Walk into any clinic today and ask a physician how they feel about their EHR. Odds are, you’ll hear about inefficiency, clunky interfaces, and how much time it takes away from patient care. That’s because most EHRs weren’t designed by people who actually practice medicine.
At Counsel, we’re both.
We’re physicians and engineers rethinking the foundation of clinical care. Our mission is to multiply the world’s clinical capacity, and to do that, we’re building an asynchronous-first care model from the ground up. Deciding whether to build or buy a homegrown EHR wasn’t an easy decision. We had many late-night discussions and constantly went back and forth, but ultimately realized that our vision wouldn’t be possible with legacy EHRs that are built for a visit-based, reimbursement world. We needed infrastructure purpose-built for how we deliver care, not the other way around.
So, we built our own custom EHR.
An electronic health record (EHR) is a secure digital system that stores all of a patient's health information, including medical history, prescriptions, lab results, and doctors’ notes. EHRs enable clinicians to access accurate, up-to-date information quickly, facilitating safer and more personalized care.
When designed well, they create a seamless health story that enhances coordination and improves patient outcomes.
Despite their benefits, most electronic health record systems create common frustrations for clinicians. Here are the main EHR usability challenges seen in practice:
Solving these challenges is key to making EHRs safer, faster, and more helpful for every patient and care team.
When we set out to transform healthcare, we faced a simple but critical choice: Should we buy an EHR system, or build our own from scratch.
When we started evaluating EHRs, We found most EHRs to not only be visit-centric, but also built around scheduling, billing codes, and in-person clinic workflows, which limits their utility to supercharge our care model. While newer EHRs provide UI flexibility, most don’t meet the requirements for enabling the speed and flexibility required to iterate and build a best-in-class asynchronous care experience.
Off-the-shelf EHRs get clinics up and running faster, but they have their own set of limitations. They can’t easily adapt to advanced personalization, fast iteration, or unique workflows.
Our vision demanded more. Building a custom EHR gave us full control to design smart routing, secure messaging, and continuous care features that evolve with the needs of both patients and physicians. While this required a higher upfront investment, the flexibility and ownership it gave us were essential for truly personalized care.
Counsel offers unlimited, on-demand access to licensed physicians via messaging. That means no appointments, phone trees, or waiting rooms. Patients message us directly through our app and hear back from physicians within minutes. This model is optimized for accessibility and continuity, with physicians providing ongoing support and advice through a friendly, easy-to-use chat interface.
Unlike traditional in-person care or telehealth appointments, Counsel is creating a new care model that’s designed for responsiveness, personalization, and longitudinal support.
To build the kind of care experience we envisioned, we needed full control over the underlying infrastructure. A custom EHR allowed us to:
This ownership has allowed us to move quickly and build with precision. Many of our most-used features were developed directly from physician feedback, sometimes in less than 24 hours. Highlights include:
By building for our exact needs, we’ve created an EHR that not only powers our current care model, but also adapts with us as we scale and evolve.
Just a few years ago, building an EHR meant starting from scratch. Today, a growing ecosystem of modular, API-driven tools has made it possible to build what we need. We’re not reinventing the wheel, but assembling best-in-class building blocks that let us focus on our differentiators: experience, care quality, and the physician-patient relationship.
None of this is easy. Building an EHR requires significant investment. Collecting and structuring data across multiple systems to make it actionable is complex and ongoing. Each third-party integration also brings trade-offs and operational complexity. However, we’re confident the investment is worth it. Over time, our system will develop a working memory of patient-physician conversations with minimal documentation burden.
That’s not just better infrastructure. That’s better access to the highest quality healthcare.
For us, building an EHR wasn’t just a tech decision. It was a clinical one, as well.
Dr. David Whitehead is a member of the Clinical Product team at Counsel Health. A practicing emergency physician, he focuses on building clinical tools that empower clinicians to deliver high-quality asynchronous care. Previously, Dr. Whitehead advised digital health startups on clinical, operational, and strategic challenges and led the development of an asynchronous care program at Brigham and Women’s Hospital to improve post–ED discharge care transitions.
Dr. Rishi Khakhkhar is CMO at Counsel Health. A practicing emergency physician and founding team member, he leads the clinical team in building best-in-class asynchronous care models. Previously, he served as Medical Director of Mount Sinai’s Virtual Urgent Care, the health system’s largest telemedicine service, and led emergency department operations for Hospital-at-Home while supporting mobile integrated health initiatives across the care continuum.
Our content is created for informational purposes and should not replace professional medical care. For personalized guidance, talk to a licensed physician. Learn more about our editorial standards and review process.
