Building an EHR is one of the most costly and disruptive decisions that a clinic can make. With development costs, workflow disruption, productivity dips, and compliance requirements, the stakes are high from day one.

That’s why you need to understand the requirements for building an EHR system before any development starts.

Yet, a recent report by KLAS found that only 38% of providers say their EHR implementation is a success. That means nearly two-thirds of providers walk away dissatisfied or looking for a replacement.

However, what’s even more surprising is that the reasons for failure are not just technology or bad vendor choice. They happen because of the gaps in planning an EHR system before starting the EHR development.

So, if you rush to build EHR software without clearly defining development scope, workflow gaps, or achievable goals, the result is a system that looks good on paper but doesn’t work in real clinical settings. When you miss core EHR system requirements early, no amount of customization can completely fix it later.

That’s why, to help you plan properly, this guide walks you through the prerequisites for EHR system development from governance to data readiness and compliance planning.

Let’s dive into your EHR development readiness checklist, designed to help you prepare properly before you start building your EHR system.

Define the Purpose & Scope of the EHR System

If you ask me, what do you need before building an EHR system? Then my answer will be clarification. Without a clear understanding of why you need to build an EHR leads to a system that can’t solve your real issues.

So, the first thing you need to do is list down your reasons, whether it is to share data in real time or complete documentation quickly. After defining why you are building the EHR, you need to identify the operational, financial, and organizational goals.

If you want to reduce clinician burnout, enable multi-location growth, or integrate remote patient monitoring, the requirements for building an EHR system change with each goal. Most importantly, aligning each goal correctly is necessary as misaligned goals impact the final outcome, leading to missed EHR system requirements.

In short, planning an EHR system must include a clear scope, proper alignment, and defined goals. That’s why, before starting development, decide what an EHR will do and what it won’t do to ensure you build custom EHR software that solves your problems, not creates new ones.

Document Clinical & Operational Workflows

Once you define the scope and goals clearly, the next step is to document how everything will work. This is the step that gives you an actual framework to build a custom EHR that works for you. First things first, map your clinical and operational workflows end-to-end.

This includes patient intake, documentation, orders, referral, billing, follow-ups, and care coordination. After mapping out your workflows, talk with your clinicians and billing team to identify where the real inefficiencies and bottlenecks are.

By doing this, it becomes easier to solve real problems the providers are facing and not just assumptions. Moreover, their issues reveal the true requirements to build EHR software that supports seamless care delivery rather than slowing it down.

For instance, if clinicians have to repeatedly enter data in each new system manually, the requirement is interoperability and real-time data synchronization. Having insights like this becomes crucial when planning an EHR system, as they define what needs to be changed.

Finally, if you are a specialty clinic, then specialty-specific needs add another layer of complexity. Primary care, urgent care, and behavioral health operate differently. That’s why the needs also change— understanding this early helps you build custom EHR solutions that align with real clinical workflows, avoiding costly rework.

Identify Stakeholders & Decision Ownership

Before beginning the development of your EHR, one crucial thing that needs to be decided is ownership. Because when too many stakeholders state their opinions without a final authority, decisions stall, and the timeline is never maintained.

So, before proceeding to build EHR software, identifying stakeholders and defining who owns what is essential. When it comes to identifying stakeholders, it typically includes clinicians, nursing staff, front-desk teams, billing teams, IT, and compliance leadership.

Each group interacts with the system differently, changing the requirements for building an EHR system for each team. If you miss even one requirement, then it creates gaps that impact the management later.

Similarly, establishing accountability and decision ownership early makes approving each change easier. If you have a person who approves workflow changes, feature priority, and resolves conflicts, it prevents debates and keeps development seamless.

In short, having clear ownership and stakeholders makes development much easier and faster. Without aligning this, even well-defined EHR system requirements can fail.

Define High-Level EHR System Requirements

One more thing that is a must before starting the development is defining what the EHR is expected to do at a high level. These are the foundation EHR system requirements that guide the development, not just technical specifications.

And if you rush this step to build EHR software quickly, the development becomes reactive rather than intentional. So, defining expectations early creates shared clarity and ensures that development efforts stay aligned with real organizational goals. This step is a core part of planning an EHR system effectively.

Here are some of the crucial high-level requirements to define before development:

Defining these requirements for building an EHR system up front creates a stable foundation for development. It ensures teams build custom EHR solutions that scale with growth instead of becoming stagnant.

Prepare for Compliance, Security, & Integration Readiness

After the high-level requirements are defined, the next crucial step is ensuring that your organization is ready to support them safely and compliantly. You need to embed compliance, security, and integration from the start because they shape how an EHR must be designed from the ground up.

Start with regulatory awareness. First, clearly understand their HIPAA obligations, data retention policies, audit requirements, and reporting responsibilities before development begins. These considerations directly influence system architecture, access controls, and data workflows. Without this clarity, even a well-designed system can fail compliance reviews.

Then comes the Security readiness. You need to define expectations around role-based access, authentication, audit trails, and incident response early. Knowing who can access what—and under which circumstances—helps avoid over-permissioned systems that increase risk and undermine trust.

Finally, consider integration readiness at a conceptual level. Identify which systems the EHR must connect with, such as labs, billing platforms, pharmacies, or remote patient monitoring tools. You don’t need technical details yet, but understanding data exchange needs early prevents siloed designs. Preparing for interoperability now ensures your EHR can scale and adapt without friction later.

Frequently Asked Questions