Custom EHR software development company
We build custom EHR software for specialty practices, virtual care companies and health tech vendors: charting, orders and results, e-prescribing, billing and patient access on a record model that is FHIR R4 and US Core ready from the first sprint. When your customers need certified health IT, we engineer to the ONC criteria, including (g)(10), and prepare the test evidence with you.
Scope your custom EHRFor EHR vendors, specialty-care platforms, virtual-first providers and healthcare organizations replacing a legacy or home-grown record. Updated September 26, 2026.
Identity, eligibility, history and outside records pulled in before the visit
Specialty templates, structured findings and signed notes with addenda
Lab orders over HL7 or FHIR, e-prescriptions and EPCS through Surescripts
837 claims to the clearinghouse, FHIR APIs and SMART apps for patients and partners
Illustrative workflow · scope tailored to your environment
The short answer
Custom EHR development builds the clinical record for a specific care setting: charting, orders, results, prescribing, the billing hand-off and patient access. It connects that record to the labs, pharmacies, clearinghouses and health information networks the setting depends on. A US-market EHR also needs FHIR R4 APIs to US Core with SMART App Launch, HIPAA safeguards and, where customers use certified health IT for CMS programs, a planned path through the ONC Health IT Certification Program.
Read our EHR software development guideStart with the real problem
Any team can render a patient summary. The engineering is in what happens next: an ORU arrives that amends a result a clinician already acted on, two users edit the same medication list, a signed note needs an addendum rather than an edit, duplicate patients must be merged without losing history, a controlled-substance prescription needs two-factor signing, and a claim comes back rejected because a rendering provider was missing. We design the record model and the interfaces for those events first, because they decide whether clinicians trust the system.
What we build
Each EHR type carries a different integration and compliance load. We scope it before the first estimate.
Behavioral health, dental, physical therapy, oncology, wound care and other specialties whose workflows a general-purpose EHR handles poorly: scoring instruments, treatment plans, visual charting and outcome measures.
Behavioral health platformsProducts whose customers report to CMS programs and therefore need ONC-certified health IT for the criteria they use.
Health IT certification readinessA standards-based API layer so patients, partner apps and payers can read the record, and so your own apps launch inside it.
FHIR integration servicesElectronic lab orders and results with reference and hospital labs, including the corrections and cancellations that break naive integrations.
Laboratory integrationNew prescriptions, renewals, cancellations, medication history and controlled substances from inside the clinician workflow.
Pharmacy and e-prescribing integrationCharge capture that flows from the signed encounter to a clean claim and back as posted payments and denials.
RCM software developmentYour starting point
Your care model does not fit a general-purpose EHR, or the EHR is your product. We scope the first care setting end to end, including the interfaces it cannot run without.
A home-grown or aging record slows every change. We carve out one module at a time, migrate the data behind it and keep clinicians working during the move.
Customers are asking for certified health IT or a (g)(10) API. We map your product against the criteria, close the gaps and run the test tools before you book formal testing.
The Engineering Engagement
Workstreams are selected around your priorities. Each comes with an output your team can inspect, test and own.
Map intake, documentation, review, sign-off and follow-up with the clinicians who do the work, including interruptions, co-signature and addenda. Prototype the chart before building it.
Model patients, encounters, problems, medications, allergies and observations with source, status and version on every entry. Map to USCDI v3 so the API and exports are not a translation afterthought.
Expose patient and population data through FHIR R4 with SMART App Launch 2.0 for standalone and EHR launch, Bulk FHIR for population export, and an authorization server with scopes and token revocation.
Build the interfaces the first care setting depends on: HL7 v2 lab orders and results, NCPDP SCRIPT e-prescribing, CCDA and FHIR exchange with HIEs, and X12 claims through your clearinghouse.
Extract, map and reconcile demographics, problem lists, medications, allergies, notes, documents and open balances. Run trial loads and clinical spot checks before cutover.
Role-based access, break-the-glass access with review, tamper-evident audit logs, encryption, session controls and BAA-covered hosting, designed with the certification security criteria in view.
Map each claimed criterion to features, run the ONC test procedures and Inferno before formal testing, and prepare the documentation the testing lab requests.
Compare your options
A custom build is right when the workflow is your product or your advantage. This is how we advise buyers to choose.
| Custom EHR build | Off-the-shelf certified EHR | Open-source or headless base | |
|---|---|---|---|
| Best for | A specialty or care model the market serves poorly, or an EHR you sell | Standard ambulatory or inpatient care with common workflows | Teams that want a head start on the record and APIs and will own the code |
| Workflow fit | Built to your care setting and roles | Configured within the vendor's templates and roadmap | Extended in code, within the base project's data model |
| ONC certification | Engineered to the criteria you need, then tested and certified | Already certified for the vendor's claimed criteria | Your modified product needs its own certification for the criteria you claim |
| Interoperability | FHIR, HL7 v2, NCPDP and X12 interfaces built for your counterparties | Vendor interfaces, marketplace apps and interface fees | Depends on the base; interfaces are usually yours to build |
| Data and exit | You own the model, the data and the roadmap | Export and API terms set by the vendor contract | Code license terms set by the project |
| Cost shape | Build cost, then run and improve | Per-provider subscription and interface fees | Build and maintenance cost on top of a free core |
Many teams combine them: keep a certified EHR for general documentation and build the specialty workflow, patient experience or API layer around it.
Expertise is in the decisions
If customers need certified health IT, list the 170.315 criteria you will claim now. Audit logging, the (g)(10) API, USCDI v3 data and the security criteria shape the data model and authorization server, and are expensive to add later.
Keep source, time, author, status and version on every entry. An amended lab result, an entered-in-error medication and a signed note with an addendum are different events, and both the chart and the API must show them correctly.
Surescripts certification, the EPCS third-party audit, lab interface slots, clearinghouse enrollment and HIE onboarding each run on someone else's calendar. We open them at kickoff so they do not become the critical path.
We build to the certification criteria and run Inferno and the ONC test procedures before formal testing. An ONC-Authorized Testing Lab tests the product and an ONC-Authorized Certification Body issues the certification.
Surescripts certifies connections to its network, and DEA rules require a third-party audit or certification of the EPCS application. We build to those requirements and support each review.
Decision support rules, order sets and medication logic are specified and approved by your clinicians. We build, test and version the approved logic.
Timeline
Dates follow discovery. Scope, the number of interfaces, data migration and certification decide the schedule more than screen count.
Map the care setting, prototype the chart and confirm interface and certification scope.
One care setting end to end: scheduling, charting, orders, prescribing and the billing hand-off.
Runs alongside the build; third-party onboarding and formal testing often set the pace.
More specialties, locations, APIs and ongoing criteria updates.
Delivered work
Client names are withheld; each is a real engagement. Our open-source EHR work is public on GitHub.
A headless EHR with a FHIR R4 API and SMART App Launch that passed 47 of 47 ONC (g)(10) SMART App Launch tests in Inferno on 11 June 2026.
Scheduling, tooth-level charting, treatment plans, insurance billing and double-entry practice accounting in one system for a multi-location group.
A clinic record that supports offline capture on powered devices, collects readings from connected instruments and reconciles when network access returns.
Scheduling, charts, care plans and billing on a FHIR server with no private database, and single sign-on bridged through OAuth token exchange.
Recording starts only with consent on record, drafts are grounded in the patient's own chart, and every suggestion is accepted, edited or rejected by the clinician before it reaches the note or a claim.
Hardened an inherited clearinghouse integration for a behavioral health EHR: claim validation, acknowledgement handling and remittance reconciliation.
From discussion to delivery
Care setting, users, interfaces, migration and certification scope, agreed in writing.
Chart prototypes reviewed with clinicians; record model and security design signed off.
Working software every two weeks, with interface tests against real message shapes.
Trial data loads, Inferno and criteria test runs, pilot and go-live with a support model.
We agree the scope, dependencies, acceptance criteria and commercial model before implementation. Your existing team can stay involved throughout.
Find the right starting point ↗Cost is driven by four things: the number of care settings and user roles, the interfaces (each lab, pharmacy network, clearinghouse and HIE connection is its own workstream), data migration from the current system, and whether you need ONC certification. We give a fixed-scope estimate after discovery, broken down by module and interface, so you can phase scope with the numbers in front of you.
A focused first release for one care setting is planned in months, not years, when scope is bounded. Third-party steps such as Surescripts certification, lab interface slots, clearinghouse enrollment and formal ONC testing run on outside calendars, so we start them at kickoff and plan the schedule around them.
Buy when your workflows are standard and a certified vendor product fits. Build when the workflow is your product or your advantage, when a specialty is served poorly, or when you need to own the data model and roadmap. A common middle path keeps a certified EHR for general documentation and builds the specialty workflow or API layer around it.
We engineer the product to the 170.315 criteria you plan to claim, run Inferno and the ONC test procedures, and prepare the documentation for testing. An ONC-Authorized Testing Lab then tests the product and an ONC-Authorized Certification Body issues the certification.
Criterion 170.315(g)(10) requires a FHIR R4 API that serves USCDI data using the US Core implementation guide, SMART App Launch for patient standalone apps and clinician EHR launch, Bulk FHIR export for populations, and published API documentation and terms. Under HTI-1 the baseline moved to USCDI v3, US Core 6.1.0 and SMART App Launch 2.0 from 1 January 2026.
Yes. We build NCPDP SCRIPT e-prescribing through Surescripts, including new prescriptions, renewals, cancellations, medication history and formulary checks. For controlled substances we implement identity proofing, two-factor signing and the audit trail that DEA rules require, and support the third-party EPCS audit.
We build HL7 v2 ORM and ORU interfaces, or FHIR ServiceRequest and DiagnosticReport where the lab supports them, map results to LOINC, and handle preliminary, final, corrected and cancelled results so the chart always shows the current value and its history.
Yes. Signed encounters produce charges that become X12 837P or 837I claims through your clearinghouse. We process 999 and 277CA acknowledgements, post 835 remittances, run 270/271 eligibility checks and route denials to work queues.
We extract demographics, problems, medications, allergies, results, notes, documents and balances through the vendor's export, database access or FHIR and CCDA, map them to the new model, then run trial loads with reconciliation reports and clinician spot checks before a rehearsed cutover.
Yes. Specialty EHRs are the most common custom build: behavioral health with 42 CFR Part 2 consent and segmentation, dental with tooth-level charting, physical therapy with plans of care and outcome measures, and oncology, wound care and pediatric workflows.
We build the HIPAA Security Rule safeguards into the product: access control, audit controls, integrity, authentication and transmission security, on BAA-covered hosting. We sign BAAs and we are ISO 27001:2022 certified.
Yes. We add modules, FHIR APIs, SMART apps and interfaces to existing EHR products, and modernize one module at a time with explicit coexistence and rollback boundaries, so clinicians keep working during the change.
A useful first conversation
Tell us what exists today, who uses it and where the workflow breaks. We’ll discuss the scope, access dependencies and the next practical step.
A product overview and a de-identified workflow are enough to start. No patient records or credentials are needed.
These are independent reference sources, not endorsements. Applicability, platform access and current requirements are confirmed for your project.
