Great question! You've included asking about the cost of "choosing" an EHR, whereas, the usual buyer will not address this "soft", intangible cost! Hence, let me first address that cost. As you are aware, there are thousands of certified solutions to choose from, so you need to narrow that list down, hence cutting the cost of choosing. First, you must understand how you are going to assess the products by defining your selection criteria (i.e. # of years in business, financial stability, # of install base, Black Book and other rankings, Vendor location, support (VAR network?), training process (free online training?)a speciality EHR?, and referenced vendors.) Then narrow your choice to 3 - 5 vendors fitting that criteria, for demo's. Understand the cost of choosing, is aligned with your selection process. For example, you may decide to develop a scorecard, assigning greater points for meeting the most important criterias, defined by the stakeholders.
In terms of implementation costs, it varies based whether there is a need to upgrade hardware (usually in a client/server platform), and in your approach to implementation. If you do not qualify for HITECH MU dollars, then I suggest you use, what I refer to in my website, the S.W.E.E.T (A Stepwise EHR Execution Tactic) implementation approach. This is a phased approached that includes proper planning, that will reduce training costs and down-time of the office. Unfortunately, in this world of Meaningful Use, offices are requiring faster implementations, so a "stepwise" approach isn't so wise if you miss attestation!
Regardless of approach, most implementations will have these costs, Hardware, Software, Training, and Support! The cost of hardware and training are variable costs, depending on needs. However, support is usually dictated by the vendor and is a hard cost. One tip.....make sure you understand the true cost of vendor upgrades and enhancements! Additionally, don't forget to address the need to train new employees. If you have high turnover in the lab, how will you train the new person on the CPOE application?