How to Create an EHR software: Comprehensive Guide 2025

You must have read multiple reports on the surging adoption of electronic health record (EHR) systems. Nearly 4 in 5 office-based physicians (78%) and almost all non-federal acute care hospitals (96%) have adopted a certified EHR, marking significant progress from 2011, when only 34% of physicians and 28% of hospitals had embraced this technology. This growth is marked by the incentives provided under the Meaningful Use program, regulatory requirements, and the need for better patient care. 

With this widespread adoption, many healthcare organizations now face a crucial decision—whether to upgrade their current systems or build a new EHR from scratch. This guide is designed to walk you through the complex process of EHR development or upgrade. By the end, you’ll have the knowledge needed to resolve 2025’s healthcare challenges and build a future-proof EHR.  

What is an EHR System? 

An Electronic Health Record (EHR) system is a digital version of a patient’s comprehensive medical history, designed to be shared across various healthcare settings. Unlike traditional paper records, EHRs allow real-time access to patient data, including treatment plans, test results, and prescriptions. An EHR goes beyond basic patient records—it is built to facilitate sharing with other healthcare providers, improving communication and care coordination across practices, hospitals, labs, and even different regions. 

The key value of EHR systems is their interoperability and integration between healthcare providers. With features like telemedicine, analytics, and patient portals, EHRs are crucial in making healthcare more patient-centric and improving clinical workflows. 

What is an EMR System? 

An Electronic Medical (EMR) system, on the other hand, is often limited to a single healthcare provider or organization. EMRs serve as the digital equivalent of paper charts, containing medical history, diagnoses, and treatment plans specific to that facility. While EMRs are highly efficient for internal record-keeping and operational improvements, they fall short in terms of sharing information outside their originating institution. 

EMRs can be considered the first step towards a fully digital healthcare system, but their lack of interoperability makes them less suitable for collaborative care environments where patient data needs to be accessible to multiple providers. 

Key Differences Between EHR and EMR Systems 

Although EHR and EMR systems are often confused, the distinction is essential for healthcare providers considering which system to adopt or upgrade. 

• Interoperability 

EHRs enable data sharing across healthcare networks, while EMRs remain restricted to the originating facility, limiting cross-provider collaboration. 

• Scope 

EHRs offer a broader, more holistic view of patient health, encompassing a range of data from different sources. EMRs are generally limited to the scope of care provided by the originating facility. 

• Patient Engagement 

EHR systems typically offer features like patient portals, where individuals can access their health data, schedule appointments, and communicate with their providers. EMRs are more focused on internal record-keeping, with limited direct interaction with patients. 

Choosing between an EHR or EMR depends largely on the scope of your practice. EHRs are more suitable for multi-facility networks or organizations that emphasize coordinated, patient-centered care. Meanwhile, smaller practices might find EMRs sufficient for their more localized needs, but they may face limitations when integrating with other healthcare providers. 

Key Features of an EHR System 

The foundation of any successful EHR or EMR system lies in the core and advanced features it offers. Understanding these core and advanced functionalities helps healthcare providers ensure they use the full potential of their EHR system to deliver higher-quality care. 

Core Features 

• Patient Management: EHR systems provide patient registration, scheduling, and communication. They also manage demographics, contact information, and insurance details, ensuring that all patient data is stored in one centralized system for easy access. 

• Medical Records: EHRs provide real-time access to comprehensive patient medical histories, including diagnoses, lab results, treatment plans, and allergies. Healthcare providers can deliver precise, timely care by having up-to-date information at their fingertips. 

• Prescription Management and Billing: EHRs include e-prescribing functionalities through which healthcare providers send prescriptions directly to pharmacies, reducing errors and improving efficiency. Integrated billing features automated invoicing, insurance claims, and payment processing for smoother financial workflows and faster reimbursements. 

Advanced Features 

• Telemedicine Integration: Modern EHR systems offer built-in telemedicine tools through which healthcare providers conduct virtual consultations, monitor remote patients, and integrate telehealth data seamlessly into patient records. 

• AI-Driven Analytics: Advanced EHR systems use AI and machine learning to analyze patient data, predict health trends, and provide actionable insights for personalized treatment plans. This enhances preventive care, early detection of diseases, and improved clinical decision-making. 

• Patient Portals: These portals help patients by providing secure access to their health records, test results, and medication history. Patients can schedule appointments, request prescription refills, and communicate with healthcare providers directly through the portal, leading to better engagement and proactive care management. 

Complete guide on how to build an EHR and EMR system 

Creating an effective EHR or EMR system is more than ticking off features. In this guide, you’ll discover the essential steps to build a system that balances innovation with real-world usability. 

1. Requirement Gathering and Analysis 

Requirement gathering is the foundation of building an effective EHR or EMR system. It starts by identifying the needs and expectations of all stakeholders—clinicians, administrators, IT teams, and patients. A clear product backlog and roadmap help ensure alignment of the system’s objectives and the features that need to be prioritized. 

Essential steps for requirement gathering and analysis: 

• Stakeholder Engagement: The first task is to engage a diverse set of stakeholders to capture a holistic view of the system requirements. Clinicians may prioritize ease of use and patient safety, while administrators focus on workflow efficiency and regulatory compliance. 

Misalignment between stakeholders is common, leading to confusion about system functionality and priorities. Conducting regular workshops and meetings to ensure alignment and resolve any misunderstandings early in the process. 

• Documenting Requirements: Use visual aids like process flowcharts and wireframes to clearly document functional and non-functional requirements (security, scalability, compliance). This ensures everyone involved understands the scope. 

Incomplete or evolving requirements can delay development and introduce scope creep. Iterative prototyping allows stakeholders to see the system in action and refine requirements early. Agile methodologies (like Scrum) can help manage ongoing adjustments efficiently. 

• Regulatory Compliance: Ensure the system is designed with compliance in mind, addressing regulations such as HIPAA and GDPR, including role-based access controls and audit trails. 

Navigating complex healthcare regulations while also meeting the functional needs of the system can be difficult. Collaborate with legal and compliance experts throughout the process to ensure that regulatory requirements are embedded into the design from the start. 

2. Pre-Development Assessment 

The Pre-Development Assessment is a critical phase where you evaluate your current infrastructure and organizational readiness for EHR or EMR system implementation. This involves conducting a thorough analysis of your existing hardware, software, network systems, and technical resources to ensure a smooth transition into a new or upgraded EHR system. 

• Infrastructure Review: A comprehensive evaluation of the current IT setup, including servers, storage systems, and network capacity. You’ll need to determine whether your infrastructure can handle the data-intensive requirements of an EHR system, especially for real-time data processing and storage. 

• Resource Evaluation: Understanding whether your organization has the in-house expertise and resources, such as developers, IT personnel, and project managers, or if you need external assistance. A resource plan should outline human, financial, and technical capacities. 

Considerations for Predevelopment Assessment: 

• Resource Availability: Does your organization have the necessary hardware, software, and personnel? If not, you need to plan for upgrades or external support. This includes considering outsourcing options, especially if your internal teams lack the necessary expertise. 

• Technical Infrastructure: Ensure your infrastructure can support the scalability, data security, and interoperability needs of the EHR system. Assess network bandwidth, data storage capacity, and server performance. 

• Risk Assessment: Identify potential risks, such as outdated hardware, insufficient data security measures, or lack of trained personnel. Understand how these risks could impact the implementation and long-term performance of the EHR system 

Challenges 

• Resource Constraints: Limited access to the necessary IT and human resources can lead to delays. In some cases, healthcare organizations may have older IT systems that are not easily upgraded. 

• Budget Limitations: EHR systems often require significant upfront investments. It’s important to evaluate the costs of upgrading infrastructure, hiring external developers, and ongoing maintenance. 

• Lack of Clear Scope: One of the most common issues is the unclear definition of the project scope, particularly when it comes to complex features like billing integration or interoperability with third-party systems. 

Solutions 

• Resource Planning: Create a detailed plan that allocates human, financial, and technical resources appropriately. Consider leveraging cloud-based infrastructure to reduce initial capital expenditure  

• Budget Management: Secure funding for both the initial development and ongoing support. Creating a cost-benefit analysis and securing stakeholder buy-in early can help alleviate financial constraints. 

• Thorough Risk Assessment: Implement a risk management strategy that identifies, evaluates, and mitigates risks before development begins. This can include contingency planning for resource shortages or unexpected technical challenges ( 

3. Technical Architecture: Choosing the Right Technology Stack 

Selecting the right technology stack is foundational for building a scalable, secure, and efficient EHR system. This involves choosing the programming languages, frameworks, databases, and hosting options that align with the project’s requirements and your organizational infrastructure. 

• Programming Languages and Frameworks: Popular choices for EHR systems include Python, Java, and .NET for back-end development, with JavaScript frameworks (like React or Angular) for the front-end. The choice of language should support scalability, security, and high performance. 

• Databases: The database selection depends on your need for scalability and speed. SQL databases like PostgreSQL and MySQL are often used, but NoSQL options like MongoDB might be preferred for handling large, unstructured data sets common in healthcare systems  

Considerations for Cloud-Based vs. On-Premise Solutions: 

• Cloud-Based Solutions: Cloud infrastructure is increasingly popular for EHR systems because of its scalability, cost-effectiveness, and ability to handle large amounts of data. With a cloud-based system, you can scale up or down based on usage and avoid significant upfront costs associated with on-premise hardware 

• On-Premise Solutions: On-premise systems provide greater control over data security and compliance but come with higher upfront costs and ongoing maintenance needs. This approach may be necessary for organizations with strict regulatory environments or limited internet connectivity  

• Designing the System Architecture: 

Designing a flexible and secure architecture is crucial for ensuring the long-term viability of your EHR system. 

• Modular Architecture: A modular design allows different components (e.g., patient management, billing, and clinical modules) to operate independently but remain connected. This structure makes it easier to update or replace specific modules without disrupting the entire system. 

• Microservices: Microservices architecture allows different services to be developed, deployed, and maintained independently. This makes it easier to scale and update specific components, such as patient portals or telemedicine features, without affecting the rest of the system  

• API Integration: APIs (Application Programming Interfaces) are essential for ensuring seamless communication between your EHR system and other healthcare systems, such as lab information systems, imaging tools, and billing platforms. Adhering to industry standards like FHIR (Fast Healthcare Interoperability Resources) and HL7 ensures that your system can exchange data securely and efficiently. 

Importance of Scalability and Interoperability: 

• Scalability: Your EHR system should be able to handle increasing patient data volumes, user loads, and additional functionalities as your organization grows. Both cloud and microservices architectures are ideal for scalability  

• Interoperability: Modern healthcare requires data sharing across platforms. Designing your system with interoperability in mind—by adhering to standards like HL7 and FHIR—ensures that your EHR can communicate with other healthcare applications, improving care coordination and data accuracy  

4. Data Evaluation 

Data evaluation involves assessing the quality, structure, and sources of existing data before integrating it into the new EHR system. This ensures that the data is suitable for the new environment and meets regulatory standards. 

Considerations for Data Evaluation 

• Data Accuracy and Consistency: Verify that the data is clean, accurate, and consistent across all sources. This involves checking for duplicate records, and incomplete information, and ensuring proper formatting. 

• Compatibility: Ensure that the existing data formats are compatible with the new EHR system, especially when dealing with legacy systems. 

Challenges 

• Data Quality Issues: Inconsistent, incomplete, or incorrect data can lead to errors in patient records. 

• Security Concerns: Ensuring that data migration processes comply with data protection regulations such as HIPAA and GDPR. 

• Interoperability: Ensuring that data can be easily exchanged between different systems using APIs for standardized data formats like ICD or CPT codes. 

Solutions 

• Data Cleaning: Use automated tools to clean and normalize data before migration. Regular audits should also be performed to maintain high data quality. 

• Security Protocols: Implement encryption and access controls to ensure data security during migration. 

• Standardization: Standardize data formats and use industry standards like HL7 and FHIR for seamless integration with external systems. 

5. Existing System Evaluation 

This step involves analyzing current systems and workflows to identify potential integration points, areas for improvement, and gaps in functionality. 

Considerations for Existing Systems Evaluation: Process and Technology Compatibility:  

Ensure that the current workflows and IT systems align with the new EHR’s capabilities. Understand how well legacy systems can integrate or if they need to be replaced. 

Challenges 

• Legacy Systems: Many healthcare providers rely on outdated systems that may not be compatible with new EHR platforms. 

• Resistance to Change: Staff may be resistant to transitioning to new systems, especially if it significantly alters their daily workflows. 

• Complex Workflows: Healthcare processes are often complex, making seamless integration a challenge. 

Solutions 

• System Compatibility Assessment: Conduct a thorough review of existing IT infrastructure to identify potential integration issues. Develop custom connectors or APIs to facilitate compatibility. 

• Change Management: Implement a structured change management plan to ensure a smooth transition. This should include training programs and clear communication with staff about the benefits of the new system. 

• Workflow Analysis: Use process mapping tools to analyze current workflows and identify areas for automation or optimization. 

6. Designing the Solution (UI/UX) 

Designing the user interface (UI) and user experience (UX) focuses on creating an intuitive, accessible, and efficient system that healthcare providers and patients can easily navigate. 

Considerations for Designing the Solution 

• Usability: The system must be easy for clinicians and administrative staff to use, ensuring minimal disruption to workflows. 

• Accessibility: Ensure the system complies with accessibility standards for all users, including those with disabilities. 

• User Engagement: Include features that enhance user engagement, such as customizable dashboards and intuitive navigation. 

Challenges 

• User Adoption: Poorly designed interfaces can lead to low user adoption rates, especially among busy healthcare staff. 

• Accessibility Issues: Not all users have the same needs, so designing an inclusive system that works for everyone can be challenging. 

• Design Consistency: Maintaining consistency across different modules is important to avoid confusion. 

Solutions 

• User-Centric Design: Involve actual users (clinicians, nurses, and administrators) in the design process to ensure the system meets their needs. This may include usability testing and gathering feedback at early design stages.  

• Adherence to Accessibility Standards: Follow WCAG (Web Content Accessibility Guidelines) to ensure the system is accessible to all users. 

• Consistent Design Guidelines: Maintain a consistent visual and interactive design throughout the system to enhance user experience and reduce training time. 

7. Coding and Development 

The coding and development phase involves translating the design and requirements into functional code so that the EHR system is secure and maintains performance standards. 

Considerations for Coding and Development 

• Best Coding Practices: Use industry standards for clean and maintainable code. This includes following object-oriented principles, using proper version control (e.g., Git), and adhering to coding conventions. 

• Security: Implement security measures such as encryption, multi-factor authentication, and regular security audits to protect sensitive patient data. 

Challenges 

• Scope Creep: Unplanned features or changes can extend the development time, increase costs, and introduce bugs. 

• Technical Debt: Poor coding practices or rushed development can lead to technical debt, which makes the system harder to maintain over time. 

• Integration Issues: Complexities arise when trying to integrate the EHR with external systems such as labs, pharmacies, or billing software. 

Solutions 

• Strict Scope Management: Clearly define the scope at the outset and use agile methodologies to prioritize features in sprints. 

• Regular Code Reviews: Implement peer reviews and automated testing tools to identify bugs early. 

• Modular Development: Build the system in independent modules (e.g., patient management, and billing), allowing for easier updates and troubleshooting. 

8. Testing and Validation 

Testing and validation are critical phases where the EHR system is rigorously tested to ensure it functions as expected and meets all specified requirements. 

Considerations for Testing and Validation 

• Functional Testing: Verifies that the EHR features (e.g., appointment scheduling, patient records management) are working as intended. 

• Performance Testing: Assesses the system’s performance under peak load conditions to ensure that it can handle high volumes of users and data. 

• Security Testing: Ensures that the system complies with regulatory requirements and that data remains secure during transmission and storage. 

Challenges  

• Comprehensive Testing: Covering all aspects of the system—functionality, performance, security—can be time-consuming and resource-intensive. 

• Performance Issues: Ensuring the system performs efficiently under high loads, especially in large healthcare organizations. 

• User Acceptance: Engaging end-users (e.g., clinicians, administrators) in testing is vital but can be challenging due to scheduling and workflow disruption.  

Solutions 

• Detailed Test Plan: Develop a thorough plan that outlines all areas for testing (functional, performance, security, and integration testing). 

• Performance Testing: Use load testing tools to simulate real-world usage and stress-test the system under heavy traffic. 

• User Training for Acceptance Testing: Offer comprehensive user training and workshops to familiarize end-users with the system before going live. 

9. Deployment and Integration 

Deployment involves implementing the EHR system in the live environment and ensuring successful integration with other healthcare systems, such as billing platforms, laboratory information systems, and patient portals. 

Considerations for Deployment and Integration 

• Minimal Downtime: Plan deployment during off-peak hours to minimize disruptions in healthcare services. 

• Data Migration: Ensure that data from legacy systems is accurately and securely transferred to the new EHR. 

• Post-Deployment Support: Provide ongoing technical support and user training after the system goes live to address issues promptly. 

Challenges 

• Complex Integration: Integrating the EHR with existing systems and workflows can be challenging, especially when different platforms use various data standards. 

• Data Migration Issues: Ensuring that all historical data is transferred accurately without loss or corruption is a common challenge. 

• System Downtime: Downtime during deployment can impact healthcare operations, potentially causing delays in patient care. 

Solutions 

• Incremental Deployment: Deploy the system in phases to allow time for adjustments and avoid complete system outages. 

• Robust Data Migration Tools: Use specialized migration tools and ensure thorough testing of data integrity before switching to the new system. 

• Strategic Downtime Planning: Schedule system downtime during low-traffic hours, such as weekends or holidays, to minimize the impact on patient care 

10. Training and Education 

Training and education involve providing users—clinicians, administrators, and IT personnel with the knowledge and resources to effectively use the new EHR system. 

Considerations for Training and Education 

• Comprehensive Training Programs: Design training programs that cater to different user roles, including tailored sessions for clinicians, administrators, and support staff. 

• Ongoing Education: Ensure that training is not a one-time event but an ongoing process to accommodate updates, new features, and evolving user needs. 

Challenges 

• User Resistance: Healthcare professionals may resist changes, especially if the system disrupts existing workflows. 

• Training Scale: Scaling training across multiple departments or locations can be challenging, especially in large healthcare networks. 

• Knowledge Retention: Users may struggle to retain information, particularly when the system is complex, or training sessions are not engaging. 

Solutions 

• Early User Engagement: Involve users in the development process through early demos and feedback sessions to ease resistance. 

• Blended Learning: Combine classroom-based, virtual, and hands-on training approaches to ensure effective learning. 

• Continuous Learning: Provide ongoing support through help desks, refresher courses, and interactive guides to ensure long-term knowledge retention. 

11. Documentation and Reporting 

Creating detailed documentation of the EHR system includes system architecture, workflows, user guidelines, and compliance measures. This documentation is crucial for audits, troubleshooting, and ongoing reference. 

Considerations for Documentation and Reporting 

• Thorough Documentation: Ensure all aspects of the EHR system are documented, from technical details to user manuals. 

• Compliance: Detailed documentation of compliance with regulations such as HIPAA, HITECH, and GDPR is essential for audits and legal protection. 

Challenges 

• Regulatory Compliance: Ensuring that the documentation is up to date with regulatory standards can be time-consuming and complex. 

• Data Overload: Managing and documenting large volumes of data, especially in a healthcare environment, can become overwhelming. 

• User-Friendly Interface: Documentation must be easily accessible and understandable by both technical and non-technical users. 

Solutions 

• Involve Compliance Experts: Work closely with compliance officers to ensure that documentation meets all legal and regulatory requirements. 

• Data Management Tools: Utilize tools like Confluence, Jira, or other data management platforms to automate documentation updates and track changes efficiently. 

• User-Centric Design: Ensure the documentation is structured and written in a way that makes it accessible and easy to understand for all users. 

12. Continuous Monitoring and Improvement 

Continuous monitoring ensures the EHR system remains compliant, performs optimally, and evolves with technological advancements. 

Considerations for Monitoring and Improvement 

• Real-Time Monitoring: Implement monitoring tools to track system performance, data flow, and security incidents in real-time. 

• Regular Reviews: Schedule regular system reviews to assess performance, compliance, and user satisfaction. 

Challenges 

• Identifying Improvement Areas: It can be difficult to pinpoint where improvements are needed without proper user feedback and performance metrics. 

• Keeping Up with Technology: Healthcare technology is evolving rapidly, and it can be challenging to keep the system up to date. 

• System Scalability: As the system grows, ensuring scalability without compromising performance can be a challenge. 

Solutions 

• Feedback Mechanisms: Create channels for users to provide feedback on the system, which can inform updates and improvements. 

• Technology Partnerships: Work with technology vendors to ensure the system stays updated with the latest advancements in healthcare IT. 

• Scalable Architecture: Design the system with scalability in mind, using cloud solutions and modular architecture to handle growth without disruption. 

Future Trends in EHR and EMR Development 

The future of EHR and EMR development is shaped by a wave of technological advancements that promise to redefine healthcare delivery. With the integration of artificial intelligence for predictive analytics, the rise of wearable devices offering real-time patient data, and the transformative insights from big data, the potential is limitless. Let’s get a glimpse of what the future holds for EHR and EMR Development. 

AI and Machine Learning Integration 

AI and machine learning are playing a significant role in EHR systems by providing predictive analytics, enhancing diagnostic accuracy, and enabling personalized treatment plans. For example, AI can analyze patient data to predict health risks or automate routine tasks like appointment scheduling. 

Blockchain for Data Security 

Blockchain technology offers a way to securely store and share patient data by creating immutable records. This can significantly enhance data security and interoperability, allowing different healthcare providers to access patient data without compromising security. 

Patient-Centric Models 

The future of EHR systems is shifting toward a more patient-centric model, where patients have greater control over their health data. This includes patient portals, where they can access their medical history, communicate with providers, and actively participate in their care plans. 

How Nalashaa Health Solutions Can Help in your EHR and EMR development Journey? 

The rise of EHR systems marks one of the most transformative developments in healthcare. As organizations look to stay competitive, integrating advanced features like telehealth services, AI-driven analytics, and seamless patient data management is crucial for improving the quality of care. 

The guide above offers a comprehensive overview of what goes into developing an EHR system—from idea validation to deployment. Every stage, from technology selection to ensuring compliance with healthcare regulations, requires careful planning and attention to detail. Given the complexity of this process, partnering with an experienced EHR software vendor can help you navigate the challenges and build a solution that meets the evolving needs of healthcare providers and patients alike. 

At Nalashaa Health Solutions, we bring over 13 years of experience in delivering innovative healthcare solutions, with 400+ successful projects in the healthcare domain. Our team specializes in developing top-tier EHR systems that enhance patient care and streamline workflows for healthcare providers. We integrate cutting-edge technology so that your EHR system is suited best for your operation. 

Get in touch with us today and let’s take your healthcare technology to new heights with a top-tier EHR system that is both efficient and patient-friendly.