How to Build a Custom EHR Software in 90 Days

In today’s healthcare environment, electronic health record (EHR) systems have become essential, with over 96% of non-federal acute care hospitals implementing certified EHR technology (HealthIt, 2023).

However, many practitioners find that off-the-shelf EHR solutions do not meet their specific needs, leading to workflow frustrations and reduced productivity. Most doctors report spending more time managing EHRs than with patients, indicating a need for change.

Is it possible to develop a custom EHR software in 90 days? With the right approach, it is. This guide will help you create a tailored EHR system that meets your practice's unique requirements within a realistic timeframe.

EMR vs. EHR — And Why It Matters for Your Practice

This section helps clarify the essential distinctions between EMR and EHR systems, which is crucial when planning your custom EHR software development project. Understanding these differences will help you determine exactly what system your practice needs.

Why This Distinction Impacts Your Build and Workflow Integration

It is essential to understand the distinction between EMRs and EHRs when designing your custom solution. 

When developing an EMR, you will concentrate on internal workflow and documentation. For a full-fledged EHR, you must add interoperability standards, secure data exchange protocols, and more robust patient information management.

Your choice will impact everything from database architecture to security requirements. Most modern practices benefit from full EHR functionality, but knowing your needs helps create an efficient development roadmap.

Why Custom EHR Software Makes Sense for Modern Practices

In this section, we explore why custom EHR software is increasingly becoming the preferred choice for healthcare practices seeking to optimize operations and improve patient care. 

The limitations of one-size-fits-all solutions have become apparent as practices realize their unique workflows demand tailored solutions.

One Size Doesn't Fit All: Your Workflow Is Unique

Each healthcare practice has unique workflows depending on specialties, patient populations, and staff. Dermatology practices differ from cardiology clinics. Rural healthcare providers encounter different challenges than urban hospitals.

Pre-built EHR systems force you to adapt to their structure rather than supporting your existing processes. This misalignment creates inefficiencies that cost money and frustrate staff. A 2023 study in the Journal of the American Medical Informatics Association found that EHR customization led to 27% higher physician satisfaction and 18% lower burnout rates.

5 Common Reasons Practices Go Custom (And See Results)

1. Specialty-Specific Requirements: Typical EHRs do not include functionality required by specialized practices such as oncology, psychiatry, or physical therapy.
    
2. Integration with Existing Systems: Custom solutions can integrate smoothly with your existing technology infrastructure without costly middleware.
    
3. Regulatory Compliance: Custom EHRs can be designed to meet your particular compliance needs, whether HIPAA, local regulations, or specialty-specific guidelines.
    
4. Competitive Advantage: A custom system can enable distinctive service offerings that set your practice apart.
    
5. Long-Term Cost-Effectiveness: Although initial cost is greater, tailored systems save on recurring license fees and are more easily modified to meet evolving requirements.

Where Off-The-Shelf Software Fails to Deliver in the Real World

Pre-built EHR platforms typically introduce formidable pain points to everyday practice. Physicians spend almost two hours on EHR tasks for every hour spent in direct patient care when utilizing off-the-shelf systems, a 2024 American Medical Association survey found.

Common gripes are too much clicking, redundant data entry, and rigid templates. These drawbacks result in lower patient satisfaction, provider burnout, and lost revenue due to waste in processes.

Custom solutions resolve these issues by creating interfaces and workflows tailored to your staff's requirements and preferences.

Custom EHR Software vs. Off-the-Shelf: Which Is Best for You?

This comparison will help you evaluate whether custom EHR software development is the right choice for your practice. 

Understanding the trade-offs between customized and pre-built solutions is essential for making an informed decision that aligns with your long-term goals.

Comparing Cost, Flexibility, Ownership, and Support

When weighing your choices, keep the following factors in mind:

• Upfront Expense: Off-the-shelf systems generally cost less upfront but more over time. Custom development costs more initially but pays off in the long term.
   
• Flexibility: Pre-built solutions cannot customize, but custom EHRs can be heavily customized as your practice grows.
   
• Ownership: With custom development, you control the intellectual property and can dictate future development direction. With commercial products, you're at the mercy of the vendor's roadmap.
   
• Support: Commercial solutions deliver standard support packages. Custom solutions involve maintenance arrangements, but support is usually more responsive and customized.

When Going Custom Is a Strategic Advantage

Custom EHR software development is most advisable for:

• Practices with specialized workflows that don't lend themselves to standard templates
• Organizations with high growth rates or anticipating substantial expansion
• Healthcare providers who are innovation- or specialty-care-model driven
• Practices inconvenienced by limitations of existing systems
• Organizations wanting long-term cost control and ownership

When Off-the-Shelf Still Works (For Now)

Essential EHR solutions may be adequate if:

• Your practice has typical workflows
• You have few IT resources for maintenance
• Your number one priority is speed of implementation
• Your budget issues make the upfront costs of development too high
• Your requirements are straightforward and well-supported by current solutions.

Building a Custom EHR Software in 90 Days

This comprehensive roadmap outlines the process of custom EHR software development from start to finish in just 90 days. 

Following this structured approach ensures that your project stays on track while addressing all critical aspects of design, development, and implementation.

Days 1–15: Strategy and Planning

Begin by defining your goals, gathering requirements, and mapping workflows to create a strong foundation for your custom EHR software.

Set Clear Business Goals and Clinical Needs

Begin by defining what success looks like for your custom EHR. Document specific objectives such as reducing charting time by 30%, improving billing accuracy, or enabling new service offerings. Identify key performance indicators to measure these outcomes.

Next, conduct a thorough needs assessment. Interview physicians, nurses, administrative staff, and IT personnel to understand pain points with current systems and wish-list features for the new solution.

Map Existing Workflows and Compliance Requirements

You must document your existing clinical and administrative workflows in detail. Highlight inefficiencies that may be optimized through automation or redesign. Determine compliance requirements specific to your specialty and location, such as HIPAA, state laws, and specialty-specific guidelines.

Develop workflow diagrams that map patient paths from check-in to follow-up. These maps will be blueprints for your custom EHR software development. 

Involve Stakeholders Early (Doctors, Admins, IT)

• Establish a representative steering committee with clinical, administrative, and technical views. 
• End-user input is vital to create an EHR that functions in the real world, not the abstract world.
• Establish a communications plan to inform all stakeholders throughout the custom EHR software development process. 
• Early engagement enhances adoption rates and minimizes resistance to change.

Days 16–30: Wireframes and UX Design

Translate ideas into visual mockups and prototypes by focusing on real-world usability, role-specific needs, and early feedback loops.

Create UX-First Prototypes That Reflect Real-World Use

Develop low-fidelity wireframes that define the structure and functionality of the primary screens. Prioritize the most heavily used features first, such as chart notes, order entry, and scheduling.

Utilize rapid prototyping software to execute rapid iterations on the design. Consider modeling a common patient visit to validate the logical sequence of the interface.

Various user roles have varying priorities. Physicians require practical documentation tools. Nurses are concerned with task management and tracking. 

Front office personnel are concerned with scheduling and insurance verification. Design interfaces that support each role's main tasks.

Consider accessibility needs and design for multiple devices if mobile access is required. Make the interface uncluttered and straightforward to minimize cognitive load on hectic clinical days.

Iterate Fast — Gather Feedback Early

Perform usability testing using representative users representing each role. Watch them execute typical tasks and identify areas of confusion or inefficiency.

Change designs based on feedback prior to moving on to development. Upfront changes cost much less compared to changes that occur after coding has started.

Days 31–60: Core Development

Conduct rigorous performance, security, and real-user testing to catch flaws and polish your system before the go-live milestone.

Frontend + Backend Development Begins

With approved designs, initiate concurrent development of backend infrastructure and frontend interfaces using the latest frameworks that support rapid development without compromising security and performance.

Execute core data models for patients, orders, results, and encounters with correct relationships between entities to support advanced clinical workflows.

Key Modules: Scheduling, Billing, e-Prescriptions, Patient Records

Prioritize initial development on critical modules:

• Detailed patient records with problem lists, medications, allergies, and history
• Intuitive scheduling tool with appointment reminders and resource management
• Integrated billing with insurance verification and claim submission
• Electronic prescribing with drug interaction checking and pharmacy communication

Labs, Pharmacies, and Existing Tool Integrations

Deploy standard interoperability protocols such as HL7, FHIR, and API connections to critical external systems. Make integrations required for day-one operations a priority, including laboratory interfaces, e-prescribing networks, and existing practice management systems.

Make data flow between systems automatically without the need for human intervention. Incorporate error handling and alerting for failed transmissions.

Days 61–75: Testing and Fine-Tuning

Prepare teams, migrate data, and provide support for a smooth go-live while minimizing disruption to daily clinical operations.

QA for Speed, Stability, and Security

• Test extensively on all modules and integrations. 
• Test system performance under a load that emulates peak usage. 
• Test security features such as access controls, encryption, and audit logging.
• Conduct vulnerability scans and penetration testing to determine possible security vulnerabilities. 
• Resolve all issues before going live with patient information.

Real-User Testing to Catch Gaps Before Launch

• Invite representative users to test the system with real-world scenarios. 
• Develop test scripts that address typical workflows and edge cases. 
• Track and quantify task completion time, error rate, and user satisfaction. Document all
• results and rank fixes by impact on clinical operations and patient safety.

Complete Features Based on Feedback Loops

• Implement final tweaks based on test outcomes. 
• Address high-priority problems that would hinder go-live readiness. 
• Develop a backlog of lower-priority improvements for post-launch development.
• Complete training materials based on user issues seen during testing.

Days 76–90: Go Live and Train Staff

Prepare teams, migrate data, and provide support for a smooth go-live while minimizing disruption to daily clinical operations.

Move Data from Legacy Systems Successfully

Implement your data migration strategy, transferring patient records, appointments, and billing information from current systems. Confirm data integrity by sampling and validating checks.

Take a phased migration route when handling huge amounts of historical data. Provide crucial patient data starting from day one.

Offer Onboarding, Training, and Live Support

Schedule role-based training classes for all staff. Develop simple reference guides to popular tasks and workflows. Assign super-users at each department who can assist staff from their colleagues.

Establish a support desk staffed by specialized staff during the first few weeks following launch. Monitor system utilization and resolve inquiries rapidly to prevent losing momentum.

Plan for Real-World Launch with Contingency Plans

Develop fall-back procedures for likely system faults. Keep paper forms on hand as a backup, if necessary. Establish escalation routes for technical issues that could occur during transition.

Schedule a minimal patient load in the first week to provide staff time to get up to speed with new processes.

HIPAA Compliance & Security: Built from the Ground Up

Security considerations are a critical aspect of custom EHR software development. 

This section outlines ensuring your system meets all regulatory requirements while protecting sensitive patient information.

What HIPAA Requires — and What That Means for Your Build

HIPAA compliance involves both technical and administrative safeguards. Your custom EHR must implement proper access controls, encryption, and audit mechanisms to protect patient information.

According to HHS data, over 40% of HIPAA violations involve unauthorized access or disclosure. A custom-built system can implement security measures aligned with your specific practice vulnerabilities.

Data Privacy, Access Control, and Role-Based Permissions

Design your system based on the principle of least privilege—users only need access to what they require for their own role. Have role-based access controls that limit sensitive information appropriately.

Add patient consent management capabilities that record and enforce privacy choices. Incorporate mechanisms for securely allowing patients to access their records.

Essential Security Features: Encryption, Audit Trails, Multi-Factor Access

Data Security is paramount in healthcare. Your custom EHR software development must include the following practices:

• Enforce encryption for data in transit and at rest according to today's industry standards.
• Develop detailed audit logs that record all access and changes to patient records.
• Insert multi-factor authentication for all users, particularly those accessing the system remotely.
• Add automatic timeout functions and robust password policies to thwart unauthorized access.

Must-Have Features in a Custom EHR Software

When planning your custom EHR software, these essential features should be prioritized to ensure maximum utility and user satisfaction. These components form the core functionality that makes your system truly valuable to healthcare providers.

Clinical Workflows That Match How You Work

Create documentation tools that reflect how your clinicians actually work. This could mean financial templates by specialty, voice recognition capabilities, or AI-driven charting options.

Implement clinical decision support with appropriate alerts without generating alert fatigue. Order sets and protocols for individual practice patterns.

Dashboards, Scheduling, Lab Results, Messaging

Apply role-specific dashboards that emphasize important information for every user type. Develop intuitive scheduling interfaces with custom appointment types and duration settings.

Develop clear lab result displays with abnormal value highlighting and trending capabilities. Develop secure messaging features for staff communication and patient outreach.

E-Prescriptions, Billing, Telehealth, and Interoperability

Provide complete e-prescribing functionality with formulary checking and controlled substance management. Develop billing workflows that capture all billable services and enable clean claims.

Add telehealth functionality if applicable to your practice. Implement interoperability through standard data exchange protocols to interface with hospitals, labs, and other providers.

Selecting the Right Tech Stack for Your Custom EHR Software

The technical foundation of your custom EHR software development project will determine its performance, security, and longevity. This section explores the key technologies that power modern healthcare applications.

Backend, Frontend, Databases, APIs, and Hosting

Based on security, performance, and long-term sustainability, choose the Custom EHR software development technologies. Popular backend options include Node.js, Python, or .NET frameworks. For frontends, React, Angular, or Vue.js offer responsive interfaces.

Use PostgreSQL or MongoDB for database requirements, based on your schema requirements for data. API structure must be in RESTful or GraphQL patterns for easy maintainability.

Standard Tools: Node.js, React, MongoDB, AWS, and Why They Work

These cutting-edge technologies provide benefits for health applications:

• Node.js enables effective backend computation for data-heavy applications
• React generates responsive UIs that adapt dynamically
• MongoDB provides a schema-less design for intricate clinical data
• AWS gives HIPAA-compliant hosting with strong security functionalities

Designing for Scalability, Speed, and Long-Term Maintenance

Build your architecture to accommodate user growth, data volume, and functionality. Implement caching strategies to maintain performance as your database grows.

Use containerization and microservices where appropriate to facilitate updates without system-wide downtime. Establish comprehensive documentation practices to support long-term maintenance.

EHR Development Cost Breakdown

Understanding the financial aspects of custom EHR software development is crucial for proper planning and budgeting. 

This section provides insight into the various cost factors and how to maximize your return on investment.

What Impacts Cost: Feature Scope, Team, Timelines

Custom EHR software development prices vary greatly depending on complexity and needs. Major cost drivers are:

• Number and intricacy of features
• External systems to integrate with
• Security and compliance needs
• Development team location and composition
• Timeline restrictions

Based on industry averages, custom EHR software development can range between $100,000 and $500,000 for full-featured systems.

MVP vs. Full Build: What to Expect at Each Stage

Look to a phased development, beginning with a Minimum Viable Product (MVP) that contains the bare minimum features. This lets you get out the door earlier and iterate on actual usage.

Initial MVP development could be 40-60% of the overall project cost, with the next phases introducing more advanced features and integrations.

The ROI of Going Custom: Ownership and Operational Savings

Though upfront costs of development exceed the cost of licensing off-the-shelf offerings, custom-built EHRs tend to achieve superior long-term ROI via:

• Avoidance of per-provider subscription fees
• Decreased training expenditures due to self-explanatory, workflow-appropriate interfaces
• Increased productivity by virtue of process streamlining
• Decreased personnel turnover due to less technology-induced frustration
• Competitive differentiation resulting from distinct strengths

Should You Build or Buy? Here's How to Decide

Considering whether to pursue custom EHR software development or purchase an existing solution, this final section helps you decide based on your practice's specific circumstances.

Recap: When Custom EHR Makes Strategic and Financial Sense

Custom development is optimal when:

• Your practice has one-of-a-kind workflows that stock systems aren't great at handling
• You've figured out long-term cost benefits through lower licensing fees
• You want to keep control of and ownership of your technology
• Your plans for growth call for adaptability that packaged solutions can't give
• Existing systems are slowing down provider efficiency and satisfaction

Ask Yourself These 3 Questions Before You Build

1. Does your practice have the time (money, skills) available to enable a custom development project?
2. Have you determined particular limitations in current systems that directly affect patient care or revenue?
3. Are you willing to continue to maintain and develop a bespoke solution?

Conclusion

A tailored EHR is an investment, but it provides strong returns in terms of efficiency, provider satisfaction, and quality of patient care. With the proper planning and design strategy, you can develop a system that effectively meets your practice's specific requirements within a sensible 90-day time frame.

The healthcare tech landscape keeps changing at a faster pace. Grabbing the reins of your digital tools puts your practice on a path to lasting success in an ever-more competitive marketplace.

Frequently Asked Questions (FAQs)

How much, typically, is the cost to create a custom EHR system?

Custom EHR software development typically ranges from $100,000 to $500,000, depending upon complexity, functionality, and level of required integration. 

A great number of practices choose phased implementation to disseminate costs over a period while accruing incremental advantages.

Will a custom EHR remain eligible for regulatory programs and incentives?

Yes, custom EHRs can be eligible for initiatives such as Promoting Interoperability (previously Meaningful Use) if they adhere to certification standards. 

Have developers skilled in healthcare regulations assist you in abiding by all the applicable standards.

How do we sustain a custom EHR software after development is done?

Most organizations keep their development partner on for ongoing maintenance or establish an internal IT staff to service the system. 

Include budget for periodic updates, security patches, and feature additions in your total cost of ownership.

Can we integrate our custom EHR with existing hospital systems?

Certainly, contemporary interoperability standards such as HL7 FHIR facilitate integration with external systems easily. Sound planning at the design stage allows your custom EHR software to communicate with critical partners in your healthcare ecosystem easily.

How long does staff training generally take when using a custom EHR?

Training needs differ by organization size and system complexity, but typically last 2-4 weeks. Custom systems usually require less training time than off-the-shelf products because they're designed to fit current workflows instead of requiring users to adopt new ones.

What are the main advantages of custom EHR software over off-the-shelf solutions?

The main advantages of custom EHR software include workflow optimization tailored to your specific practice needs, elimination of unnecessary features that can cause confusion, improved user satisfaction leading to higher adoption rates, and long-term cost savings through increased efficiency and reduced training time.

How can we ensure our custom EHR software remains compliant with changing regulations?

When undertaking custom EHR software development, it's important to build flexibility into the system architecture. Establish a regular review process with your development team to monitor regulatory changes and implement necessary updates. Many practices establish a compliance committee to oversee this ongoing process.

*[EHR]: Electronic Health Record

*[EMR]: Electronic Medical Record 

*[HIPAA]: Health Insurance Portability and Accountability Act 

*[HIMSS]: Healthcare Information and Management Systems Society 

*[MVP]: Minimum Viable Product 

*[ROI]: Return on Investment