Migrating Off a Legacy or Enterprise EHR
You've outgrown Epic, Cerner, or Meditech and the workarounds have piled up. You need a path out that doesn't destroy your data.
Trusted by startups and global leaders
Three Scenarios We Build For
Most organizations coming to us for a custom EHR are in one of three situations. It helps to name them upfront — so you can read what's most relevant to where you are.
Building for the First Time
A health-tech startup, new specialty practice, or service line — no legacy constraints, but it must be production-ready, compliant, and scalable.
Extending an EHR Into Something Different
The core EHR works but lacks AI, payer interoperability, or a modern patient layer — extend it without losing your clinical data history.
What We Build Into Every Custom EHR
Nine capabilities, each built around the encounter types, clinical vocabulary, and workflows your providers actually use — not a horizontal system stretched to fit.
The AI Layer — What AI Actually Does in a Custom EHR
Because we build from the ground up, we integrate AI properly rather than grafting it onto a system not designed for it.
The provider talks, the system drafts a structured note in real time — forty-five minutes of post-visit charting becomes five.
ICD-10 and CPT suggestions from the encounter note as it's written — with confidence scoring and gap alerts.
Alerts calibrated to your specialty and population — relevant drug interactions, risk scores trained on patients like yours.
No-show risk scoring, readmission risk for high-acuity panels, and care-gap identification — surfaced before your team goes looking.
Learns your payers' patterns — flags orders likely to need auth, pre-populates requests, and tracks status automatically.
Migration — Getting Off Your Current EHR
EHR migration is high-stakes — and most information about it comes from vendors with a financial interest in making it sound easy. Here's what it actually involves.
Data Extraction & Migration
We've moved clinical history out of Epic, Cerner, Athenahealth, Meditech, and eClinicalWorks. We scope it during discovery and tell you what migrates cleanly, what needs transformation, and what belongs in a historical archive.
Parallel Operation
Hard cutover is clinically too risky for most organizations. We run both systems simultaneously with a defined timeline and clear protocols for which is the system of record.
Training & Adoption
Training runs as a structured workstream alongside late-stage development — role-specific sessions and go-live support during the weeks when adoption questions peak.
Payer & Integration Continuity
We map every integration — labs, imaging, clearinghouse, payer portals, pharmacy — during discovery and plan each cutover explicitly. Nothing gets missed.
EHRs We've Built. What Changed After They Went Live.
Each number comes from a custom EHR we designed and shipped.
Talk to Our Team70%
Less documentation time — Specialty Oncology EMR (generic EHR had no treatment-cycle management; chemotherapy dosing errors eliminated)
60%
Faster session documentation — Behavioral Health EHR (progress-note requirements unmet by a general platform; audit-ready compliance from day one)
25→1
Patient record unified — Ambulatory Multi-Site EMR (25 locations on disconnected systems; real-time cross-location clinical visibility)
90 days
To group-level reporting — Dental DSO Practice-Management EHR (25-clinic group on a single-site platform; reporting impossible at scale)
40%
Less admin time per visit — Rehabilitation Outcome-Tracking EHR (outcomes on paper; MIPS reporting now automated)
70%
Less charting time — AI-Assisted Ambulatory EHR (physicians documenting 3+ hours post-shift; satisfaction up within 60 days)
98%
Collection rate — Revenue-Cycle-Integrated EHR (charge capture disconnected from docs, 18% denials; coding errors down 85%, 15-day avg reimbursement)
How a Custom EHR Engagement Runs
The gap between how software projects are presented and how they actually run is wide — wider still in healthcare. Hover or tap a stage to see what it actually involves.
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Discovery
Discovery
We talk to every role that will use the system — physicians, nurses, MAs, front desk, billing, IT. We document the workarounds your staff has built and map workflows as they actually run.
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Architecture
Architecture
Data structure, AI integration, external system connections, access controls — all decided before development starts. Changing architecture mid-build compounds in cost quickly.
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Two-Week Sprints
Two-Week Sprints
Working software every two weeks — not status slides. Problems surface when they're cheap to fix. Clinical team reacts to what they see, not a description of what they'll eventually see.
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Clinical Validation
Clinical Validation
Staff runs real scenarios before any patient data touches the system. Usability problems at this stage cost a fraction of what they cost post-launch.
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Go-Live
Go-Live
We monitor under real clinical load and respond to issues in hours. The first weeks post-launch surface the most valuable feedback — we're present to act on it.
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Post-Launch
Post-Launch
Clinical requirements evolve, regulations shift, AI improves. We stay engaged — updates, new capabilities, and responding to what only becomes visible once real clinicians use the system.
Compliance We Treat as Architecture, Not a Checklist
A custom EHR carries a heavier compliance burden than most software. Every standard below is an architectural requirement, built in from the start.
Privacy
Privacy & Patient Rights
PHI handling, access controls, audit logging, and breach notification.
Security
Security & Risk
Independently audited security and risk controls across the stack.
Interoperability
Interoperability & Health IT Certification
FHIR-compliant APIs, ONC certification, and CMS interoperability rules.
Clinical & Rx
Clinical Safety, Devices & Prescribing
FDA SaMD guidance, EPCS e-prescribing, and MIPS data-capture infrastructure.
State Rules
State-Specific Requirements
PDMP integration, state consent laws, and telehealth standards.
Accessibility
Accessibility
Usable by every clinician and patient, by design.
We've Built For Specialties
Each specialty has documentation requirements, workflows, and a regulatory load that general platforms treat as edge cases. Here's where we've built EHRs around the specialty instead of stretching a horizontal system to fit.
Oncology
Medical Oncology & Infusion
Behavioral Health & Psychiatry
Substance Use Disorder Treatment
Orthopedics & Sports Medicine
Physical & Occupational Therapy
Chiropractic
Podiatry
Cardiology
Neurology
Pain Management
Dental & DSO Groups
Oral & Maxillofacial Surgery
Dermatology
Gastroenterology
Ophthalmology
Pediatrics
Geriatrics & Memory Care
Concierge & Direct Primary Care
Fertility & Reproductive Medicine
Urgent Care & Walk-In
Home Health & Hospice
Radiology & Imaging
Pathology
Your EHR Is Costing You More Than You Pay for It
Not in licensing fees — in clinician time, workarounds, and billing errors from clinical and financial layers that don't talk. Ready for an honest talk about timeline and cost? Thirty minutes. No pitch.
Talk About Your EHR
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Frequently Asked Questions
[ 1 ]
How is a custom EHR different from a highly configured commercial one?
A commercial EHR gives you options within the vendor's boundaries. A custom EHR is built around your actual clinical workflows — the boundaries are yours. For practices with unusual documentation, billing structures, or AI needs, configuration has a ceiling that custom doesn't.
[ 2 ]
Can you migrate our existing patient data from our current EHR?
Yes. We've migrated from Epic, Cerner, Athenahealth, Meditech, eClinicalWorks, and proprietary systems. We scope it during discovery and tell you what migrates cleanly, what needs transformation, and what belongs in a historical archive.
[ 3 ]
What happens to our existing integrations during migration?
We map every integration — labs, imaging, pharmacy, clearinghouse, PDMP, HIE — during discovery. Each one is explicitly planned into the migration timeline.
[ 4 ]
How long does a custom EHR build take?
A focused specialty EMR runs five to eight months. A full enterprise EHR with multiple modules, AI, patient portal, and migration runs twelve to twenty months. We give you a milestone-based timeline after discovery and hold to it.
[ 5 ]
Does a custom EHR need ONC certification?
It depends on your use case. ONC certification is required for MIPS participation or patient data access rights. We build to ONC criteria for organizations that need it and support the certification process.
[ 6 ]
What does the go-live period actually look like?
We go live in stages where clinical risk warrants it, monitor the system through launch, and respond to issues in hours. We don't hand over the keys and disappear.
[ 7 ]
Who owns the EHR after it's built?
You do — full IP transfer at project close. Source code, data models, documentation. No license fees, no ongoing dependency on us.
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