EHR: Build vs. Buy? The Best Healthtech Companies Are Doing Both (Part 1)

At APrime, we specialize in building and scaling healthtech platforms for startups. One dilemma we often field from our clients is whether to build or buy an EHR — but in our experience, that’s not actually the right question. In nearly every case, a hybrid strategy is the right move and the real challenge is deciding which EHR components to build and which ones to buy.

In this series of blog posts, we’ll talk through how to balance the need for customization with the speed and reliability of existing solutions and give specific recommendations on using established EHRs for fundamental needs like patient data management, scheduling and billing, while building custom components for your unique workflows and AI-driven automation. In this introductory post, we discuss the complexity of this decision and describe the core components of typical healthtech platforms.

You can also read Part 2: Making the Build vs. Buy Decision for Each EHR Component, a deep dive on the core components of a typical EHR integration with key questions to determine your platform’s needs.

Why Is This Decision So Complex?

Choosing an EHR might seem like a straightforward cost-benefit analysis, but organizations must weigh several critical factors:

• Regulatory & Compliance: Managing HIPAA, SOC 2, and HITRUST requirements – can and should your team handle this, or should you rely on vendors?
• Customization vs. Standardization: Off-the-shelf solutions offer structure but may limit innovation. The key is identifying where custom development truly adds value.
• AI and Automation: LLMs and AI tools are transforming healthcare data interaction, adding new layers to compliance and data management.
• Interoperability: Traditional EHRs often struggle with data exchange, pushing organizations toward API-driven solutions.
• Total Cost of Ownership: Beyond licensing fees, consider maintenance, security, and engineering resources.

The build vs. buy decision is no longer just about choosing an EHR — it’s often about designing an entire digital health ecosystem. Many healthtech companies and providers must integrate:

• Core EHR functions (scheduling, charting, billing, e-prescribing)
• Telemedicine capabilities
• AI-driven clinical decision support
• Secure patient communication
• Scalable cloud infrastructure 

Luckily, modern API-first platforms and modular EHRs make it possible to combine off-the-shelf systems with custom workflows. You’ll want to assess your starting point by (1) Evaluating existing tools that could be optimized, (2) Identifying the most pressing pain points in your current workflow, and (3) Evaluating your team’s capacity for maintaining custom systems. Starting fresh isn’t always the answer – often, the smartest approach is building upon what works while strategically replacing what doesn’t.

A balanced strategy lets you scale quickly while maintaining control over your tech roadmap, combining pre-built solutions for core compliance and data management with custom components where innovation matters most. 

We outline a comprehensive list in Part 2: Making the Build vs. Buy Decision for Each EHR Component, but not every organization needs every feature. As you go through the next entry in this series, focus on the pieces that matter most to your workflows, scalability, and compliance needs.

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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.