Have you considered hosting the solution in a HIPAA compliant secure environment?
How would you handle backups and disaster recovery?
Do you have a plan for how to handle open-source code changes?
Have you considered interfacing with external systems (laboratories, e-prescriptions, registries, clearing houses, health information exchanges, etc)?
Do you have support to assist you in installing and using OpenEMR? Please note that blueEHR does not offer support for OpenEMR.