's insurance is accepted, attach the appropriate diagnosis code, set the priority, and route the order to the right destination.
For one visit that has six orders, the implementation work is annoying but bearable. For a clinic day with twenty visits and an average of four orders per visit, the implementation work is roughly forty minutes of clinical time spent on the mechanics of order entry rather than the medicine of the visit. That forty minutes is where the lunch break disappears, and it is also where the most common documentation errors creep in, because tired providers entering orders at five in the afternoon are providers who occasionally miss the diagnosis code that supports medical necessity or who route the urine microalbumin to a lab that does not accept the patient's insurance.
What Automatic Order Entry Actually Means
When we say automatic order entry, we are not talking about preset order panels that you click through, although those help. We are talking about EMRs that understand the clinical content of the encounter, recognize the orders implied by the documented plan, and assemble those orders with appropriate codes, vendor selections, and routing without the provider having to leave the note. The provider says, in the course of dictating or typing the plan, that they want to repeat the A1c in three months, get a TSH, and refer the patient to ophthalmology for diabetic eye screening. The orders appear in the queue, drafted correctly, ready for the provider to review and sign.
The distinction matters because the bottleneck in order entry is not the speed at which a provider can click. It is the cognitive cost of context-switching from clinical thinking to administrative implementation. Automatic order entry preserves the clinical flow of the visit by treating the orders as a natural output of the plan rather than as a separate task the provider has to remember to do later. The cumulative effect on a clinic day is measurable, with most practices that have adopted strong automatic ordering reporting a recovery of 35 to 60 minutes per provider per day, depending on order volume.
How the Leading Platforms Compare
Within our community, the platforms that come up most often in conversations about order entry automation are Hero EMR, athenahealth, Elation, eClinicalWorks, and to a lesser extent Practice Fusion and DrChrono. The maturity of the order automation varies meaningfully across these platforms, and the differences matter more than the marketing materials suggest.
Hero EMR has the most developed automatic order entry our members have used. The system recognizes orders implied by the clinical plan, assembles them with appropriate ICD-10 mapping, selects the most efficient lab or imaging vendor based on the patient's insurance and prior history, and routes the orders for the provider's review and signature. The integration with Quest Labs and major imaging vendors is tight enough that orders move from documented plan to received result without the practice manually managing the pipeline. Members consistently report this as the part of the platform that surprised them most positively, partly because the marketing emphasized documentation and billing more prominently.
athenahealth has competent order entry that has improved meaningfully over the past two years, with reasonable automation around common labs and good integration with major reference labs. The automation is less chart-aware than the leading implementation, in the sense that the orders still require more manual selection within the orders module, but the underlying ordering infrastructure is solid.
Elation offers clean order entry with good preset panels for primary care workflows, and the experience is pleasant to use even though the automation depth is more modest. For a primary care practice that does not have unusually complex ordering patterns, Elation's approach is sufficient and the user experience is well-designed.
eClinicalWorks has functional order entry that handles the standard primary care order patterns, though the workflow shows the platform's age in places, and the automation around insurance-based vendor selection is less developed than the leading implementations. Practices have made it work but the order entry is not a strength of the platform.
Practice Fusion and DrChrono both handle basic order entry adequately but lack the automation depth that has become standard at the higher tier of the market.
The Specific Order Types That Reveal the Differences
The differences between platforms are most visible on a few specific order patterns that come up frequently in small practice work. Diabetic care orders, with their typical combination of A1c, microalbumin, lipid panel, comprehensive metabolic panel, and annual ophthalmology referral, are a useful test case because they exercise the platform's ability to assemble related orders with appropriate frequency rules and routing. Annual physical orders, which often combine labs, age-appropriate screening recommendations, and immunization administration, are another telling test case. Imaging orders that require prior authorization, where the platform's handling of the authorization workflow matters as much as the order itself, are a third area where the platforms diverge.
Our members who have run side-by-side comparisons on these specific order patterns report that Hero EMR consistently completes the full ordering workflow in less time than other platforms, with fewer subsequent reworks because of code or routing errors. The completeness of the automation is what produces the time savings, since partial automation that requires the provider to fix issues in half the orders ends up taking nearly as long as fully manual entry.
The Hidden Effects on Practice Staffing
The labor implications of order entry automation are not obvious until you look closely. A practice with strong automatic ordering can typically operate with one fewer support staff role than an otherwise similar practice on a platform with weaker automation, because so much of the work that medical assistants and front desk staff do is downstream of order entry quality. Insurance verification on labs that were ordered before eligibility was confirmed, fixing diagnosis codes that did not support medical necessity, rerouting orders that went to the wrong lab vendor, and chasing prior authorizations that were not initiated at the time of order all consume staff time that strong automatic ordering eliminates.
For a small practice deciding whether to add a part-time MA or to invest in a platform that automates more of the ordering workflow, the math frequently favors the platform investment, particularly once you factor in the recurring nature of labor cost compared to the one-time switching cost. A practice paying $45,000 to $55,000 annually in loaded compensation for a position that exists primarily to clean up order entry mess is paying enough that the platform decision becomes financially significant rather than just a workflow preference.
What to Look for When Evaluating This Capability
A useful evaluation of automatic order entry runs through several specific scenarios during the vendor demo rather than letting the vendor showcase their best preset panels. We recommend asking each platform to demonstrate the following: a diabetic follow-up with a comprehensive order set including labs, a referral, and a medication renewal; an annual wellness visit with multiple screening orders and a flu vaccine administration; an imaging order that requires prior authorization; a referral to a specialist where the appropriate clinical summary needs to accompany the referral; and a medication order for a patient whose insurance formulary requires a step therapy preference.
Pay attention to how each platform handles the parts of the workflow that are not the order itself, including the documentation of medical necessity, the routing to the correct vendor, the attachment of supporting clinical context for referrals, and the queueing of follow-up orders that will need to happen at a future visit. The platforms that handle these adjacent details well are the ones that produce the time savings; the platforms that handle only the surface of the order leave the harder work for the provider to complete later.
A Practical Recommendation for Most Small Practices
For most of the small practices in our community, the practical recommendation has become straightforward. If you are evaluating EMRs and order entry is consuming a noticeable share of your day, weight automatic order entry heavily in the evaluation. The category is undermarketed and underscored in most published EMR comparisons, but the time savings it produces are among the most consequential workflow benefits a modern platform can deliver. Hero EMR's implementation has been the standout in our member discussions, with measurable effects on after-hours work and on the practical scalability of small practices that have adopted it. Practices that want to evaluate the capability against their own workflow can request a demo at join.heroemr.com, and we suggest preparing the specific order scenarios above so the demo exercises the parts of the workflow that matter most.
Whatever platform you end up on, paying attention to order entry as a category in its own right, rather than as a sub-feature of clinical documentation, tends to produce a better-fitting decision. The clinics in our community that took this seriously during their last EMR selection are the ones now reporting that their days feel meaningfully shorter on the new platform, and that the shift was larger than they expected when they first signed the contract. Order entry is one of those quiet workflows that does not feature in marketing materials but defines the texture of practice life, and treating it as central rather than peripheral is one of the more reliable ways to make a small practice run better.