Custom EHR software development
Healthcare organisations work with patient data spread across dozens of systems. Appfront develops custom EHR modules and complementary healthcare software that fit seamlessly with your existing infrastructure, from GP practices to mental health institutions, from home care organisations to hospitals. We build in line with Dutch healthcare information standards, with NEN 7510 (information security in healthcare) as the foundation.
From monolithic EHR to a modular healthcare landscape
The Dutch EHR landscape is dominated by a handful of large vendors. ChipSoft (HiX) and Epic are the standard in the hospital sector, while GPs work with systems such as Medicom, Promedico and CGM. In mental health care, widely used EHRs include User and Gerimedica. These monoliths cover a broad spectrum, but rarely offer the flexibility organisations need for their specific care processes.
The Act on Electronic Data Exchange in Healthcare (Wegiz) requires healthcare providers to exchange patient data electronically through standardised messages. This is driving a shift from closed, monolithic systems towards an open, modular landscape in which specialist modules communicate with one another via HL7 FHIR and Zorginformatiebouwstenen (ZIBs).
This is exactly where Appfront operates. We don't build the next monolithic EHR, but develop targeted modules that complement existing systems: a specialist intake portal, a medication verification tool, an eHandover module, or a fully custom EHR for care organisations that fall outside the standard categories. Always built on Dutch healthcare information standards, and always ready to integrate with the Landelijk Schakelpunt (LSP, national switch point) and the MedMij network.
The consolidation wave in the hospital sector (NEXUS ends EHR maintenance in 2027, SAP/Cerner has withdrawn) makes the demand for alternative and complementary solutions urgent. Smaller care organisations, mental health providers, rehabilitation centres and home care providers don't have the budgets for an enterprise EHR, but they do have legal obligations around data exchange and a genuine need for good record-keeping.
Custom EHR software offers the answer: a system that does exactly what your organisation needs, no more and no less. Built with modern web technology, with FHIR interfaces for integrations, and designed around the workflows of your care professionals rather than the other way round. The result is software that supports clinicians in their primary task, delivering good care, without burdening them with recording requirements that don't fit how they work.
Appfront combines care-domain knowledge with technical expertise in interoperability, privacy by design, and the Dutch information standards managed through Nictiz and the Informatieberaad. We work alongside clinical informaticians, functional administrators and end users to build software that works in the consulting room, not just in the boardroom.
Features of custom EHR software
An electronic patient record is more than a digital filing cabinet. Below are the core features Appfront develops, tailored to your care process, patient population and recording requirements.
Patient registration and identification
Structured capture of demographic data in line with the Basisgegevensset Zorg (BgZ). BSN verification via the BRP register, with built-in checks for duplicate registrations and aliases. Support for multiple identification numbers (AGB, UZI pass, insurance number).
Medical record and progress notes
Structured recording of medical history, physical examination, diagnoses (ICD-10/ICPC), treatment plans and progress notes. SOEP recording for GPs, ROM measurements for mental health care, nursing reporting for long-term care. Everything is searchable and linked to episodes.
Medication overview and verification
Up-to-date medication overview based on the ZIB Medication Use. Interaction checks via the G-Standaard (Z-Index), contraindication monitoring and allergy registration. Electronic prescribing with an integration to the Landelijk Schakelpunt (National Switch Point) to retrieve medication history.
Laboratory and diagnostics
Electronic laboratory requests conforming to EDIFACT message standards. Automatic processing of results with reference-range flagging and trend charts. Integration with PACS for imaging. Support for LOINC coding so laboratory data can be exchanged unambiguously.
Scheduling and worklists
Appointment management per practitioner, department or location. Waiting list management, recurring appointments and automated reminders by SMS or email. Worklists for nursing tasks, checks and follow-up. Integration with ZorgDomein for referrals.
Clinical decision support
Protocol-driven workflows that alert practitioners to relevant guidelines, missing records or abnormal results. Based on NHG Standards, multidisciplinary guidelines or internal protocols. This does not replace clinical judgement, but it does provide a safety net.
An indicator that is only pulled from the record when it is delivered always involves extra investigative work. See the page on the app for recording indicators at source.
Development process: from clinical need to working software
EHR development calls for an approach that combines technical precision with a deep understanding of care processes. Our process is built around close collaboration with healthcare professionals, functional administrators and information security specialists.
Intake and process analysis
We map out your care processes: which clinicians work with the system, which records are mandatory, which integrations are needed. We analyse your current systems landscape and identify where custom software adds the most value.
DPIA and security architecture
A Data Protection Impact Assessment (DPIA) is mandatory for EHR systems. We carry it out together with your DPO, design the security architecture in line with NEN 7510 and define the authorisation model based on the need-to-know principle.
Iterative development with clinical validation
We build in short iterations and validate every delivery with end users: doctors, nurses, allied health professionals. Working screens are tested in the context of real consultations and workflows. Nothing is approved without the agreement of the frontline teams.
Go-live and change management
Migration of existing patient data, training for end users and a supported transition period with on-site support. After go-live we monitor performance, user adoption and compliance. Ongoing management and further development based on user feedback.
Interoperability: integrations with the Dutch healthcare network
An EHR that cannot communicate with the rest of the healthcare sector is a dead end. Appfront builds integrations that comply with the standards prescribed by Nictiz and the Informatieberaad.
Messaging standards
- HL7 FHIR R4 — the international standard for structured healthcare data exchange. We build FHIR servers and clients that comply with Nictiz's Dutch profiles.
- HL7v3 / CDA: for integrations with older systems that do not yet support FHIR, such as some HIS and ZIS implementations.
- EDIFACT — the standard for electronic laboratory requests and results, supported by almost all Dutch laboratories.
- Healthcare information building blocks (ZIBs) — standardised information models for clinical concepts such as Allergy, Medication Use, Blood Pressure and Body Weight. ZIBs are the building blocks of the Basic Set of Healthcare Data.
Networks and platforms
- Landelijk Schakelpunt (LSP) — the national network for retrieving medication history and out-of-hours GP data. Opt-in model with BSN verification.
- MedMij is the Dutch framework of agreements that gives patients access to their own health data via personal health environments (PGOs). We implement MedMij-compliant data exchanges.
- ZorgDomein: for electronic referrals between primary and secondary care. Appfront builds integrations that automate referral letters and reporting back.
- eOverdracht is the Nictiz standard for nursing handover between care organisations. It is essential for community care providers and hospitals at discharge and transfer.
Information security and privacy assurance in healthcare
Health data is among the most sensitive personal data there is. Appfront takes a security-first approach that goes beyond checklist compliance. Below are the pillars of our security framework.
Standards frameworks and certification
NEN 7510 is the Dutch standard for information security in healthcare, based on ISO 27001 but supplemented with healthcare-specific measures. Appfront develops in line with NEN 7510 and supports your organisation in implementing the required Information Security Management System (ISMS).
NEN 7513 requires the logging of access to patient data. Every consultation, change and export is recorded in an irrefutable audit trail: who viewed which record, when, via which system and for what reason. These logs are immutable and retained for at least five years.
AVG/GDPR — data protection is not a feature but an architectural principle. We apply data minimisation, implement purpose limitation in the authorisation model and facilitate patients' rights of access, rectification and data portability.
Technical security measures
- Encryption — data at rest and data in transit is encrypted using AES-256 and TLS 1.3. Key management via an HSM or cloud-native KMS.
- BSN processing — in line with the Wet BSN in de zorg (Wbsn-z). BSNs (citizen service numbers) are stored encrypted and processed only by authorised systems holding a valid UZI certificate.
- Role-based access control (RBAC) — authorisations based on job function, department and treatment relationship. Break-the-glass procedure for emergency access with mandatory retrospective justification.
- Penetration testing — periodic security audits by independent parties, including OWASP Top 10 testing and healthcare-specific attack scenarios.
- Hosting in the Netherlands — data is stored in Dutch data centres that comply with ISO 27001. No data transfers to countries outside the EEA without adequate safeguards.
EHR solutions by healthcare sector
Every healthcare sector has its own recording requirements, terminology and working processes. Appfront builds sector-specific EHR modules that match the reality of your workplace.
Mental health and addiction care
Treatment plan recording according to the GGZ model, with ROM measurements, crisis plans and risk assessment instruments. Support for DBC/DBBC registration and the transition to the Zorgprestatiemodel. Integration with the SBGGZ chain and Vektis for billing.
Community care: nursing, care and home care
Care plans based on the Omaha System or Gordon's functional health patterns. Reporting per care moment with client-specific points of attention. Electronic handover via the eOverdracht standard on admission and discharge. Integration with assessment systems (CIZ, Wlz).
General practice and primary care
SOEP registration, ICPC coding, episode-oriented record keeping. Integration with the LSP for retrieving medication history. Referral module to secondary care via ZorgDomein. Support for the NHG Practice Accreditation registration process and chronic care programmes (DM2, COPD, CVRM).
Hospitals and university medical centres
Additional modules on top of HiX or Epic: specialist outpatient workflows, research data registration, patient portals. Integration with PACS, laboratory systems and pharmacy systems. SNOMED CT coding for diagnosis recording in line with national data standards.
Youth care and youth mental health
Recording within the youth care domain, with specific requirements around parental authority, consent models and information sharing with municipalities. Support for Jeugdwet recording, the referral index and connection to the Municipal Data Hub (GGK).
Rehabilitation and forensic care
Multidisciplinary treatment plans with input from rehabilitation physicians, physiotherapists, occupational therapists and psychologists. Assessment scales and measurement instruments (FIM, Barthel Index) integrated into the record. For forensic care: secure environments with additional authorisation levels and judicial reporting modules.
Frequently asked questions about EHR development
A standard EHR, such as HiX, Epic or Medicom, is a broadly applicable package that is configured for your organisation. A custom EHR is developed specifically for your care processes. Custom software makes sense when your workflows deviate from the standard, when you need specific integrations, or when your organisation falls outside the target group of the large EHR vendors. A hybrid approach is often the most effective: a standard EHR as the backbone, supplemented with custom modules for specialist needs.
NEN 7510 compliance starts with the architecture, not with a checklist afterwards. We design with encryption, access control and audit logging as fundamental building blocks. During development we carry out threat modelling and document all security measures. We support your organisation in setting up the required ISMS and deliver the technical documentation needed for certification or assessment by an auditor.
Yes. Connecting to the LSP requires conformity with the AORTA standards and a certification process via VZVZ. Appfront has experience with the technical implementation of LSP integrations and guides you through the certification process. The lead time for an LSP connection depends on the complexity of your system and VZVZ's availability for assessment.
HL7 FHIR uses modern web technology (REST, JSON, OAuth) and is therefore considerably easier to implement than HL7v3 or CDA. FHIR resources are modular and reusable, which speeds up building integrations. In addition, FHIR is the standard that Nictiz and the Informatieberaad prescribe for new exchanges, so investing in FHIR is future-proof.
Migration begins with a data inventory: which patient data must be transferred, in what format it is available, and which data quality issues exist. We draw up a migration plan with a pilot phase (limited dataset, limited department) and full migration after validation. Historical records are archived and kept available through a read-only interface, so no data is lost.
Absolutely. Smaller organisations in particular, such as allied health practices, clinics, private clinics and youth care providers, often benefit from a custom-built system. The major EHR vendors focus primarily on hospitals and large mental healthcare institutions; their licensing models and implementation processes are often not geared towards smaller organisations. A custom EHR can be more focused, cheaper to maintain and a better fit for your scale.
The BSN is a special category of personal data that may only be processed by healthcare providers authorised to do so under the Dutch Act on the BSN in Healthcare (Wbsn-z). We store the BSN encrypted, separate it from other patient data where possible, and ensure that only authorised applications and users can access it. Verification takes place via the BRP system using UZI certificates.
EHR software that works on the shop floor
Good healthcare software starts with understanding clinical processes. Appfront builds EHR modules that support clinicians, comply with Dutch standards and integrate seamlessly with your existing systems. Tell us about your situation and we'll think it through with you, no obligation.
On applatenmaken.com we cover the same subject from the development perspective: building EHR software.
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