Custom EHR: benefits, key features,
and a development guide

Custom EHR: benefits, key features, and a development guide

November 8, 2023

Key Custom EHR features

The best part of developing medical records software from scratch for your organization is that it can be equipped with features and integrations relevant to your practice, which prevents the system from being overcomplicated.

General features

First and foremost, EHR and EMR software are tools for gathering, storing, and sharing patient information. Thus, their basic set of features should include patient profiling and capabilities for secure data acquisition, access, and transfer for doctors and patients.

Patient profiling

Profiling features give healthcare professionals a 360-degree view of patients which extends beyond medical records. However, it is up to you to decide which information your practice requires and discuss the possibility of expanding the patient profile later with your EHR vendor. Patient records can include the following:

  • Demographic information, including gender, age, place of residence, and social security number
  • Examination notes
  • Supplementary data, such as laboratory test results and medical images
  • Previous diagnoses and current health conditions (e.g., injuries, surgeries, allergies, and chronic illnesses)
  • Prescription history, drug intolerance, and side effects reports
  • Immunization history
  • Financial details, including insurance policy numbers, subscription plans, and billing information

Automated data acquisition

Clinicians don’t have to work overtime to put patient data into the system because the process can be almost entirely automated. EHRs typically include multiple tools for gathering information:

  • Integrations with patient portals so that patients can manage their health data 
  • Integrations with wearables, remote patient monitoring gadgets, and other smart medical devices that provide real-time reports about the patient’s condition
  • AI-supported systems that automatically convert data from one format to another and facilitate patient data reception from other EHR, EMR, or alternative record-keeping software solutions
  • Modules that allow voice data entry

Dashboards for healthcare personnel

Medical workers should be able to access all the data they need in one centralized place without the hassle of opening multiple windows and performing hundreds of operations. For example, nursing EHRs are optimized for bedside note-taking and display daily patient procedures on a single dashboard. Such dashboards for authorized clinicians can enable:

  • Reviewing, managing, and updating patient profiles
  • Automatic reminders about upcoming appointments, vaccinations, and prescription refills
  • Notifications about receiving lab results, medical images, diagnoses from other specialists, incoming information requests from insurance companies or other departments and organizations, and unusual readings from RPM devices

Practice-specific add-ons

There are a plethora of customizable add-ons helpful to specialists within a particular medical practice. After all, the functionality and interface of a dental EHR will differ drastically from a surgical EHR. Discuss your needs and ideas with your software provider to learn what features are feasible to embed right now and what would be better to integrate down the line:

Scheduling & reminders
These features help staff manage their tasks effectively by providing a task management dashboard and connecting it to the appointment scheduling functionality. You can also enable notifications so neither doctors nor patients forget about an appointment, vaccination, re-fill, or other procedures.
Analytics & reporting
This functionality enables healthcare workers to see patterns in patients’ conditions and predict potential risks. It also helps assess a particular treatment, analyze and forecast the effectiveness of a prescribed treatment, and find connections between patients’ health and other factors (for example, their demographics).
Medical information resources
You can enhance the quality of care by outfitting your EHR with built-in compendiums about various health conditions, international disease classification, medical research, drug usage, controlled substances, treatment plan templates, and other valuable information. Make sure it is easy to access and navigate to save your personnel’s time.

You can integrate your electronic health record software with video or audio conferencing tools to facilitate primary care virtual sessions.

Billing & financial management
Financial modules make it easier for specialists to charge for their services by integrating appointment scheduling modules with billing, insurance, and subscription plan management systems.

How to choose the right EHR software development option?

Custom software development can greatly boost most practices’ productivity, however, it doesn’t mean everyone should get an EHR designed from scratch. There are many possible ways to tune your healthcare solution to better suit your clinical and business needs.

We can help you choose a plug-and-play commercial EHROur experts can help you build a customized and affordable open-source EHROur experts can build a uniquely tailored custom solution to fit your practiceOur integration team can help you get more value from your EHR with add-ons and fine-tuningDoes your organizationalready use an EHR/EMR software?Will general out-of-the box solution's functionality be enough?Does it cover all your requirements?Can you afford paying a subscription fee to use an out-of-the box EHR?Can you afford building
a custom EHR?Do you require extensive customizations?Would you like to upgrade it with additional modules?YesNoYesYesNoNoYesYesNoNoYesYesNo

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Our services

Itransition supports care providers at any stage of their EHR implementation journey, whether they plan to adopt a custom system or upgrade their legacy software.

EHR customization

Our team specializes in re-engineering legacy EHR software to make them fit modern healthcare industry regulations and challenges, developing and connecting additional modules to out-of-the-box solutions, and tuning EHR platforms to make them more specialty-oriented. We work closely with medical professionals to understand how they want to expand their EHR capabilities. Then we develop additional modules from scratch or build upon various third-party integrations.

Custom EHR development

We craft brand new electronic health record systems precisely for organizations operating in specific areas of healthcare. Our Healthcare Center of Excellence constantly develops its expertise, implementing the most innovative technologies in EHR software. Our experts ensure top-level security, reliability, usability, and flexibility of a custom solution, with our client’s budget and specifics in mind. We also integrate EHRs in clients’ ecosystems, providing post-development support and user training.

Client spotlight

Custom software is more than just another mundane tool for medical providers. Our clients use custom EHRs as a means to offer truly unique and innovative services.

Telemedicine-ready EHR


innovative EHR modules

Triptych Technologies Inc. requested our assistance with a bold futuristic project: an EHR and patient portal software that utilized innovative data input methods (voice, smart pen, etc.) and teleconferencing capabilities.  Together we created Sapiocare – a solution that automates scheduling patient appointments, keeping medical history records, and forming billing reports without the integration of a specific payment system. It is instead integrated with televisit software and platforms for natural language processing and voice recognition to enable voice input, an Automated System of handwriting recognition, and Apache cTakes clinical text analysis to allow data input with a smart pen and paper. The EHR has been tested for an extended period of time and is proven to be highly functional and fully secure.

Custom oncology treatment platform


therapy orders created each month

A US-based provider of health information solutions for practicing oncologists wanted to develop a HIPAA-compliant platform that can be easily integrated with hospital software and help doctors make timely and evidence-based patient treatment decisions. Our team developed a solution that stores organized treatment information from medical research, streamlines orders’ creation, and generates reports for therapy recommendations. We integrated the platform with the EHR system used by the customer’s partner via API. The solution  provides the connection with various other EHR and practice management systems, laboratories, insurance providers, and data analytics software. The platform’s launch was successful, and it is currently used by 700+ employees from 30+ medical institutions across the US.

Custom EHR vs off-the-shelf solution

Custom EHRs, as well as ready-made solutions, have their unique advantages and limitations. It’s crucial to consider both before starting the implementation.




Tailored to your organization’s clinical specialization Based on your clinicians’ requirements and feedback Personalized, user-friendly interface Integrated with value-adding third-party apps and medical devices Faster upgrades

Standardized Faster and cheaper to implement Doesn’t require much work from the adopter Abundant pre-made training materials Large community of users that can give advice


Typically more expensive Usually takes longer to implement Requires developing personalized training materials Possible obstructions in data transfer between custom and off-the-shelf EHRs

Overloaded with unnecessary features  Cumbersome interface Hard to integrate with other software and hardware Often lacks features for specific practice needs Slow to incorporate innovations into

Custom EHR development pipeline

Thorough pre-deployment analysis, a clear project plan, a defined roadmap, and transparent communication between the vendor and healthcare provider, increase the chances for successful EHR implementation.



Defining EHR requirements and tech stack.



Creating a roadmap and crafting a solution compliant with industry standards and privacy regulations.

Integrating the EHR with other healthcare applications.

Conducting quality assurance and test runs throughout the development process.



Implementing custom EHR into the organization’s IT ecosystem and migrating relevant data.



Providing software performance monitoring, improvements, updates, and  different levels of support during the use of EHR.

Outline the basics of your custom EHR implementation, including its interface, features, and capabilities. Assemble a team consisting of a project manager, a business analyst, clinicians that represent all end-users, and an IT department expert to decide which EHR workflows should be updated or automated and how its interface should look.   By the end of this step, the development team offers a solution with functionality that fully covers or even exceeds the client's expectations, creates system architecture and comes up with the basic design, defines the tech stack, and gives recommendations about the necessary changes to the organization’s hardware and software.
Business and software requirementsHardware and software capabilities“Nice to have” featuresDiscovery phaseTechnical solution and architecture overview (high-level architecture, technology frameworks and components, security and performance considerations for the project)WBS assessment (in particular, project cost and timeline)

Custom EHR development takes from 4 to 12 months, depending on the provider, the scale of the organization, and the system’s complexity, and consists of three major steps: 

  1. Creating the roadmap and delivering a custom EHR solution.
    A detailed plan with well-defined milestones for the EHR system’s development will help you and the development team stay on the same page. At this stage, developers create a working prototype with the most essential modules, send the working solution to clinicians for initial feedback, and make changes to processes and the system if needed. 
  2. Integrating with other healthcare applications.
    Healthcare providers that go for a custom EHR usually need it to be connected to other healthcare solutions: practice or hospital management software, lab systems, or BI tools. Development team ensures the data flow is unobstructed and secure between all of these tools.
  3. All-round quality assurance.
    A custom EHR solution stores sensitive information. Therefore, it is crucial to ensure its compliance with HIPAA, GDPR, PIPEDA, and other standards and the security of patient information before going live. Also, to get a properly performing solution, relevant functional and non-functional testing is conducted throughout the entire development and implementation cycle.

Once custom EHR software is fully developed and tested, its quality and security are assured, and feedback from clinicians is taken into consideration, the system is ready to be integrated with other medical software. 

When your EHR system is fully operational, you can proceed with data migration and personnel training. First and foremost, aim to train primary users, not experts. Start with educating the personnel on basic EHR commands, provide necessary security training, and conduct more in-depth sessions for those who need additional skills.

Custom EHRs require due maintenance, regular assessment and optimization, or upgrades if needed. This way, one system can serve a healthcare organization for an extended period of time, growing and evolving. Contact your technology partner to know exactly which post-implementation support is available to you, or hire a support team that will cover these needs.

Custom EHR deployment types

We can deploy a custom EHR system in the cloud environment, with most data stored on external servers or exclusively inside the healthcare organization’s own IT infrastructure. Both deployment methods have their pros and cons, so it’s crucial to evaluate both and decide which one suits your operations.


  • Lower upfront costs but potentially higher TCO over the years of usage
  • Relatively fast setup
  • More possibilities for a data breach, however, our experts employ the newest technologies to ensure the highest level of security
  • May require a business associate agreement (BAA) with the cloud provider
  • Easily integrated with other apps via APIs, connectors, and other tools
  • Can be scaled on the go
  • Data security and backups are the vendor’s responsibility
  • The majority of support services can be provided remotely, making them fast and effective
  • Requires stable internet connection and can be accessed remotely
  • Fewer data management and control options


  • Higher upfront cost but lower annual expenses
  • Longer setup
  • Сompanies must ensure electronic medical records’ security themselves, requiring high-skilled in-house specialists
  • External apps’ integration often takes more time and operations
  • Requires additional extensions to scale
  • Regular backups and recovery strategy is the owner’s responsibility
  • Requires dedicated hardware and an in-house support team
  • Doesn’t require 24/7 internet connection and сan be accessed inside the facility even offline
  • All data is in one place and under the organization’s control

Custom EHR cost factors

EHR costs vary even for out-of-the-box EHR solutions, and more so for custom-made ones. The research by Software Path suggests that a healthcare provider should expect to pay around $1,000 per EHR user, although this number is very relative.

Scheme title: Average budget per user for EHR software
Data source: — What practices look for when selecting EHR, 2022

There are five major factors that determine a custom EHR system’s cost:

Major factors
Needed features & integrations
Required hardware or software updates
The complexity of data migration
The number of specialists to train
The type of post-implementation support

Although the upfront EHR system cost might be higher than expected, keep in mind that healthcare practices typically reduce their spending in other aspects after installing it. Custom electronic health records system recaptures its implementation costs within a year by facilitating laboratory testing, clinical procedure scheduling, and prescription ordering. 

Considering custom EHR implementation?

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Why turn to custom EHR development?

There are three essential upsides to custom EHR systems that set them apart from platform-based solutions.

A user-friendly interface

EHR interface-related challenges like chaotic screen transitions and numerous mouse clicks are serious disruptors for clinicians who have to refocus multiple times in a row. Moreover, the need to interact with such effort-intensive EHR systems can cause clinician burnout, according to a Mayo Clinic study. The researchers matched System Usability Scale (SUS) scores with burnout rates and found that the lower the SUS score, the higher the burnout rate and vice versa. Being burnt out, clinicians can mix up patient data like height and weight in interface fields. This leads to diagnosis and treatment mismanagement and, eventually, patient harm.

To prevent such issues, providers rely on electronic records management software or adopt EHRs with interfaces customized specifically to fit particular organizations’ workflows.

Scheme title: SUS score vs. clinician burnout correlation
Data source:—The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

Enhanced flexibility & interoperability

The health industry’s IT ecosystems grow and expand, with more software implemented to support daily operations. When your EHR – one of the central hospital systems – can’t properly interact with other software and evolve alongside your practice, it sets back the entire organization. This is the case for many out-of-the-box solutions, as they are not flexible enough for frequent updates. Meanwhile, custom solutions are created with your organization’s unique set of tools and workflows in mind, highly interoperable, and easy to update if needed.

Better connection to specialized clinical settings

When built and implemented without connection to a particular field setting, an EHR system tends to ignore specifics that make the system efficient. According to the recent SOTI report on the state of mobility in healthcare, between 26% and 39% of healthcare workers enter patient data in the system manually, while 42% said patient-information systems are not well integrated into processes.

The quality of EHR implementation (and personnel training as a part of it) greatly influences a system's effectiveness and staff satisfaction. However, a custom EHR is tailored to a particular organization’s needs and available resources, giving clinicians an advantage from the start.

Get more value from your EHR with customization

Healthcare providers are under a lot of pressure to adopt electronic health records from regulatory organizations and competitors. Despite much evidence suggesting that EHRs enhance patient care, boost doctors’ efficiency, and help improve profitability, practitioners are anxious to adopt this solution. Some are concerned about its high cost and security while others see mainstream EHRs as unfit for their highly specialized clinical environments.  Custom EHR can be the key to dissolving some of these concerns. The ability to choose only necessary features for their software gives clinicians more control and makes operating the system easier. Although they might be more expensive than off-the-shelf ones, custom solutions deliver quicker ROI in the long run. Turn to Itransition’s healthcare experts to implement the best-fitted EHR solution, tailored for your practice.

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