What Makes Healthcare Different
If you're coming from fintech, e-commerce, or enterprise SaaS, healthcare software will surprise you. The technical challenges are real, the regulatory burden is significant, and the sales cycles are long.HIPAA isn't optional
If you touch Protected Health Information (PHI), HIPAA compliance is mandatory. This means encryption at rest and in transit, audit logging, access controls, incident response procedures, and Business Associate Agreements with every vendor. Fines range from $50K to $1.5M per violation.EHR integration is harder than you think
The ONC lists 800+ certified EHR vendors. Epic dominates (50% market), but every Epic instance implements FHIR differently. You'll need site-specific testing, custom field mapping, and ongoing maintenance. Budget 30-40% more time than you estimated.Standards aren't standard
FHIR has multiple versions (DSTU2, STU3, R4, R5), HL7v2 has countless variants, and vendor implementations vary wildly. What works in Epic's sandbox often fails in production. Integration testing is expensive and time-consuming.Regulatory burden is real
Beyond HIPAA, you may face FDA regulation (Software as Medical Device), ONC certification requirements, state licensing laws, and payer-specific compliance mandates. Legal review takes months. Security reviews block enterprise sales.Sales cycles are long
Expect 6-18 month enterprise sales cycles. Every customer requires security review, BAA negotiation, compliance validation, and procurement approval. SOC 2 Type 2 certification is often required before you can even engage with large health systems.Uptime expectations are 24/7
Healthcare doesn't have maintenance windows. Clinicians work nights, weekends, holidays. Your disaster recovery plan needs to account for data loss (HIPAA requires it), and your SLAs will be scrutinized during security reviews.Common Mistakes (& How to Avoid Them)
Learn from others who've navigated healthcare development. Here are the most common pitfalls and how to avoid them."We'll just use a middleware platform"
Problem: Per-member-per-month fees destroy unit economics at scale. A platform charging $2/patient/month costs $2.4M annually at 100K patients.When it's right: Fragmented market, quick validation, broad EHR coverage needed.When it's wrong: Analytics use case, concentrated market (2-3 EHR vendors), high patient volumes."HIPAA compliance is just encryption"
Problem: Encryption is table stakes. You also need audit logging, access controls, incident response plans, employee training, and annual risk assessments.Reality: Technical + organizational + legal requirements. Documentation is as important as code.Cost of wrong: $50K-$1.5M fines per violation, reputation damage, customer loss."Epic's FHIR API will work like our sandbox"
Problem: Every Epic instance configures FHIR differently. Sandboxes are idealized. Production has custom fields, missing data, inconsistent formats.Reality: Site-specific testing, custom field mapping, ongoing maintenance required.Budget: Add 30-40% more time than you estimated. Plan for iterations."We'll build our own integration platform"
Problem: Underestimating 5-year maintenance cost. New FHIR versions, EHR updates, breaking changes happen constantly.When it's right: 2-3 EHR vendors, 80%+ market concentration, analytics use case, high patient volumes.When it's wrong: Long-tail coverage needed, limited engineering resources, transactional workflows."We can skip the security review"
Problem: Blocks enterprise sales, delays revenue. Every hospital system requires security diligence before signing contracts.Reality: 3-6 month sales cycle includes security review, architecture review, penetration testing.Better approach: Get SOC 2 Type 1 early, design for compliance from day one."CDS Hooks is just a REST API"
Problem: Testing requires live Epic environment (expensive). Site-by-site configuration. Epic certification process is lengthy.Reality: $80-200K implementation cost, 8-12 weeks development + testing, ongoing maintenance.ROI timeline: 12-18 months minimum. Make sure your use case justifies the investment.Critical Questions for Healthcare Startups
Before you write code, answer these questions. We help startups think through these decisions with economic modeling and strategic guidance.Integration Strategy
• Who are your customers? (Hospitals, practices, payers, patients)• Which EHRs do they use? (Epic = 50% market, but what about YOUR market?)• Real-time or batch? (Clinical workflows vs. analytics)• Build vs. buy? (We model the 5-year TCO)
Compliance Posture
• Are you touching PHI? (If yes, HIPAA applies)• Cloud provider? (AWS/GCP/Azure HIPAA compliance)• Need SOC 2? (Most enterprise customers require it)• FDA regulated? (Software as Medical Device = different rules)
Technical Architecture
• Monolith or microservices? (Healthcare favors boring reliability)• Data residency requirements? (Some contracts specify US-only)• Audit logging strategy? (Required for HIPAA, often forgotten)• Disaster recovery? (Healthcare = 24/7 uptime expectations)
How We Help
Strategic guidance and hands-on implementation to help healthcare startups make the right technical decisions.Technical Strategy
Fractional CTO services and strategic technical guidance for healthcare startups.Interoperability
FHIR integration, Epic connectivity, and EHR interoperability strategy.Compliance
HIPAA, HITRUST, SOC 2 implementation and security architecture.Product Engineering
Staff augmentation and full-stack development for healthcare apps.Healthcare Developer Resources
Essential tools, documentation, and frameworks to help you navigate healthcare software development.Getting Started
Epic's FHIR DocumentationComprehensive guide to Epic's FHIR API implementation. Start here if you're building on Epic.
SMART on FHIR TutorialsInteractive tutorials for building SMART apps that launch from EHRs.
FHIR SpecificationOfficial HL7 FHIR spec. Dense but authoritative. Use as reference, not learning material.
Compliance & Security
HHS HIPAA GuidanceOfficial HIPAA rules and guidance from Health & Human Services. Start with the Security Rule summary.
HITRUST CSFComprehensive security framework. Relevant if you're pursuing enterprise healthcare customers.