Ask a practice administrator why a workflow works the way it does and often enough the answer is "that is how the system does it." Ask what an interface to the new lab partner would cost and the answer is a number the vendor supplied, unchallenged.
This is not a criticism of the administrator. It is what happens when the only party in the room with deep knowledge of the platform is the party selling it.
How the dependency forms
It forms honestly. The EHR is the system of record for clinical care, and clinical care is the business. It touches scheduling, documentation, coding, billing and reporting. Changing it is genuinely disruptive, so the switching cost is real rather than manufactured.
From there the pattern is predictable. Every integration goes through the vendor, at the vendor's rate. Every module you might want is theirs. The upgrade schedule is theirs. And because switching is expensive, the commercial pressure that normally disciplines a supplier relationship is absent.
None of that requires bad faith on the vendor's part. It just means nobody is asking the questions a buyer would ask.
The three questions worth asking every year
What are we paying, in total? Not the licence. Licence, hosting, per-provider fees, module fees, interface fees, support tiers, and the professional services that get treated as one-offs and recur annually. Assembled from the general ledger rather than the contract, this number surprises people.
What are we paying for and not using? Practices commonly license modules bought during an expansion that never happened, or during an implementation whose phase two was cancelled.
What did the last three change requests actually cost, and was there an alternative? Interfaces in particular are frequently quoted as bespoke work when a standard interface exists, or when a third-party integration engine would do the same job across every future partner at a fraction of the cumulative cost.
The upgrade and the leverage window
The one moment you hold leverage is renewal, and it arrives on a date somebody should have in a calendar. Practices routinely discover the notice window has passed and the agreement has rolled for another term at an uplift nobody negotiated.
Knowing your renewal and notice dates, twelve months ahead, is the single cheapest thing on this list and the one most often missed.
Where an independent read helps most
Three situations in particular.
A replacement decision. Every vendor in the evaluation has a platform. Somebody in the room should be able to say whether your current system is genuinely at end of life or whether the implementation was simply never finished, which in our experience is at least as common.
A practice acquisition. You are about to inherit another system, another contract, and another set of interfaces. The integration cost belongs in the acquisition model, and it usually is not there.
An interface programme. Deciding once whether to buy standard interfaces from the vendor or run an integration layer changes the cost of every partner you connect for the next decade.