Run the office
The back office, on premises
Charting with a history, scheduling and check-in, membership billing through your own accounts, documents, mail, the CRM and a calendar of obligations: one stack, one login, every record kept per business.
Excelsior Framework · a physician-owned MSO
Your whole practice, on a platform you own.
Records, visits, memberships, billing, messages, mail, the website and a private AI, on computers in your own office. Built by a family physician, inside a working practice, for any clinician who holds protected health information.
☰Excelsior EHRSearch patients, codes, pages… ⌘KClinical workspace◈ CopilotRADr. AlluriFAMILY MEDICINE
Wednesday, September 9
Good morning, Dr. Alluri.
Your day, your patients, and the work waiting for you.
Today's visits6View today's schedule →
Active members412412 on panel · 3 onboarding
Open orders1Across 1 chart · Review →
Inbox3Unread messages →
Today's visits 6 scheduled
September 9 · Your practice agenda
09:00TMT. Marshin person · Annual visitbooked
09:30NWNora WhitfieldVideo visit · Blood pressure follow-upbookedStart VisitOpen chart →
10:15DKD. KimVideo visit · New member · first visitbookedStart Visit
11:00PLP. Lindqvistin person · Medication reviewbooked
13:30open slot
15:00TMT. Marshphone · Result callbooked
Video visits use your private visit service. The existing join window and clinical access checks still apply.
✓ 1 encounter signed today 1 linked item signed with it.
Your patients All patients →
412 active · 3 onboarding
TMT. MarshMRN 000031 · 58y · malemember · active
NWNora WhitfieldMRN 000042 · 46y · femalemember · active
DKD. KimMRN 000057 · 34y · femaleonboarding
PLP. LindqvistMRN 000012 · 71y · malemember · active
Identifiers and membership only. Clinical history stays inside the chart; chart access is audit-logged.
The scheduleThe video visitThe visit notePatient CopilotThe chart
The record our clinic uses
A made-up patient, the real software. Click anything; what it does appears here.
The health record →The platform
Twelve systems, one record
Every piece works on its own. Together they write to one chart, one ledger and one calendar, on computers you own.
Health recordChart, medications, results, prevention plan
Scheduling and check-inBooking and a pre-visit check-in
TelehealthVideo visits on your own server
MessagesPatient messaging, filed to the chart
AIScribe, chart review, summaries, on a computer you own
Patient portalThe whole practice, on a phone
Documents and wearablesRead on your own machines, matched by a private id
MembershipsFlat fees on your own accounts
BillingA ledger of every charge
MailCovered mailboxes and a private mail server
WebsiteThe practice site, built to be found
Business officeCRM, calendar, documents, per business
1 clinicExcelsior Medicine in Reston runs on it every day.
0 requestsThis page loads nothing from anyone else's server.
0% shareNo revenue share, no per-patient fee. What renting costs →
Who it is for
Any clinician-owned practice that holds patient data
Direct care first, because that is what our clinic is. The clinician who holds the license owns the systems, solo or a group. Every practice type, and how well it fits →
Direct primary careFlat-fee memberships, no claims. The model fits exactly; it is what runs today.fits today
Family and internal medicineThe record, the check-in and the visit were built inside a family practice.fits today
Behavioral health and therapyPrivate video, secure messaging and a record that never leaves the building.fits today
Physical therapy and rehabVisit series and progress notes in one record; home programs and to-dos on the patient's phone.fits, with care
Concierge and membershipRetainers, packages and hybrid revenue on your own merchant account.fits today
Functional, integrative, longevityLong visits, prevention plans, wearables and documents read on premise.fits today
Virtual clinicsVideo on your own server, a portal on the patient's phone, no app to install.fits today
Insurance-billing practicesNeeds a claims lane we have not built yet.not yet
Questions clinicians ask
Straight answers
Answered the way we would answer them on the phone.
Is Excelsior Framework an EHR?
Yes, and more. A self-hosted record at the center, and around it the memberships, billing, scheduling, video, messaging, mail, website, portal and AI a practice needs. We do not sell a subscription. We build it on computers you own and run it with you.
Is AI included?
Yes, on every build, on a computer in your own office. No AI tier, no per-note bill. A person approves anything that matters.
What do we need to run it?
Hardware you own, in the office, or a cloud you already use. The system is vendor-agnostic: it runs the same on Google Cloud or AWS, with the business agreements a practice needs in place.
Do we have to take all twelve systems?
No. Pick what you need and add the rest when you want it. Each piece works on its own; together they write to one chart, one ledger and one calendar.
Can I take my data if I leave?
Yes, all of it, in the format the system keeps it in, with its full history. No export fee.
Is it HIPAA compliant?
No software is a HIPAA certificate. We build the controls, keep the evidence and hand you the documentation: encryption, access control, audit trail, signed business associate agreements, and a network that only lets traffic out by name. The obligations stay yours, and you will know exactly what they are.
Does it run a real clinic?
Yes. Excelsior Medicine, a direct primary care practice in Reston, Virginia, runs on it every day.
Does it fit a practice that is not primary care?
Yes. Behavioral health, physical therapy and rehab, specialty and virtual clinics run the same record, visits, messaging and portal. Insurance claims are the one lane we have not built.
Get in touch
Tell us what you're working with
A sentence or two is plenty. We read everything and reply ourselves.
This lands in our own CRM, on our own hardware. No form service, no pixels.
Prefer email? excelsior@excelsiorframework.com
Excelsior Framework / Information / The MSO model
The MSO model
Keep the practice. Own the back office too.
A management services organization runs the business side of a medical practice so the clinicians can run the medicine. It is also the structure private equity uses to buy clinics. The difference is who owns it, and where the records live.
Bring the patients
The front door, built to be found
A practice site built to be found, outreach that is tracked, and one record per person from first inquiry to first visit. We are building this out on our own practice first.
Own the stack
Nothing rented back to you
Your data format is your export format. Backups are encrypted before they leave, keys stay with you, and outbound traffic is denied by default. If you ever leave, you take everything.
In most states a corporation cannot own a medical practice, so an investor buys the MSO instead and signs a management agreement that captures most of the revenue. The clinicians keep the license and the liability; the owner keeps the margin. Private practice now accounts for 42.2% of physicians, down from 60.1% in 2012.
Ours is the physician-owned version: no revenue share, no platform fee that scales with your billing, no term sheet. It is also how our own companies are arranged: a technology company that operates the systems and a medical practice that delivers care, kept legally distinct with a signed agreement between them.
Where this stands today: one practice runs on it, a direct primary care practice in Northern Virginia. Direct care skips insurance billing by design; a fee-for-service practice would need insurance claims, which we have not built, and we will say so before you ask.
Sources
- 1. Kane CK. Physician Practice Characteristics in 2024: Private Practices Account for Less Than Half of Physicians in Most Specialties. American Medical Association, Policy Research Perspectives, 2025-05-29. www.ama-assn.org
- 2. Rooke-Ley H, Reddy M, Mehta N, Singh Y, Fuse Brown EC. The Corporate Backdoor to Medicine: How MSOs Are Reshaping Physician Practices. Milbank Memorial Fund, 2025-04-28. www.milbank.org
- 3. Singh Y, Song Z, Polsky D, Bruch JD, Zhu JM. Association of Private Equity Acquisition of Physician Practices With Changes in Health Care Spending and Utilization. JAMA Health Forum 2022;3(9):e222886, 2022-09-02. doi.org
- 4. Owens M. Physician-owned management model: An alternative to private equity. Healio Gastroenterology, 2022-06-28. www.healio.com
- 5. American Academy of Family Physicians. Direct Primary Care: 2024 Data Brief. AAFP, 2024. www.aafp.org
- 6. DPC Frontier. Direct Primary Care Mapper. dpcfrontier.com, continuously updated. mapper.dpcfrontier.com
Figures are quoted from the source itself; where we round, we say so. Vendors are named here, and only here.
Questions about any of this?
We answer them ourselves, on the phone or by email.