The verdict in three sentences
Buy a market vendor if your need is standard, single-site and you accept its data model and per-bed pricing. Build a custom patient record if you are multi-site, with specific interoperability flows (HL7/FHIR, national record, labs) and a need for full control over the product roadmap. The financial tipping point is usually between 18 and 30 months of ROI, depending on the number of sites and connector costs.
Build vs Buy: 2026 EHR figures
The electronic health record (EHR) is the core of the system. Here are 2026 orders of magnitude for a 3-to-5-site private group.
| Item | Vendor (Buy) | Custom (Build) |
|---|---|---|
| License / development | 15,000-60,000 EUR/year | 80,000-250,000 EUR |
| HL7/FHIR integration | 8,000-25,000 EUR | included in scope |
| Lab connector | 3,000-7,000 EUR/lab | 3,000-7,000 EUR/lab |
| Compliant hosting | included or 300-800 EUR/month | 500-1,500 EUR/month |
| MVP timeline | 1-3 months (config) | 5 months |
| Support / evolutions | included (vendor roadmap) | 12-16 %/year |
The vendor sets its roadmap: you wait for its releases. Custom makes you master of the schedule but shifts maintenance and compliance responsibility onto your provider.
Interoperability: the real question
A modern EHR must speak HL7 v2 and FHIR to exchange with labs, imaging and national health records. A multi-site group connecting 3 labs and 2 imaging units budgets 5 connectors.
| Connection | 2026 unit cost | Frequency |
|---|---|---|
| Lab connector (HL7) | 3,000-7,000 EUR | per lab |
| FHIR gateway (national record) | 8,000-18,000 EUR | once |
| Imaging interface (DICOM) | 6,000-12,000 EUR | per unit |
| Billing / insurance connector | 5,000-10,000 EUR | once |
| Interface maintenance | 12-16 %/year | annual |
These costs exist whether you buy or build. The difference: with custom they are integrated into the project and evolve with you; with a vendor, each connector is billed and depends on its catalog.
Mini case study
Sophie, CIO of a 4-clinic private health group, hesitated between renewing a vendor license at 48,000 EUR/year and building a custom EHR. Over 5 years the vendor costs 240,000 EUR plus 3 lab connectors (15,000 EUR), i.e. 255,000 EUR. Custom at 190,000 EUR plus support at 14 % (26,600 EUR/year, i.e. 106,400 EUR over 4 post-launch years) and compliant hosting (1,000 EUR/month) reaches 344,400 EUR over 5 years. Here the vendor stays cheaper, except Sophie scoped 6 specific modules not covered whose vendor re-billing would be 90,000 EUR: custom becomes competitive again and gives her roadmap control. Estimated custom ROI: 26 months.
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FAQ
What are HL7 and FHIR, concretely?
They are health data exchange standards. HL7 v2 still dominates for labs; FHIR is the modern standard (REST API) required for national health records. A serious EHR must handle both.
How much does a lab connector cost?
Expect 3,000 to 7,000 EUR per lab in 2026, plus annual maintenance. Multiply by the number of partner labs: it is often the underestimated line item in multi-site projects.
Is custom risky for a health group?
The main risk is provider dependency. Require delivered source code, full documentation and a reversibility clause. Compliant hosting and security testing reduce compliance risk.
How soon is an MVP usable?
A custom EHR MVP (patient file, history, prescriptions) is usable in about 5 months. Lab and imaging integrations are added in batches afterward.
When does custom become profitable?
Generally between 18 and 30 months, once the cumulative cost of per-bed licenses and billable specific modules exceeds the initial development investment.
Let's scope your project. Give us your number of sites, the labs and imaging units to connect and your indicative budget; we model build vs buy over 5 years with connector detail. Detailed quote within 48 h. WhatsApp +221 77 596 93 33.
Mohamed Bah
Fondateur, Kolonell
Passionate about digital and entrepreneurship in Africa, Mohamed has been helping Sénégalese businesses with their digital transformation since 2020. Founder of Kolonell, he believes every SME deserves a professional and accessible online présence.
