Alex Evans

ADE
☰

Building an EHR

January 21, 2026

Why

An EHR. I know it's a stupid thing to build that has no real hope of being used in a Health System. The amount of time and money that is needed to roll out an EHR at a Health System puts this in the category of asking a big time tech company to use your new Operating System because Windows is old.

Still, I want to build one.

The reason? I have 3:

  1. I have a belief that Health Systems are relying too heavily on their EHR Vendors for technical vision. I want to prove that with effort an EHR can be built that is transparent and easily adaptable to the specific Health System's needs. NOTE: I highly appreciate the amount of work the EHR Vendors put into their products and I worked for one for 10 years and know how much people bleed over every detail in those products. This is not in any way an attack on them, I just want to see if an EHR can be built and how much of an effort it would be these days.

  2. I wanted to spend time building something big with an AI side kick. This is an opportunity for me to try out Claude Code as my Robin and see if we can produce something that would actually be usable.

  3. A former coworker of mine got sick of me talking about EHRs to a point where he said 'Just go build one' and so this is my attempt at following that good advice.

Still... No one will use this

I'm aware

The Code

It can be found on GitHub here. Feel free to take a look and contribute.

What makes this different from the others out there?

My main hope is building in the ease of use while still having it be a fully fleshed out EHR with all the necessary capabilities. I also want to be able to build in the workflows that allow a Health System to easily introduce a Model or try out a workflow that they need. That being said I can't stand software that isn't opinionated with the default settings (I call this the Which Wich sandwich shop problem), where you give a user the blank product and state 'you get to build it how you want!', this ultimately sets the user into motion to search what people tend to do by default and go with that. This is Atlassian products and although I applaud their ability to capture such a huge portion of the market out there I am baffled at the amount of features that must go unused for 80% of the users. My brain also melts down whenever a new field is just added to a workflow in case it might be needed in the future. Stand for something with your products.

What's the dev cycle?

About a year ago I created user persona's around EHR users. I then built presentations to show the needs of that user. I took the first one off the list and built an Epic (I know, that’s a dangerous word but I mean in the sense of what the Agile world would consider an Epic). From there I built out a list of stories to fulfill these needs. I then can take those stories and work with Claude Code individually on them to get the product updated with those features. I heavily emphasize unit tests to Claude on the backend and that I want business logic at the Services layer.

Presentations? Epics? Stories? This is a side project run by a PM nerd!

I needed to get things compartmentized so I could focus on just building a small piece of it. This was huge when working with Claude Code because I could then feed the smaller stories to it as I worked with it to build out the functionality I needed. I assure you I am a Software Engineer at heart, and trying to pay for my old Agile preachings of my past life.

The Process At the Start

Initially after I had an Epic and stories to do for it, I spent a few nights just working on the high level architecture. I used Claude to frame up the different guidelines / .claude files I wanted built so that the product was maintainable. I had fears that the product would become a huge mess that would be not understandable by mere mortals. These dot files (so far) appear to have helped keep the product understandable. I also mainly spent time early on refactoring the code base after a story was done.

Can you show those presentations?

Yup here they are that I'm using.

You wrote this dumb

Yeah I know it's annoying having a blog post being written with the author asking themselves questions. It's a bit of a rambling mess but I wanted to get it out.