Healthcare Implementations
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Last updated: July 2026
By: Kevin Yamazaki, Partner and CEO at Sidebench
The honest answer is almost never a binary. You will rarely build everything from scratch, and you will rarely buy one tool that does it all. The right move for most healthcare products is the middle: build custom experiences on top of proven platforms. That approach gets you to value faster while you spend engineering effort on what actually differentiates you.
Healthcare founders and innovation leads ask us this question constantly. Build or buy? Custom or off-the-shelf? The framing itself is the trap. It treats software like a single object you either construct or purchase, when every modern product is really a stack: third-party pieces for problems that are already solved, plus a thin, valuable layer of your own that solves a problem for a new customer or in a new way.
At Sidebench, we’ve done 60+ healthcare implementations over 14 years. The pattern holds almost every time. This article gives you the framework we use with clients so you can make the call with clear eyes.
- Why the real choice is a spectrum, not a switch
- Why you almost never build an EHR from scratch
- The platform layer is bigger than the EHR
- The three real options, compared
- When custom software is worth it
- When custom software is not worth it
- How to build custom experiences on top of platforms
- What a custom build costs and how long it takes
- FAQ
Why the real choice is a spectrum, not a switch
The build-versus-buy question hides a third option that is usually the best one: build custom experiences on top of platforms that already solve the boring parts. Every product you admire runs on third-party payments, identity, messaging, and content, and in healthcare it usually runs on a third-party EHR as well. The value is not in rebuilding those. It’s in how you stitch them together.
Think about what any healthcare product actually contains. Payments are solved. Identity and authentication are solved. So are messaging and notifications, CRM and lifecycle outreach, content management, and commerce. Clinical data storage, scheduling primitives, and billing workflows are solved too, and those carry compliance and interoperability requirements that took vendors years to satisfy. If you rebuild those, you inherit all of that work and none of the head start.
Your “secret sauce” is the experience layer. It’s the workflow a provider follows on a Tuesday morning, the way a patient books and prepares for a visit, the data you surface at the moment a decision gets made. That’s where custom development earns its cost. Everything underneath it should ride on something proven whenever a proven option exists.
We’ll admit the uncomfortable part: this is less satisfying than “build it all, own it all.” Founders like the idea of a pure custom platform. In practice, we’ve watched pure-custom ambitions burn months and budget on problems that an inexpensive off-the-shelf tool had already solved. The discipline is knowing which parts deserve your engineers.
Why you almost never build an EHR from scratch
Building a new EHR from scratch is almost never worth it. The compliance surface, the interoperability standards, and the sheer breadth of clinical workflows represent years of work before you ship anything a patient sees. You can instead build on an existing EHR and create branded, custom experiences that are more useful and more usable than the stock product.
An EHR is not one feature. It’s hundreds of them, plus HIPAA-compliant architecture, plus interoperability with labs, pharmacies, payers, and other systems. When you build on top of an established platform, you inherit that compliance and interoperability posture at the core instead of recreating it, and you still own it in the experience you build above. That frees your team to focus engineering on the differentiated experience, which is the only part your customers actually notice.
The platforms we like to build on are Epic, athenahealth (Athena), Charm, and Healthie. Each gives you a different starting point:
| Platform | Where it fits | What you inherit |
|---|---|---|
| Epic | Health systems and academic medical centers where Epic is already the system of record | The clinical system of record, FHIR APIs, and the institution’s existing interoperability and identity posture |
| athenahealth (Athena) | Larger practices and groups needing broad clinical and billing depth | Established billing workflows, wide interoperability, scale-tested infrastructure |
| Charm | Practices wanting a flexible clinical record with strong customization hooks | A configurable clinical core and integration surface |
| Healthie | Virtual-first and telehealth-forward care models | Scheduling, patient engagement, and telehealth primitives built for modern care |
The point is not which one wins. The point is that any of them gets you to value faster than a from-scratch build, and each carries compliance and interoperability you would otherwise fund yourself. You spend your budget on the layer that makes patients and providers prefer your product. One caveat on Epic in particular: that work moves at the pace of the customer’s security review and change-control queue rather than your engineering, which is the most common timeline surprise in this category.
The platform layer is bigger than the EHR
The EHR is the loudest platform decision in healthcare and it is rarely the only one. A real product also runs on payments, messaging and notifications, identity, CRM, content, and often commerce. Each of those is a solved problem with a mature vendor behind it, and each one you rebuild is budget you did not spend on the thing that differentiates you.
| Layer | What the platform carries | What stays yours |
|---|---|---|
| Payments and billing | Card capture, subscriptions, PCI scope, payouts | How price, coverage, and financial responsibility get explained to a patient before they commit |
| Messaging and notifications | Delivery, retries, opt-in and opt-out plumbing, deliverability | What a message may contain when the recipient is a patient, and the consent record behind it |
| Identity and access | SSO, MFA, session and token handling | Who may see which record, and how that maps to a clinical role |
| CRM and lifecycle outreach | Pipeline, segmentation, campaign tooling | Which fields may hold PHI and which may not, and where that boundary is enforced |
| Content management | Authoring, versioning, localization, delivery | Reading level, clinical accuracy, and who signs off before a patient sees it |
| Commerce | Catalog, cart, tax, fulfillment | What is being sold, and whether selling it creates a clinical or regulatory obligation |
The healthcare twist is that none of these arrive HIPAA-ready out of the box. A payment processor is not a BAA. A messaging platform will cheerfully deliver a text that should never have carried a diagnosis. The platform gives you the mechanism, and you still own the rules about what flows through it, which records it may touch, and what gets written to a log. Evaluating one of these vendors means reading the BAA and the configuration options, not the feature list.
Hoag Compass is the shape of this in practice. The subscription preventive-medicine experience runs on an Epic FHIR integration for the clinical record, Okta for identity, and Stripe for payments. Three platforms carrying three solved problems, and one custom experience layer that is the reason the product is worth using.
The sorting question is identical at every layer. Is this already solved, is it the reason a customer chooses us, and can a proven platform carry the underneath while we build the part that is ours?
The three real options, compared
There are three honest paths: buy off-the-shelf, build fully custom, or build custom experiences on top of proven platforms. The third path is the usual best answer for healthcare products because it combines speed to value with control over the experience that differentiates you.
Here’s how the three compare across the factors that actually drive the decision.
| Factor | Buy off-the-shelf | Build fully custom | Build on proven platforms |
|---|---|---|---|
| Time to value | Fastest | Slowest | Fast |
| Upfront cost | Lowest | Highest ($200K+ for a real build) | Moderate |
| Control over UX | Low | Full | High |
| IP ownership | None | Full | Partial: you own the experience layer |
| Compliance and interoperability | Inherited from vendor | You build and maintain it | Inherited at the core, maintained at the experience layer |
| Best when | The problem is already well solved | Existing platforms genuinely can’t meet your needs | You need a differentiated experience without rebuilding the core |
Read that middle column carefully. Full custom is the right call in specific cases, and we’ll get to them. But the default assumption that “serious companies build everything” is how good budgets die. The default should be the third column, and you should only move off it when you can name a concrete reason.
When custom software is worth it
Custom healthcare software development is worth it in three situations: you need a high level of control over the user experience, it opens a new revenue line where you need full IP ownership, or existing platforms genuinely don’t meet your needs. If none of these is true, custom is probably the expensive answer to a solved problem.
Let’s take each one.
You need a high level of control over the user experience. Some care models live or die on how a workflow feels. If your differentiation is a provider experience or a patient journey that no configurable tool can express, you have a real case for custom. The test is honest: can an existing platform be configured to get you 80% of the way? If yes, build the last 20% on top of it. If the experience you need is fundamentally different from what any platform can express, custom starts to make sense.
It opens a new revenue line and you need full IP ownership. This is the strongest case. When the software itself is the product you sell, and when owning the IP is part of the business model or the fundraising story, custom is not a cost center. It’s the asset. Here the $200K+ investment reads differently because it builds something you own outright.
Existing platforms genuinely do not meet your needs. Sometimes the market really does have a gap. You’ve evaluated the options, run the configuration tests, and found that no platform covers the clinical or operational reality you’re facing. That’s a legitimate custom trigger. Our one caution: this reason gets claimed far more often than it’s true. Do the evaluation before you conclude it.
A quick admission from our side: we’ve occasionally started an engagement assuming a platform would cover a client’s need, then discovered mid-discovery that it wouldn’t. That’s why we run discovery before we commit to an architecture. The framework is a starting point, not a substitute for looking closely at your specific problem.
When custom software is not worth it
Custom software is not worth it when your problem is already well solved by existing solutions, or when you’re not willing to invest $200K+ and wait 4 to 6 months to get it built. Both are disqualifiers on their own. If either is true, buy or build on a platform instead.
The first case is the common one. Basic scheduling, intake forms, e-prescribing, basic telehealth: these are solved. If your need maps cleanly onto something you can buy, buying is not a compromise. It’s the smart use of capital. Building a worse version of a mature tool to feel more in control is a mistake we see repeatedly.
The second case is about honesty with yourself. A real custom healthcare build starts around $200K+ and takes 4 to 6 months to reach something usable. If that budget or that timeline doesn’t fit your reality right now, custom is off the table regardless of how much you’d like it. That’s not a judgment. It’s arithmetic. Plenty of strong companies start on off-the-shelf tools and move to custom experiences later, once the revenue and the roadmap justify it.
How to build custom experiences on top of platforms
Building on a proven platform means the platform handles the core, its own compliance posture, and the interoperability underneath, while your team builds the branded experience that patients and providers actually touch. In healthcare that core is usually an EHR, and it is also payments, messaging, identity, and content. You get to value quickly, you inherit the hard-won foundation, and you spend engineering on differentiation instead of plumbing.
This is the model behind most of our healthcare work. A few examples of engagements where we built custom experiences on top of platforms: SimonMed Longevity, Cortica, and Brilliskin. Each needed an experience layer that the stock product couldn’t deliver on its own, built over a foundation that handled the parts already solved.
The clearest illustration is Cortica, which delivers behavioral health and autism care. We built AXON, their scheduling platform, and since then Cortica has scaled from 1 to 24 clinics across 8 states. (Disclosure: Sidebench is also an investor in Cortica.) The scheduling experience for a multidisciplinary autism care model is not something you buy off a shelf. It’s a differentiated workflow. Building it as a custom experience, rather than rebuilding an entire clinical system, is what let the team focus on the part that mattered.
The engineering discipline here is integration depth. Building on Epic, athenahealth, Charm, or Healthie means your custom layer has to talk cleanly to the clinical platform underneath, and the same applies to every other platform in the stack: rate limits, retries, idempotency, webhook ordering, and a clear boundary for where PHI is allowed to travel. All of it has to hold inside HIPAA-compliant architecture. That integration work is where a lot of custom-experience projects succeed or stall. It’s also where the real cost sits, which is why it pays to scope EHR integration costs honestly up front. Our 60+ healthcare implementations over 14 years show up right here: we’ve done this integration work enough times to know where it gets hard.
What you inherit stops at the platform boundary, and that is the part teams get wrong. A vendor’s certifications and BAA cover the vendor. Your experience layer still owns authentication and session handling, role and record-level access, what PHI your screens display and your logs retain, the audit trail for actions your product takes, and a signed BAA with every vendor that touches patient data. Compliance is inherited at the core and maintained at the experience level. Budget for the second half.
Here’s a simple sequence we use to sort a feature into buy, build custom, or build on a platform:
- Is this problem already well solved by an existing tool? If yes, buy it.
- If not, is it your differentiator, the reason a customer chooses you? If yes, it’s a candidate for custom.
- Can a proven platform handle the underlying core while you build the differentiated experience on top? If yes, do that. This is the usual answer.
- Only if no platform can carry the core, and the experience is truly novel, and you can commit $200K+ over 4 to 6 months, do you build fully custom.
Run every major feature through those four steps. Most of them will land on step 3.
What a custom build costs and how long it takes
A real custom healthcare build starts around $200K+ and takes 4 to 6 months to reach a usable product. Treat that as a floor, not a quote. The number moves with integration complexity, compliance scope, and how much of the experience is genuinely new. If those figures don’t fit your plan, choose off-the-shelf or a platform build.
We share that anchor because founders deserve a real number before they fall in love with a custom vision. The cost is not only money. It’s the 4 to 6 months your team spends before the first version ships, months during which a bought tool would already be running.
That said, when custom is the right call, the return is ownership and differentiation you can’t get any other way. The framework isn’t anti-custom. It’s anti-custom-by-default. Build custom when you can name why. Buy or build on a platform when you can’t.
Frequently Asked Questions
Should healthcare startups build custom software or buy off-the-shelf?
Most should do neither in the pure sense. The usual best answer is to build custom experiences on top of a proven platform. Buy off-the-shelf when the problem is already solved. Build fully custom only when the experience is truly novel and you own the IP.
Is it ever worth building an EHR from scratch?
Almost never. An EHR carries years of compliance and interoperability work. You can build branded, custom experiences on top of an existing EHR that are more useful than the stock product, without recreating the clinical core.
What platforms does Sidebench build on?
On the clinical side, Epic, athenahealth (Athena), Charm, and Healthie. Each gives you a different starting point, from health-system scale to telehealth-forward primitives, and each carries interoperability and a compliance posture you would otherwise fund yourself. Most builds also sit on platforms outside the EHR: payments, messaging and notifications, identity, CRM, content management, and commerce.
How much does custom healthcare software cost?
A real custom build starts around $200K+. Treat that as a floor. The figure moves with integration complexity, compliance scope, and how much of the experience is genuinely new.
How long does a custom healthcare build take?
Plan for 4 to 6 months to reach a usable product. If that timeline doesn’t fit your plan, an off-the-shelf tool or a platform build will get you running faster.
When is custom software the right choice?
In three cases: you need a high level of control over the user experience, the software opens a new revenue line where you need full IP ownership, or existing platforms genuinely can’t meet your needs. If none applies, custom is likely the wrong call.
When should I avoid building custom?
Avoid it when your problem is already well solved by existing solutions, or when you can’t commit $200K+ and 4 to 6 months. Either one is a disqualifier on its own.
What does “building on top of a platform” actually mean?
The platform handles the core, its own compliance posture, and the interoperability. In healthcare that core is usually an EHR, and it is also payments, messaging, identity, and content. Your team builds the branded experience that patients and providers touch, and you still own compliance in that layer.
Does building on a platform make us HIPAA compliant?
No. You inherit the platform’s compliance posture at the core, and you still own compliance in the experience layer you build on top: authentication, role and record-level access, what PHI your screens show and your logs keep, your own audit trail, and a signed BAA with every vendor that touches patient data. Compliance is inherited at the core and maintained above it.
Can I start off-the-shelf and move to custom later?
Yes, and many strong companies do. Start on a bought tool, prove the model, then build custom experiences once the revenue and roadmap justify the investment.
What has Sidebench built this way?
Examples include SimonMed Longevity, Cortica, and Brilliskin. For Cortica, which delivers behavioral health and autism care, we built the AXON scheduling platform, and since then Cortica has scaled from 1 to 24 clinics across 8 states. Sidebench is also an investor in Cortica.
Where this leaves you
The decision is rarely custom versus off-the-shelf. It’s knowing which parts of your product ride on proven foundations, from the EHR down to payments and messaging, and which parts deserve your own engineers. Get that split right and you ship faster, spend smarter, and own the layer that actually differentiates you.
Weighing build, buy, or build-on-platform?
We can help you run the evaluation before you commit to an architecture. See how Sidebench approaches product strategy and discovery, or start a conversation about your build.
About the author
Kevin Yamazaki is the CEO and founder of Sidebench, a Los Angeles digital transformation consultancy and product studio with more than 60 healthcare implementations over 14 years, millions of patient appointments served annually, and 14 health tech investments at Seed, A, B, and C stages. Sidebench has shipped HIPAA-compliant platforms for clients including Cortica, NOCD, IEHP, CHLA, AppliedVR, and Hoag, alongside design and product work for Sony, Microsoft, HP, Oakley, Meta, a16z, Red Bull, NBC Universal, Lightspeed, Cedars-Sinai, and the American Heart Association.
Cited sources
- Sidebench engagement record: Cortica (AXON scheduling platform; scaled 1 to 24 clinics across 8 states). Sidebench is an investor in Cortica.
- Sidebench example engagements building custom experiences on platforms: SimonMed Longevity, Brilliskin.
- Sidebench engagement record: Hoag Compass (Epic FHIR integration, Okta SSO, Stripe payments; Compass 3.0 shipped July 2025). Named with permission.
- Sidebench firm record: 60+ healthcare implementations over 14 years; HIPAA-compliant architecture; EHR integration depth.
- Clinical platforms referenced: Epic, athenahealth (Athena), Charm, Healthie. Non-clinical platform categories referenced: payments, messaging and notifications, identity and access, CRM, content management, commerce.
- Cost and timeline anchor for a real custom healthcare build: $200K+ and 4 to 6 months.
