Electronic Health Records

Electronic Health Records (EHR) systems are the clinical systems of record for healthcare providers — managing patient demographics, clinical encounters, diagnoses, medications, lab results, imaging orders, and clinical documentation. The US EHR market is dominated by Epic Systems, which serves approximately 38% of US patients, with Cerner (now Oracle Health) and Meditech serving most of the remainder. Epic's dominance is not accidental — its comprehensive integration capabilities and 40 years of clinical workflow optimization create switching costs that make displacement nearly impossible for large health systems.

EHR integration is the most common technical challenge in healthcare technology. Every healthcare application that needs patient data must integrate with the EHR — and every major EHR has a distinct integration architecture. Epic uses HL7 v2 for traditional integrations and FHIR R4 for modern integrations, but the FHIR implementation is constrained by Epic's interpretation of the standard. Cerner has its own FHIR implementation with different constraints. Meditech's integration capabilities lag significantly. Building an application that integrates with all three requires three distinct integration implementations that are tested independently and maintained as each EHR vendor releases updates.

The 21st Century Cures Act and the ONC's interoperability rules have mandated FHIR-based data exchange, creating a wave of EHR integration requirements. Health systems must provide patients with access to their data through SMART on FHIR applications. They must participate in national networks for data exchange — CommonWell, Carequality, and the emerging TEFCA network. These mandates create engineering obligations for EHR-adjacent systems and for any application that needs to exchange patient data with health system infrastructure.

We build EHR integrations and EHR-adjacent clinical systems for healthcare technology companies and health systems — implementing HL7 FHIR interfaces that pass ONC certification, navigating the specific integration architectures of Epic, Cerner, and Meditech, designing SMART on FHIR applications, and building the data governance and HIPAA compliance that every system touching patient data requires. Our teams have shipped clinical integrations that passed Epic's certification process.

Compliance-Native Architecture Guide

Design principles and a structured checklist for building software that is compliant by default — not compliant by retrofit. Covers data architecture, access controls, audit trails, and vendor due diligence.