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.
Good morning, Dr. Alluri.
Your day, your patients, and the work waiting for you.
Today's visits 6 scheduled
Video visits use your private visit service. The existing join window and clinical access checks still apply.
Your patients All patients →
Identifiers and membership only. Clinical history stays inside the chart; chart access is audit-logged.
A made-up patient, the real software. Click anything; what it does appears here.
The health record →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.
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 →
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.
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
What a practice pays to rent itself back
The stack that runs our clinic, costed from our own monitoring and bills, next to the nearest well-known vendor for each piece at their published price. The vendor column is a shape, not a quote.
- Renting
- You pay each vendor a monthly fee per clinician, per user, per member. The software is theirs, your records sit on their servers, and every one of them needs its own agreement with your practice.
- Owning
- You buy the licence to run it and it runs where you choose. One agreement, one set of logins, and the bill stops climbing when you add a person.
- Where it runs
- Machines in your own office, or a private cloud server you rent — a VPC, which is a computer at a hosting company that only your practice can reach. Same software either way.
- Your own hardware
- If you already have a decent machine in the office, that is the hardware line gone. Nothing here needs a specific brand or a new purchase.
- One piece at a time
- Nothing here is a bundle. A practice that only wants a website to bring patients in takes that and leaves the rest.
Rent scales with patients and people. Ownership does not.
Move the sliders. The rented total is the vendors' own published prices from the table: the membership-billing platform adds $45 for every 50 members, the messaging and email vendors charge per user, the EHR and video vendors per clinician. Ours moves only by a covered mailbox per person, and by a machine when a panel outgrows one.
- EHR · per clinician$350
- Video · per clinician$50
- Messaging · per user$48
- Email · per user$64
- Membership billing · per 50$270
- Managed hosting$300
- Frontier AI at list$1,492
- Hardware over four years, or the machines you have$335
- Edge boxes and domains$29
- Covered mailbox · per person$28
- Card processingfees only
- Power for the AI machine, measured$3
Monthly cost by panel size
A rented AI or OCR call sends the document out of your network: one more place a record can sit, and one more agreement to sign. On a cloud server the machine that runs AI locally costs far more than a plain one, which is why a rented practice usually rents the model too. Our line steps up once when a panel outgrows one machine; we use 1,500 patients a machine until we have run past it ourselves. The rented server is a plain 8-core, 32 GB cloud machine with 500 GB of disk at the vendor's published on-demand price, no discount applied. With AI running on it, the line steps up to a cloud machine with one GPU, the graphics chip AI models run on: 4 cores, 16 GB, a 24 GB GPU and the same disk, again at the published on-demand price. AI is off by default so the software shape is fair; switch it on to add the frontier bill at our measured volume.
| What the practice needs | Ours, per month | Rented separately, per month |
|---|---|---|
| Electronic health record | same hardware as everything below | per clinician · $3501 |
| Telehealth video visits | same hardware | per clinician · $502 |
| Secure patient messaging | same hardware | per user · $243 |
| HIPAA-covered email | covered mailbox · $14 a seat | per user · $3245 |
| Membership billing, 400 members | card fees only, no platform charge | base + $2706 |
| Hosting, backups, edge | small edge boxes and two domains · $29 | managed hosting · $300 to $60078 |
| AI assistant, at our volume | power for the AI machine, measured · about $3 | frontier API at list · $1,492 |
| Hardware, amortized over four years | three machines at list · $335, or your own | included in the vendors' prices910 |
| Per month, AI included | about $395 | about $2,520 + base · seven vendors, seven logins, seven agreements |
Rent scales with patients and people. Ownership does not. Our line steps up once when a panel outgrows one machine; we use 1,500 patients a machine until we have run past it ourselves.
The hardware line uses the makers' list prices for the machines we run, not any discount we got, so it errs high. A practice with suitable hardware already pays nothing on that line. The rented server is a plain 8-core, 32 GB cloud machine with 500 GB of disk at the vendor's published on-demand price. With AI running on it, the line steps up to a cloud machine with one GPU, the graphics chip AI models run on: 4 cores, 16 GB, a 24 GB GPU and the same disk, again at the published on-demand price.
We do not claim any vendor is a bad choice. We claim the sum is what a patchwork costs, and that ours is flat.
- 1. Software Finder. Elation Health: Pricing, Free Demo & Features (2026). softwarefinder.com, 2026. softwarefinder.com
- 2. Doxy.me. Doxy.me Pricing: Telehealth Plans for Providers and Clinics. doxy.me, 2026. doxy.me
- 3. Spruce Health. Spruce Health Pricing. sprucehealth.com, 2026. sprucehealth.com
- 4. Paubox. Paubox Email Suite pricing. paubox.com, 2026. www.paubox.com
- 5. Google. Google Workspace pricing. workspace.google.com, 2026. workspace.google.com
- 6. Hint Health. Hint Core Pricing. hint.com, 2026. www.hint.com
- 7. HIPAA Compliant Hosting. How Much Does HIPAA Hosting Cost in 2026?. hipaacomplianthosting.com, 2026. hipaacomplianthosting.com
- 8. OVHcloud US. VPS pricing (VPS-2: 2 vCPU, 4 GB, 40 GB). us.ovhcloud.com, 2026. us.ovhcloud.com
- 9. Apple. MacBook Pro 16-inch, M5 Max, 128 GB memory, 4 TB storage. apple.com, 2026. www.apple.com
- 10. Engadget. NVIDIA starts selling its $3,999 DGX Spark AI developer PC. engadget.com, 2025-10-15. www.engadget.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.