EHR: Build vs. Buy? Making the Decision for Each Core Component (Part 2)

Before deciding whether to build, buy, or go hybrid, you need a clear picture of what an EHR or healthtech platform actually requires. Whether you’re buying an off-the-shelf solution, building from the ground up, or mixing both, these core components shape the foundation of your tech stack. We outline a comprehensive list below, but not every organization needs every feature. As you go through the next sections, focus on the pieces that matter most to your workflows, scalability, and compliance needs.

In this post, Part 2 of our EHR Build vs. Buy series, we first provide a list of typical requirements and then pose key questions to guide your own investigation and documentation of your platform needs. Whether your team is just getting started or has software that is already used by thousands or millions of patients and providers, this will help you make informed decisions about each component.

1. Core Healthcare Functionality

At the heart of any EHR system are the essential day-to-day operations of patient care.

Core Requirements

• Scheduling & Appointments
  • Calendar-based appointment booking
  • Rescheduling, no-show tracking, automated reminders (via SMS, email, etc.)
  • Coordination across physicians, providers, and patients
  • Integration with external scheduling solutions (e.g., Cal.com, Acuity)
• Charting & Patient Records
  • Structured templates for clinical documentation (SOAP notes, assessments)
  • Free-text note-taking with voice-to-text support
  • Document management for scans, referrals, and lab results
  • Coding integration (such as SNOMED or ICD-10) for standardized data
• E-Prescribing & Medication Management
  • Integration with a tool like SureScripts for controlled substance prescriptions
  • Drug interaction checks and allergy alerts
  • Pharmacy communication for electronic refills
• Billing & Revenue Cycle Management (RCM)
  • Current Procedural Terminology (CPT) and ICD code compliance
  • Insurance claims processing and denial management
  • Payment integrations (credit card, HSA, Stripe, clearinghouses, etc.)

Key Questions to Consider

1. Do you just need scheduling, or do you need a full RCM-integrated system?
2. Who will need access to patient charts and records? What type of user will need to input the notes or provide annotations?
3. Are your providers using a specific documentation or coding framework that needs customization?
4. Do you plan to handle claims internally, or will you rely on third-party clearinghouses?

2. Telemedicine & Virtual Care

The rise of remote healthcare has made telemedicine an essential part of modern EHRs or healthtech platforms.

Common Core Requirements

• Video Conferencing & Virtual Visits
  • Secure, HIPAA-compliant video calls (Zoom, Twilio, WebRTC)
  • Multi-party video visits for collaborative care
  • Integration with patient portals for seamless scheduling
• Secure Messaging & Communication
  • Asynchronous chat for patient-provider communication
  • AI-powered triage responses for non-urgent inquiries
  • Encrypted SMS and email reminders
• Remote Patient Monitoring (RPM)
  • IoT integration with wearable devices (blood pressure monitors, glucose tracking)
  • Data visualization dashboards for patient and provider insights

Key Questions to Consider

1. Do you need a built-in telehealth solution, or can you integrate with existing tools?
2. Will you require continuous or recurring remote monitoring, or just one-time virtual visits?
3. How do you want your system to handle asynchronous or real-time patient communication?

3. Interoperability & Data Exchange

Many healthtech platforms do not meet the bar for seamless data exchange, so ensuring compliance with FHIR and HL7 is critical.

Typical Core Requirements

• FHIR & HL7 Standard Support
  • RESTful APIs for real-time data exchange
  • Ability to send/receive structured patient data from external providers
• Payer & Insurance Integrations
  • Eligibility verification via vendors like pVerify or Change Healthcare
  • Direct claims submission and reimbursement tracking
• Health Information Exchange (HIE) Connectivity
  • Direct messaging with hospital networks
  • Lab and imaging results retrieval

Key Questions to Consider

1. Do you need real-time data sync, or is periodic batch data sufficient?
2. Are you required to support FHIR, or do your partners use proprietary data formats?
3. How will you ensure compliance with interoperability mandates (such as the Cures Act or TEFCA)?

4. AI & Automation

The role of AI in healthcare is growing. AI-powered tools can dramatically reduce manual workload and improve decision-making.

Typical Core Requirements

• Clinical Decision Support (CDS)
  • AI-driven risk assessments and treatment recommendations
  • Predictive analytics for early disease detection
• Automated Charting & Summarization
  • NLP-based summarization of long patient histories
  • AI-driven coding for SOAP notes and other inputs
  • Auto-generated SOAP notes based on dictation
• Workflow Optimization
  • AI-powered task routing for administrative staff
  • AI agents to support recurring tasks
  • Intelligent automation for scheduling and follow-ups

Key Questions to Consider

1. Do you need real-time AI recommendations for providers?
2. What processes will you have in place to validate AI-generated for accuracy and compliance?
3. Do you need an AI-first approach, or just minor automation enhancements?

5. User Management & Security

Compliance and security are non-negotiable in healthcare and related technology solutions.

Typical Core Requirements

• Role-Based Access Control (RBAC)
  • Define access levels for physicians, nurses, admins, and billing teams
  • Enforce least-privilege access policies
• Authentication & Single Sign-On (SSO)
  • Integration with Okta, Auth0, or Azure AD
  • Multi-factor authentication (MFA) support
• Audit Logs & Compliance Tracking
  • Detailed logs for every patient interaction
  • HIPAA, SOC 2, and HITRUST compliance reporting

Key Questions to Consider

1. How do you plan to manage access permissions and auditing?
2. Do you need enterprise-grade security, or just basic authentication?
3. How will you handle user provisioning and deactivation at scale?

6. Infrastructure & Scalability

Your technology stack must scale with patient volume and stay reliable under peak usage.

Common Core Requirements

• Cloud vs. On-Premise
  • AWS, Google Cloud, or Azure for managed security and redundancy
  • On-prem options for strict data control
• Multi-Tenancy & Data Isolation
  • Ensuring proper segmentation of patient data
  • Supporting multi-organization structures when required, especially for white-labelled solutions
• Performance & Reliability
  • Auto-scaling for high-traffic periods
  • Caching layers and replication for fast response times

Key Questions to Consider

1. How will you ensure uptime and reasonable performance as platform usage grows?
2. Do you need dedicated infrastructure, or will a managed cloud solution work?
3. Are you planning to hire a dedicated Software Engineering or Infrastructure team?
4. Are you prepared for disaster recovery and failover scenarios?

Essential Takeaways: Your EHR Tech Requirements

• EHRs are more than just patient records — they need to handle scheduling, interoperability, AI automation, and security.
• Not every organization needs a full-featured EHR. Some may only require telemedicine, workflow automation, or integrations. There’s no one-size-fits-all approach, and many headless offerings provide a great starting point. 
• Compliance is a major factor. HIPAA, FHIR, and HL7 standards can make or break an implementation.

Up next in the series (coming soon!), we explore the tradeoffs between options at both ends of the spectrum: (1) when building a custom EHR makes sense, including the hidden complexities of a homegrown system; and (2) when it makes more sense to use an off-the-shelf solution. 

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At APrime, we specialize in building and scaling healthtech platforms for startups. Hop on a free consultation with our founders by scheduling a call, or send us an email at hello@aprime.io.