Developer-Friendly EHR Systems to Watch in 2025It’s time to move away from siloed EHR platforms and consider modular, API-native alternatives.

A lot of people complain about long-established electronic health record (EHR) systems not hitting the mark in the modern, Agile, interoperable world. Many EHR software companies that are still market leaders today were founded decades ago. For example, Epic Systems and Cerner Corporation have existed since 1979, while Medical Information Technology, Inc.—the entity behind Meditech EHR—was established even earlier, in 1969.

Top 3 EHR Systems by Market Share

First, let us look at the world’s top EHR systems that are still widely used in the healthcare industry despite them having limitations due to their long tenure and compounded complexity.

Here are the top 3 players by market share according to EHR in Practice:

1. Epic

Epic EHR needs no introduction. Still the most widely-used electronic health records system in the world, it leads the industry by a big margin.

• 43.92% of the ambulatory EHR market
• 37.7% of the acute care market (hospitals)

2. Oracle Health (Cerner)

Cerner is another long-time EHR player that was acquired by Oracle in June of 2022 for $28.3 billion.

• 25.06% of the ambulatory EHR market
• 21.7% of the acute care market (hospitals)

3. Meditech

Founded in 1969, Meditech is a long-serving EHR platform that offers a unified patient record across inpatient, outpatient, and specialty care.

• 12.95% of the ambulatory EHR market
• 13.2% of the acute care market (hospitals)

These longtime EHR players do try to keep up with the times and reinvent their products the best they can. Unfortunately, their modernization efforts often run into architectural and technical debt limitations.

Eric Snyder, Executive Director for Technology and Innovation at University of Rochester Medical Center says (emphasis added):

Epic, while certainly valuable for different purposes, has become a sprawling, patched-together system: like an old building expanded so many times it’s now an unwieldy maze. Its complexity hampers efficiency, adaptability and true interoperability. Instead of continuous retrofitting, it may be time to rethink and begin the monumental task of rebuilding EMRs from the ground up for modern, streamlined and multi-functional healthcare solutions.

Issues with Legacy EHR Software

1. Limited Interoperability Due to Data Silos

Recent data shows that only 70% of acute care hospitals engage in all four interoperability domains, that is, finding, sending, receiving, and integrating data. Smooth data exchange can be blocked by existing data silos, often because of the limitations imposed by outdated on-premises systems.

If I had to eliminate one legacy system today, it would be the archaic RCM (revenue cycle management – note by editor) platform that still relies on on‐premise, siloed processes. These systems not only drain resources and increase administrative errors but also block the seamless data flows we need for advanced analytics and patient‐cantered care. Replacing these outdated systems with modern, cloud‐based, API‐driven solutions isn’t just an upgrade – it’s a critical step toward unlocking operational efficiencies, reducing clinician burnout, and ultimately delivering safer, smarter patient care.

For example, older versions of Meditech Magic and other early Meditech systems rely on proprietary database structures, making data extraction difficult. At the same time, Meditech Expanse, a newer version of the famed platform, supports modern APIs and cloud-based integrations.

2. Limited EHR Customization Options

Monolithic EHR systems are all-in-one solutions that bundle numerous capabilities (clinical, billing, scheduling, analytics, etc.) into a single, tightly integrated system. When you try to customize them to your needs, it may be tricky and/or require a lot of work.

3. Third-Party Integration Challenges

Many hospital-built or in-house-built EHRs from the 1990s and early 2000s still lack modern API support. These systems often use CSV, fixed-width files, or proprietary databases instead of FHIR or RESTful APIs, which makes them difficult to integrate with modern telehealth or analytics platforms.

For example, older versions of eClinicalWorks had tightly coupled architecture, which made third-party integrations challenging.

Alternatives to Monolithic EHR Platforms

Modern-day modular EHRs allow you to assemble a custom EHR solution by picking just the components you need and smoothly integrating them in a unified system. This approach is contrasted by a situation where developers have to deal with an inflexible monolithic platform.

• Headless EHRs

Pretty much like headless CMSes, headless EHRs are frontend-agnostic, API-driven systems that provide access to data without a pre-existing user interface.

1. Oystehr

Oystehr is a headless EHR platform that allows companies to create custom software specifically fitted to their workflows at a fraction of the cost. Oystehr was founded by people deeply involved in HealthTech, with a mission to’“reduce the time and cost to deploy best-of-breed healthcare software, including full scope EHRs by 95%.’

Oystehr offers transparent usage-based pricing with no minimum payments and a free tier. In addition, the platform brings to the table FHIR-based API, ONC certification and HIPAA compliance. It also comes with an open-source frontend option: developers can use Ottehr, an open-source front-end EHR that can be customized to fit specific organizational needs.

Note: ObjectStyle is an official implementation partner of Oystehr. If you are looking to build a custom-tailored EHR that fits your clinical workflows like a glove, discover your options.

2. Medplum

Medplum is an open-source healthcare developer platform. It’s FHIR-native, designed for software engineers, and has a modular and extensible architecture. It offers HIPAA and SOC2 compliance out of the box. Medplum creators also make available Medplum EHR that supports core workflows like notes, charting, and scheduling.

Medical organizations can use the self-hosted community version or the limited-functionality cloud version for free, while paid plans start from $2000 per month.

3. Canvas Medical

Canvas Medical is another modern EHR platform that focuses on workflow automation, clinical decision support, and data-driven insights to help healthcare providers improve efficiency and patient outcomes. It comes with the Narrative Charting™ clinical documentation system that allows providers to document patient encounters in a natural, free-text format. This helps reduce administrative burden by automatically filling in relevant data fields and triggering orders.

As for pricing plans, Canvas Medical offers a variety of specialty EMRs with different payment models and the Builder plan for healthcare startups that costs $3950 per month.

4. Aidbox by Health Samurai

Health Samurai is a HealthTech company that has been developing custom solutions for clients in the healthcare industry since 2004. It is also the company behind Aidbox, the first commercial FHIR backend-as-a-service to hit the US market. To help developers out, Health Samurai offers Aidbox EHR Toolkit, which allows one to augment existing EHRs with pluggable and configurable modules like Form Builder, MPI, and Aidbox Analytics.

Aidbox offers two types of licenses: Development and Production. The first one is available for free, and the second comes with a 14-day trial. Besides, you can get production-ready Aidbox as a SaaS.

• Cloud-Based and Modular EHRs

Another group of modern electronic health record systems includes solutions ensuring streamlined integration due to their modular structure.

1. athenahealth

Athenahealth offers athenaOne, a package of solutions, including an EHR, a bunch of RCM (revenue cycle management) services, and patient management tools. Unlike many of its competitors, athenahealth operates on a fully cloud-based network that updates automatically. This ensures providers always have access to the latest features, regulatory updates, and security patches without manual upgrades.

By using available tools and resources, developers can extend the platform’s functionality with differentiated apps and integrate them into provider, patient, or biller workflows. Athenahealth pricing depends on variables like practice size, specialty, and the services selected. The provider reportedly often uses a percentage-based pricing model, with RCM service users paying 7% to 10% of their monthly collections.

2. NextGen

NextGen is a high-tech, innovative EHR that boasts a number of original features. NextGen’s Ambient Assist listens on doctor-patient conversations and automatically creates structured SOAP notes, including AI suggestions for ICD10 coding, medications, lab orders, and configurable charge capture workflow. (With many healthcare orgs reportedly struggling with charge capture and coding systems, this is a useful feature.) It also has specialty-focused EHR templates that cover 25 medical niches, including rare ones like behavioral health.

Moreover, NextGen owns Mirth Connect, a powerful HIE (health information exchange) and integration engine. The company does not publicly disclose any fixed prices. Reportedly, it uses a subscription-based model for smaller practices, charges and percentage of monthly collections for RCM users, and provides custom quotes to enterprise users.

3. Elation Health

Elation Health is a modular EHR solution for small to mid-sized clinics “built for primary care”. The platform includes an EHR, Elation Billing and a practice management system. The company offers Note Scribe, an AI-powered “scribe” that captures clinical conversations in real-time. It also has Developer Sandbox, which lets developers try Elation Health’s RESTful API, SDKs and other tools in a fully simulated EHR environment. Elation Health supports FHIR-based APIs and integrates eRx with EPCS (Electronic Prescriptions for Controlled Substances).

The EHR vendor does not disclose fixed pricing on their website. Instead, they offer personalized quotes based on practice size and specific needs, with some people on the Internet placing Elation Health pricing in the ballpark of $400 to $500 per primary care provider per month.

Strategies for Moving Away from Monolithic EHR Systems

If you’re dealing with a monolithic EHR and want more flexibility, cloud-friendliness, and interoperability, you have the following options.

1. Transition to Modular, API-First EHR Solutions

If a dated EHR system is keeping you hostage and stalls innovation, consider migrating to a modern, sleek alternative. The HealthTech platforms we analyzed above can be used as potential solutions—just pick one that best suits your specific requirements.

Why Choose Modular EHRs?

✅ Customizable workflows. The EHR solution’s modular structure allows you to mix and match components.
✅ Interoperability. Modern APIs and protocols facilitate data sharing across silos and data sources.
✅ Lower vendor lock-in. More freedom to get the best out of each solution.

2. Adopt an Interoperability Layer Instead of Full Migration

If you’re stuck with a monolithic system but can’t migrate fully, you can add an interoperability middleware to extend its capabilities.

FHIR Servers & Middleware:

• Google Cloud Healthcare API: provides FHIR, HL7v2, and DICOM storage.
• Microsoft Azure FHIR: cloud-based FHIR server for interoperability.
• AWS HealthLake: fully managed FHIR-compatible data store.
• Redox: API-driven middleware that connects legacy EHRs with modern applications.

Why Use an Interoperability Layer?

✅ Extend the life of your existing EHR while modernizing integrations.
✅ Gradual transition instead of a full rip-and-replace migration.
✅ Connect with AI, analytics, and mobile applications without changing your core system.

3. Migrate in Phases Instead of a Single-Step Replacement

Many healthcare organizations phase out their monolithic EHRs gradually by replacing key components first, such as:

• Patient portals > Swap with a modern UI/UX solution
• Billing & revenue cycle > Move to a cloud-based system
• Clinical documentation > Transition to an API-driven solution

This reduces risk and costs while ensuring a smooth transition.

Choosing an EHR Vendor That Is Right for You

It is nearly impossible to know which EHR system suits your needs without going through a thorough vendor discovery and evaluation process. Feel free to use ObjectStyle’s trusted vendor selection process.

🔲 Step 1. Make a shortlist of potential EHR vendors.

🔲 Step 2. Prepare your RFP (request for proposal) document:

• Describe your practice
• Provide the reason for seeking a new EHR
• Describe any existing EHR solutions you have (what they are and what purposes they serve)
• List the capabilities the new EHR system should have
• List any third-party integrations you will need
• Ask the vendor about their implementation process
• Ask the vendor for references from similar healthcare orgs
• Provide a deadline to proposal submissions

🔲 Step 3. Send the RFPs to shortlisted vendors.

🔲 Step 4. Hold final interviews and pick your EHR provider.

ObjectStyle’s Custom EHR Development Services

As an official implementation partner of Oystehr, we can use this platform’s powerful tools to create a modern, interoperable EHR for your organization in months (even weeks!), instead of years.

Our comprehensive Oystehr implementation includes:

• End-to-end implementation planning
• Crafting a custom-tailored EHR solution
• Providing training and support

Get the EHR system your organization deserves.Let ObjectStyle be your EHR implementation partner!Discover More