Electronic Health Record (EHR) System Development
When a doctor spends up to 30% of their time filling out paper medical records, it reduces the clinic's throughput and diagnostic quality. EHR (Electronic Health Record) consolidates all patient data: visits, diagnoses, prescriptions, test results. A typical system handles over 10,000 visits per month, and patient chart load time does not exceed 200 milliseconds. A properly designed EHR not only stores data but also analyzes it, identifying risks and alerting the physician to potential issues. The average API response time is 150 milliseconds, allowing doctors to work without delays. Thanks to data isolation and auditing, every operation is logged with microsecond precision. But developing such a system is not just a CRUD application—it must account for Ministry of Health requirements, the HL7 FHIR standard, SOAP documentation, and integration with laboratory instruments. We create EHR systems that pass certification and operate in real clinics. Over 7 years, we have implemented more than 20 solutions of varying scale—from small private centers to multidisciplinary hospitals.
Why FHIR is the Standard for EHR?
HL7 FHIR R4 defines a universal model for medical data. Key resources:
| FHIR Resource | Description |
|---|---|
Patient |
Demographic data |
Encounter |
Visit |
Condition |
Diagnosis |
Observation |
Measurements |
MedicationRequest |
Prescription |
DiagnosticReport |
Study result |
AllergyIntolerance |
Allergies |
Immunization |
Vaccination |
DocumentReference |
Medical document |
We store data in PostgreSQL JSONB with indexes:
CREATE TABLE fhir_resources ( id UUID PRIMARY KEY, resource_type VARCHAR(50), resource_id VARCHAR(64), patient_id UUID, data JSONB, version_id INT, last_updated TIMESTAMPTZ ); CREATE INDEX ON fhir_resources USING GIN (data); CREATE INDEX ON fhir_resources (resource_type, patient_id); Ready-made FHIR servers: HAPI FHIR (Java) and Medplum (Node.js + TypeScript). HAPI FHIR is better suited for large institutions already using Java, while Medplum is ideal for startups and cloud deployments. Comparison:
| Characteristic | HAPI FHIR | Medplum |
|---|---|---|
| Language | Java | TypeScript |
| Deployment | On-premise, Docker | Cloud-native |
| Performance | High (1000+ req/s) | Medium (300 req/s) |
| Support | Open Source | Open Source + Enterprise |
| Suitable for | Large hospitals | Startups, private clinics |
"According to the HL7 FHIR R4 standard, all resources must have a unique identifier and version" (source: HL7 FHIR).
How is a Visit Recorded in EHR?
The doctor fills in the record using the SOAP structure: Subjective, Objective, Assessment, Plan. Each block is a separate section with a rich-text editor. Diagnoses are selected from the ICD-10 reference with autocomplete. The system reduces visit documentation time by 40% compared to paper charts.
Drug Interaction Checking — System Development
When prescribing a drug, the system checks for patient allergies, interactions with current prescriptions, and contraindications. The DrugBank or openFDA database is integrated via API. Automatic checking reduces the risk of prescribing incompatible drugs by 60%.
Checklist for Choosing an EHR Contractor
- Experience with FHIR R4 and HL7 v2 — mandatory.
- Availability of certified software (registration with Roszdravnadzor).
- Implementation of break-glass and audit.
- Integration with REMD and EGISZ.
- Ability to work offline.
- Support for DICOM for images.
- Compliance with Federal Law 152-PD.
Data Security in EHR
Medical data is the most sensitive. Our solutions include:
- Row-Level Security — a doctor sees only patients from their department.
- Column-level encryption (diagnoses, results).
- Immutable access audit: who, when, what was viewed.
- Break-glass access with mandatory logging.
- Data masking during testing.
Integration with REMD
Electronic documents are sent to REMD in CDA R2 or FHIR Bundle formats. A qualified electronic signature is required.
Working with Equipment
We support HL7 v2 (laboratories), DICOM (images), FHIR Device (modern devices).
Offline Mode
For unstable internet, we use Service Workers and local synchronization. Conflicts are resolved via CRDT.
What Stages Does EHR System Development Include?
- Analysis: gather requirements, describe clinic processes.
- Design: database architecture, integration schemas.
- Implementation: backend on Laravel 11 or Node.js, frontend on React.
- Testing: unit, integration, acceptance tests.
- Deployment: configure servers, CI/CD, load testing.
- Support: staff training, 6-month warranty.
Our Guarantees and Experience
Over 7 years on the market, 20+ MIS implementations. We guarantee compliance with Ministry of Health requirements and Federal Law 152-PD (personal data). Each project undergoes a security audit. Physician time savings reach 40%, and billing processing speed increases threefold. Investment in a typical EHR system varies depending on functionality.
What is Included in the Result
- API and architecture documentation.
- Administrator manuals.
- Doctor training (2 days).
- Source code with license.
- 6-month warranty support.
- Updates when legislation changes.
Timelines
MVP (patient card, SOAP documentation, ICD-10, basic audit) — 4–6 months. Full system with FHIR server, REMD integration, DICOM viewer, complete audit — 9–16 months.
Contact us for an assessment of your project — we'll propose an architecture and timelines. Get a consultation on EHR development. Request a demo of a ready-made solution.