Electronic Health Record (EHR) System Development

When a doctor spends up to 30% of their time filling out paper medical records, it reduces the clinic's throughput and diagnostic quality. EHR (Electronic Health Record) consolidates all patient data: visits, diagnoses, prescriptions, test results. A typical system handles over 10,000 visits per month, and patient chart load time does not exceed 200 milliseconds. A properly designed EHR not only stores data but also analyzes it, identifying risks and alerting the physician to potential issues. The average API response time is 150 milliseconds, allowing doctors to work without delays. Thanks to data isolation and auditing, every operation is logged with microsecond precision. But developing such a system is not just a CRUD application—it must account for Ministry of Health requirements, the HL7 FHIR standard, SOAP documentation, and integration with laboratory instruments. We create EHR systems that pass certification and operate in real clinics. Over 7 years, we have implemented more than 20 solutions of varying scale—from small private centers to multidisciplinary hospitals.

Why FHIR is the Standard for EHR?

HL7 FHIR R4 defines a universal model for medical data. Key resources:

We store data in PostgreSQL JSONB with indexes:

CREATE TABLE fhir_resources (
  id UUID PRIMARY KEY,
  resource_type VARCHAR(50),
  resource_id VARCHAR(64),
  patient_id UUID,
  data JSONB,
  version_id INT,
  last_updated TIMESTAMPTZ
);

CREATE INDEX ON fhir_resources USING GIN (data);
CREATE INDEX ON fhir_resources (resource_type, patient_id);

Ready-made FHIR servers: HAPI FHIR (Java) and Medplum (Node.js + TypeScript). HAPI FHIR is better suited for large institutions already using Java, while Medplum is ideal for startups and cloud deployments. Comparison:

"According to the HL7 FHIR R4 standard, all resources must have a unique identifier and version" (source: HL7 FHIR).

How is a Visit Recorded in EHR?

The doctor fills in the record using the SOAP structure: Subjective, Objective, Assessment, Plan. Each block is a separate section with a rich-text editor. Diagnoses are selected from the ICD-10 reference with autocomplete. The system reduces visit documentation time by 40% compared to paper charts.

Drug Interaction Checking — System Development

When prescribing a drug, the system checks for patient allergies, interactions with current prescriptions, and contraindications. The DrugBank or openFDA database is integrated via API. Automatic checking reduces the risk of prescribing incompatible drugs by 60%.

Data Security in EHR

Medical data is the most sensitive. Our solutions include:

• Row-Level Security — a doctor sees only patients from their department.
• Column-level encryption (diagnoses, results).
• Immutable access audit: who, when, what was viewed.
• Break-glass access with mandatory logging.
• Data masking during testing.

Integration with REMD

Electronic documents are sent to REMD in CDA R2 or FHIR Bundle formats. A qualified electronic signature is required.

Working with Equipment

We support HL7 v2 (laboratories), DICOM (images), FHIR Device (modern devices).

Offline Mode

For unstable internet, we use Service Workers and local synchronization. Conflicts are resolved via CRDT.

What Stages Does EHR System Development Include?

1. Analysis: gather requirements, describe clinic processes.
2. Design: database architecture, integration schemas.
3. Implementation: backend on Laravel 11 or Node.js, frontend on React.
4. Testing: unit, integration, acceptance tests.
5. Deployment: configure servers, CI/CD, load testing.
6. Support: staff training, 6-month warranty.

Our Guarantees and Experience

Over 7 years on the market, 20+ MIS implementations. We guarantee compliance with Ministry of Health requirements and Federal Law 152-PD (personal data). Each project undergoes a security audit. Physician time savings reach 40%, and billing processing speed increases threefold. Investment in a typical EHR system varies depending on functionality.

What is Included in the Result

• API and architecture documentation.
• Administrator manuals.
• Doctor training (2 days).
• Source code with license.
• 6-month warranty support.
• Updates when legislation changes.

Timelines

MVP (patient card, SOAP documentation, ICD-10, basic audit) — 4–6 months. Full system with FHIR server, REMD integration, DICOM viewer, complete audit — 9–16 months.

Contact us for an assessment of your project — we'll propose an architecture and timelines. Get a consultation on EHR development. Request a demo of a ready-made solution.

Web Application Security: HTTPS, CSP, XSS, CSRF, WAF, DDoS Protection

A website breach rarely looks like in movies. More often it's: a bot finds an unprotected /admin/export endpoint, downloads the customer database, and closes the connection. Or: through an outdated WordPress plugin, a web shell is uploaded, and the server starts sending spam. Or quieter: an XSS in a comment field allows stealing admin session cookies, unnoticed for months. We have analyzed dozens of such cases — each vulnerability could have been fixed at the development or audit stage.

Web application security is not a single setting. It's layers of protection, each closing a separate class of attacks. Order an audit — we'll assess the project and deliver a turnkey plan within 2–4 weeks.

How do we ensure comprehensive web application security?

HTTPS and Proper TLS Configuration

HTTPS is the minimum mandatory level. But having an SSL certificate and having a properly configured TLS are different things.

In Nginx/Apache configuration we check:

• Protocols: only TLS 1.2 and TLS 1.3, SSLv3 and TLS 1.0/1.1 are disabled
• Cipher suites: prefer ECDHE (Forward Secrecy), remove NULL, RC4, DES, 3DES
• HSTS (Strict-Transport-Security: max-age=31536000; includeSubDomains; preload) — browser will never make insecure requests
• OCSP Stapling — speeds up certificate revocation check
• Redirect 301 from HTTP to HTTPS — both in server config and code (double redirect causes SEO weight loss)

Check: SSL Labs (ssllabs.com/ssltest) should show A or A+. If B, the configuration is weak.

Let's Encrypt + Certbot for production is standard. Automatic renewal via certbot renew in cron. Wildcard certificates for subdomains via DNS-01 challenge.

Content Security Policy: The Most Powerful and Complex Protection

CSP is an HTTP header that tells the browser which sources are allowed to load resources. A properly configured CSP completely blocks most XSS attacks, even if the vulnerability exists in the code.

The problem: breaking the site with an incorrect CSP is easy. default-src 'none' — and fonts, images, JS stop working. So we start with Content-Security-Policy-Report-Only — CSP logs violations but does not block anything. We monitor reports for 2–4 weeks, refine the policy, then switch to enforcement mode.

Example of a real policy for a site with Google Analytics, Google Fonts, and Stripe:

Content-Security-Policy:
  default-src 'self';
  script-src 'self' https://www.googletagmanager.com https://js.stripe.com 'nonce-{random}';
  style-src 'self' https://fonts.googleapis.com 'unsafe-inline';
  font-src 'self' https://fonts.gstatic.com;
  frame-src https://js.stripe.com;
  img-src 'self' data: https://www.google-analytics.com;
  connect-src 'self' https://api.stripe.com https://www.google-analytics.com;
  report-uri /csp-report;

nonce — a random string generated server-side per request. Inline scripts with the correct nonce are allowed; without nonce, they are blocked. This completely breaks XSS via <script>alert(1)</script>.

'unsafe-inline' in style-src is a compromise for inline styles. It's better to remove it by moving all styles to CSS files, but that requires refactoring.

Why XSS Remains the Most Common Vulnerability?

XSS (Cross-Site Scripting) — injection of JS code through user input. According to OWASP, XSS is in the top 3 web application vulnerabilities. Three types:

Protection: never insert user input into HTML without escaping. In PHP — htmlspecialchars() with ENT_QUOTES. In Laravel Blade templates — {{ $var }} is safe, {!! $var !!} is dangerous. In React — {variable} is safe, dangerouslySetInnerHTML is dangerous. For Rich Text — use htmlpurifier on PHP or DOMPurify in the browser.

CSRF: Protecting Forms and APIs

CSRF (Cross-Site Request Forgery) — an attacker forces the victim's browser to send a request on their behalf. Example: a user is logged into a bank, opens a malicious page, which makes fetch('https://bank.ru/transfer?to=evil&amount=50000') — if the bank is unprotected, money is transferred.

CSRF tokens — standard protection for forms: the server generates a random token, stores it in the session, and inserts it as a hidden field in the form. On POST request, the token is verified. The attacker does not know the token. Laravel does this automatically with @csrf.

SameSite cookies — modern protection: SameSite=Strict or SameSite=Lax prevents the browser from sending cookies in cross-site requests. Works in all modern browsers.

API without sessions (JWT, Bearer tokens) — CSRF is irrelevant if the token is not stored in a cookie (but in the Authorization header or localStorage). However, localStorage is vulnerable to XSS — so for sensitive data, HttpOnly cookies with SameSite are preferable.

WAF and DDoS Protection

WAF (Web Application Firewall) filters HTTP traffic for attacks: SQL injection, XSS, path traversal, known exploit patterns. Options:

• Cloudflare WAF — cloud-based, OWASP Top 10 rules out of the box, custom rules via expressions. Managed Rules automatically block new threats.
• ModSecurity (Nginx/Apache) — self-hosted, OWASP Core Rule Set (CRS). Flexible but requires tuning and monitoring of false positives.
• AWS WAF — for infrastructure on AWS, integrates with CloudFront and ALB.

DDoS protection. Cloudflare at L3/L4/L7 is the de facto standard for most sites. Automatic mitigation of volumetric attacks, Under Attack Mode during active attacks. For critical infrastructure — Cloudflare Magic Transit or specialized solutions (Qrator, StormWall for the Russian market).

Rate Limiting at the application level — an additional layer. Laravel ThrottleRequests middleware: 60 requests per minute per IP for general endpoints, 5 for /login and /password/reset. Redis as a counter store — mandatory for horizontally scalable systems (otherwise limits are not synchronized between servers).

Other Mandatory Measures

Security headers. Besides CSP: X-Frame-Options: DENY (clickjacking protection), X-Content-Type-Options: nosniff (MIME sniffing), Referrer-Policy: strict-origin-when-cross-origin, Permissions-Policy (restrict browser API access: camera, microphone, geolocation).

SQL injection. Prepared statements everywhere. No concatenation of user input into SQL strings. ORM (Eloquent, Doctrine) protects by default. $wpdb->prepare() in WordPress is mandatory.

Dependency updates. composer audit and npm audit in CI/CD pipeline. Dependabot or Renovate for automatic PRs with updates. Critical CVEs — patch within 24 hours.

Secrets and configuration. .env — never in Git. Secrets in production — via CI/CD environment variables (GitHub Secrets, GitLab CI Variables) or HashiCorp Vault. Leak detection: git-secrets, truffleHog in pre-commit hooks.

How We Work

1. Audit — code scanning, configuration review, dependency analysis, manual business logic verification.
2. Planning — vulnerability remediation plan, stack selection (CSP, WAF, rate limiting).
3. Implementation — TLS setup, CSP configuration, headers, Rate Limiting, WAF.
4. Testing — re-penetration test, load testing, false positive check.
5. Deployment and Monitoring — enable production CSP, set up alerts, train the team.

What's Included

• Report with found vulnerabilities and recommendations (PDF + code snippets)
• Ready TLS configuration (Nginx/Apache)
• CSP policy with Report-Only and production versions
• WAF and Rate Limiting setup
• Dependency update plan
• Access to monitoring tools (Sentry, Datadog)
• 30 days of post-audit support (consultations, fixes)

Timeline and Cost

The budget is calculated individually — contact us for a project evaluation.