Choosing the Right Technology Stack for Your Custom EHR

The technological drive is simplifying healthcare for everyone around the world, from allowing patients to access care services easily and without much delay to allow providers to deliver and manage care from a distance.
With Electronic Health Records (EHR) becoming the epicenter of the healthcare landscape it has brought uniformity and streamlined management of patient health information. However, there has been a unique trend that has been observed in healthcare software development lately, and especially with custom EHR development.
As practices have begun to extend their reach and off-the-shelf EHR software unable to meet their evolving needs, requirements and clinical and administrative workflows, there has been a rise in healthcare practices building their own EHR for their practices.
Though the initiative would have been extremely beneficial for the practices, many of their endeavour fails given the lack of technical knowledge and majorly due to choosing the wrong tech stack for their EHR system.
But they are not to be blamed completely. However, the custom EHR with the right tech stack can be revolutionary for your healthcare practice.
On that note, to help you in choosing the right tech stack for your EHR and not be just another number in the failed custom EHR software development list, let this blog be your guide to choosing the right technology stack for custom EHR development.
The Ultimate Guide to Technology Stack for Custom EHR Development
Free eBookFront-End Technologies

First things first, let’s start with how you want your custom EHR software to be seen. Most of the part in this comes under the front-end technology. Below are the user interface frameworks and CSS frameworks that you must know and consider according to your needs for custom EHR development:
User Interface Frameworks
There are basically three user interface technologies that can be used to develop user interface frameworks, namely React, Angular, and Vue.JS. Let’s take a look at them in a short brief below:
1. React: The major benefit of using React lies in its component-based architecture, which promotes reusability and modularity. On top of that, virtual DOM leads to high performance and offers flexibility for both small and large-scale applications. However, it might require more coding even for implementing simple components, and it majorly depends on the specialty of the developer.
2. Angular: Angular on the other hand provides a full suite of tools, which can be used for building complex applications. Its typescript further enhances code reliability and maintenance, and also contains built-in features like routing, dependency injection and form validation. But be careful before going ahead with Angular as the technology can be less flexible and incompatible for smaller applications.
3. Vue.js: Compared to React and Angular, Vue.js is considered by many as a perfect technology developing scaling application. Furthermore, it efficiently updates the UI and balances performance with ease of use. However, Vue.js developers can be hard to find and fewer third-party libraries and tools are available. On top of that it can lead to less maintainable codebases if not used carefully.
CSS Frameworks
While you will be planning the interface development, you will also have to manage their development phases to streamline the development; the CSS framework can be an essential tool, especially for EHRs. Since they provide pre-built CSS components and utility classes, they drastically reduce development time and ensure consistent design across platforms and devices. Here are some CSS frameworks that you can consider:
1. Bootstrap: Using Bootstrap, you can easily create layouts that can adapt to different device screen sizes and offer a wide range of components like buttons, forms, navigation bars, etc. However, it can sometimes be inflexible and require customization.
2. Material-UI: Material-UI on the other hand follows Google’s material design guidelines for a clean and modern look. Furthermore, it offers a wide range of customizable components and can be perfect if you are choosing React as a programming language. However, many users might not recommend this highly customized design.
3. Tailwind CSS: If you’re looking for a low-level utility class for building your custom EHR software interface design, then Tailwind CSS is the perfect framework for you. Moreover, it offers you complete control over the final designs and offers a minimal core library, which makes it performant and lightweight. However, only consider this if you are ready to take a different approach to CSS development and write more code.
While considering both user interface framework and CSS framework, there are two things that you need to consider, performance and scalability in user interface and customization options and responsiveness in CSS frameworks.
Back-End Technologies
Technology is not just what we see on screen. There are a lot of things that run in the background which can determine the performance of your application. Here are some of the things you need to consider while choosing the back-end technologies for your EHR software development.
Programming Languages

Programming languages are basically the languages that computer systems understand. While there are a wide range of programming languages that you can use, here are some of the most commonly used in EHR software development, with their pros and cons:
1. Python: Python as a programming language is very clean making it ideal for quick development. Along with that, with libraries like Django and Flask, it provides robust tools for web development, making it excellent for data analysis and machine learning. However, it can be slower in terms of performance as compared to Java and its global interpreter lock limits its ability to completely utilize multi-core processors.
2. Java: Java on the other hand has a strong system and memory management making it perfect for large-scale applications. Moreover, it is compatible with different operating systems and has a vast ecosystem of libraries and frameworks. However, it can be a complex language unlike Python and needs writing more codes.
3. Node.JS: Node.JS is often used to develop real-time applications and web servers, as it is excellent at handling concurrent requests. However, it is single-threaded in nature and can limit its ability to fully utilize multi-core processors. On top of that, it can lead to complexities if not managed carefully.
Choose the right programming language for EHR and some of the major things to consider in this are performance and scalability consideration. Consult your vendor for custom EHR development before making a final decision.
Frameworks and Libraries

Just like you would plan the back-end development, you will require certain things to boost the speed and other intricacies. Here are some frameworks and libraries that you must consider for building a secure and scalable EHR:
1. Django: Django offers high-level abstractions and its built-in features enables you to develop web applications quickly, while considering the scalability factors. Moreover, it offers protection against common web vulnerabilities such as SQL injection and cross-site scripting, which can be crucial in your custom EHR development. However, it can provide limited flexibility and is less suitable for highly complex systems.
2. Spring Boot: Spring Boost is built on spring framework offering a comprehensive platform making it ideal for building enterprise applications with preferred flexibility and customizations. However, it can be complex and oftentimes require more boilerplate code for basic setup.
3. Express.JS: Express.JS is a minimalist framework that allows for fine-grained control over the application, with high performance and scalability features. Furthermore, it can be used for developing simple API based applications as well as complex web applications. Having said that, it can require more manual configuration and careful attention to security best practices must be adopted during development.
While choosing the framework for back-end you must consider things like security and maintainability as your EHR system will majorly deal with sensitive patient health information
Databases

While you are at it, let’s help you in also choosing the right database for your custom EHR software development.
1. Relational Databases: This type of database organizes data in tables, rows and columns, making it easier to interconnect relationships, data storage, retrieval and manipulation. MySQL and PostgreSQL are some of the popular common relational database management systems you can use upon careful consideration.
2. NoSQL Databases: Also known as Not Only SQL databases, it is a more flexible approach to data storage and retrieval. It is designed to handle large volumes of unstructured data, making it an ideal choice for high scalability, performance, and availability. MongoDB, Cassandra, and Couchbase are some of the systems that you can use.
Cloud Platforms

While choosing the technology stack for custom EHR, you will most likely be comparing different EHR tech stacks. In such cases, you might find some cloud-based EHR software. Club-based platforms are usually more robust in nature and come with their benefits and drawbacks. Here are some things about cloud platforms that you should consider:
1. AWS
Also known as Amazon Web Services, offers a wide range of services to provide maximum flexibility and makes it perfect for custom software development. It supports scalability and has a wide range of pricing models allowing you to optimize cost, while providing robust security features like encryption, access control and compliance certifications like HIPAA, HITRUST and GDPR.
2. Azure
Azure on the other hand integrates perfectly with Microsoft products, which makes it a good choice if you are using Microsoft technologies. Its scalability features focus on autoscaling features, making it perfect for fluctuating loads. It also provides comprehensive security features and just like AWS offers a variety of pricing options.
3. Google Cloud
Google Cloud is known for its innovative services and a strong focus on data analytics and machine learning. This makes it perfect for developing flexible and scalable platforms. Though it offers competitive pricing, its security measures include compliance certification, data encryption, identity and access management, etc.
Serverless Computing
Another trend that is slowly starting to take its place in healthcare software development is serverless computing. It is a cloud computing execution model, which allows you to build and run applications without the need to manage servers. Interesting isn’t it?
Its major benefits come in the form of a FaaS – Function as a Service. Its unique offerings reduce operational overhead as there is no need to manage servers, operating systems, or even infrastructure. Moreover, the scaling functionality is automated with simplified maintenance and updates.
Last but not least, the pay-per-use pricing model makes it a cost-effective venture which allows you to only pay for the resources you have consumed and there is no upfront cost for infrastructure or maintenance.
API Integration

Your EHR software system needs to connect with disparate healthcare software solutions to enable you to offer care faster. And since you will be majorly using your custom EHR software system to deliver care, API integration is a must.
API integration is nothing but a process of connecting two or more software systems using APIs or Application Programming Interfaces to exchange data and services. On that note, here are a few things about API integrations that you must know:
1. RESTful APIs: RESTful API is a type of API that uses Representational State Transfer (REST) architectural style and constraints. It is generally used for communication between the back end and the front end. It allows seamless integration with third-party services, which can be extremely useful for your EHR system to connect with other disparate healthcare systems.
2. API Gateways: While RESTful API acts like the connecting link between the front-end and back-end, an API gateway acts as a point of interaction between your request and takes the request to the receiver server. It simplifies the pathway for your request and takes it directly to the server to fulfill your request. Some of the things to consider in this are security and authentication, along with rate limiting and throttling.
3. API Testing and Documentation: API testing and documentation are two other aspects of API, where one verifies the intended functionality of the API, and the other is the documentation of the activity to explore its full functionality and potential. In this, you need to ensure the APIs developed are reliable and perform as intended.
Security & Compliance
The digital drive of the healthcare industry has kind of made it a goldmine of cyberattackers. Furthermore, since you deal with sensitive data of your patients, compromising your EHR systems security can compromise their fundamental right to privacy as well. That is why you must implement robust security measures and adherence to regulatory compliances to navigate the legal landscape.
To give you an idea about it and make it simple, here are a few security and compliances that you must consider:
1. Data Encryption: These security best practices use encryption to make the data unreadable for others without the key. This helps you protect sensitive patient data from unauthorized access and can be extremely useful in case of a breach. However, if you are implementing data encryption, then encryption algorithms and key management are a few aspects that you must not compromise on.
2. Access Controls: Another best practice in building a secure and scalable EHR is to implement role-based access control along with two-factor authentication. This not only allows only authorized personnel to access the data but also adds another layer of security to protect data from unauthorized access.
3. HIPAA Compliance: HIPAA is a US federal law that sets standards and guidelines to ensure patient data safety, privacy, and ethical use. Failing to adhere to HIPAA regulations can lead to hefty penalties and even loss of reputation. Adhere to the HIPAA regulations and conduct regular security audits and vulnerability assessments to identify gaps in security. It also makes it easier for you to adapt to the evolving nature of healthcare technology as well as the regulatory landscape.
Conclusion
The success or failure of your custom EHR software directly depends on choosing the right technology stack for custom EHR development. That is why it is not only important to choose the right programming language for EHR but also to build a secure and scalable EHR software. And everything that we discussed here directly depends on the technology stack.
Having said that, with the right technology stack it becomes easier for you to achieve interoperability in custom EHR solutions and deliver better care, faster. On that note, let this blog be your guide to choose the right technology stack for your custom EHR development and if you’re still confused where to start, then click here, and let’s get the dice rolling.
If you’re still convinced with EHR development, then click here to read the ultimate EHR software development guide, and know everything you need to know about custom EHR software development in 2025.
Frequently Asked Questions
Consider these factors when selecting a technology stack for your custom EHR:
- Scalability: Can the stack handle future growth and increased user load?
- Security: Does it offer robust security measures to protect sensitive patient data?
- Interoperability: Can it integrate with other healthcare systems and devices?
- Developer Experience: Is the stack developer-friendly for ongoing maintenance and customization?
- Cost: What are the licensing and maintenance costs involved?
- Regulatory Compliance: Does it adhere to relevant healthcare regulations like HIPAA?
Popular technology stacks for custom EHR development include:
- Front-end: React, Angular, Vue.js for building user-friendly interfaces.
- Back-end: Node.js, Python (Django/Flask), Ruby on Rails for robust server-side logic.
- Database: PostgreSQL, MySQL, MongoDB for efficient data storage and retrieval.
- Cloud Platforms: AWS, Azure, Google Cloud Platform for scalable and reliable deployment.
- Additional Tools: GraphQL for API development, Docker for containerization, Kubernetes for orchestration.
To build a secure and scalable EHR platform, consider these key aspects:
- Implement robust access controls and encryption.
- Regularly update software and conduct security audits.
- Adhere to HIPAA and other relevant regulations.
Security:
- Choose a cloud-based architecture for flexibility.
- Design for horizontal scaling to handle increasing data.
- Optimize database performance and consider data sharding.
Scalability:
- Prioritize user experience and interoperability.
- Invest in data analytics and machine learning capabilities.
Additional Considerations:
The cost to develop a custom EHR varies greatly depending on factors like complexity, features, technology stack, and team location. It can range from $50,000 to $500,000 or more.
- Define Your Needs: Clearly outline your specific EHR requirements, including features, integrations, and scalability.
- Research: Look for vendors specializing in healthcare IT and your preferred technology stack. Check their portfolio, client testimonials, and industry experience.
- Request Proposals (RFPs): Send RFPs to shortlisted vendors, detailing your project scope, budget, and timeline.
- Evaluate Proposals: Analyze proposals based on technical expertise, pricing, communication skills, and alignment with your project goals.
- Conduct Interviews: Schedule interviews with top contenders to assess their understanding, problem-solving abilities, and project management approach.
- Check References: Contact previous clients to verify the vendor’s performance, reliability, and adherence to timelines.
- Sign a Comprehensive Contract: Ensure a detailed contract covering project scope, milestones, payment terms, intellectual property rights, and dispute resolution mechanisms.
AI, blockchain, and cloud computing offer significant benefits for custom EHR solutions. AI enables advanced analytics, predictive insights, and automated tasks, improving efficiency and decision-making. Blockchain ensures data security, transparency, and interoperability, while cloud computing provides scalability, accessibility, and cost-effectiveness. Together, these technologies enhance patient care, streamline workflows, and improve overall healthcare outcomes.
To future-proof your custom EHR, consider these key technology choices:
- Cloud-based architecture: Enables scalability, accessibility, and automatic updates.
- Interoperability standards: Ensures seamless data exchange with other systems.
- AI and machine learning: Improves decision-making, automation, and predictive analytics.
- Cybersecurity measures: Protects sensitive patient data with robust security protocols.
- Modular design: Allows for flexibility and easy customization as healthcare needs evolve.
By prioritizing these technologies, you can create a sustainable and adaptable EHR solution.