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 hardware in your own office. Built inside a direct primary care practice.

Start a conversationSee the platform
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 →
Why we built it

Practice software should answer to the physician who uses it. So a physician built this one.

Every screen started as something Dr. Alluri needed in the middle of a visit. His training shaped the software, and the software stayed inside the practice.

The platform

Twelve things a practice runs on, sharing one record

Every piece works on its own. Together they write to one chart, one ledger and one calendar, on your hardware. Each has its own page.

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 your GPU
Patient portalThe whole practice, on a phone
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
Documents and wearablesRead on premise, paired by an opaque id
Business officeCRM, calendar, documents, per business
An example

One patient's week, in six of them. Tap a tab to hold it.

Excelsior EHRSearch patients, codes, pages… ⌘KClinical workspaceRADr. AlluriFAMILY MEDICINE · MD
Nora Whitfield 0000421 draft note×
NW

Nora Whitfield member

MRN 000042 · 46y · DOB 1980-03-14 · Reston, VA
⚠ Allergies: PenicillinHypertension
MessageBillingScheduleCheck-in · review needed
OverviewStoryEncountersPrevisitVitalsLabsMedicationsOrdersDocuments
BP, home average128/78↓
A1c5.6%
Colon screeningdue2027
Active problems 2
  • Hypertensioncontrolled
  • Seasonal allergiesprn
Medications reconciled
  • Lisinopril 10 mgdaily · still taking
  • Cetirizine 10 mgas needed
Since last visit
  • 14 home readingsavg 128/78
  • Check-inwaiting
  • 1 documentfiled · on premise
History rev 14
  • Noteunsigned draft
  • Patient summarydraft
EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOMedicine PLLC◧ agent
Excelsior Medicine · CRM · Contacts
Lead InboxPipelineContactsCallsCommsAccounts
Nora WhitfieldXR-01J8 · member since Aug 2026
Plan$250/moactive
Renews1 Octcard on file
Panel412no per-member fee
touchwhenwhere
Site form · inquiry14 Augexcelsiormedicine.com
Enrolled · adult membership15 Augself-service
Portal account created15 Augpractice edge
EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOMedicine PLLC◧ agent
Excelsior Medicine · Payments · Overview
OverviewBy businessMoney inRecurringPayouts & feesMoney outReceipts & statements
Ledger · SeptemberExcelsior Medicine · your merchant account
Collected$103,000412 renewals
Processing fees$3,110to the processor
Platform fee$0always
dateentryamount
1 SepMembership · Nora Whitfield250.00
1 SepCard processing fee−7.55
1 SepRevenue share0.00
portal.excelsiormedicine.com/portal/checkin
Excelsior MedicinePATIENT PORTALvoice on

Get ready for your visit

A few questions from your Excelsior assistant so your care team walks in already knowing your story. Talk or type; tap an answer when one fits.

Excelsior is getting you readywe're on: blood pressure · 1 answered
voice onsave and leavestart over
Excelsior asks · 2 of 3
Since your last visit, has your home blood pressure been higher, lower, or about the same?
One-tap answers
HigherLowerAbout the same
Or type your answer in your own words…
SendSkip this oneI'm done
HomeVisitsGet readyMessagesExcelsior

Monday evening: the check-in asks about blood pressure in one tap. The answers wait for the clinician, not for a model.

portal.excelsiormedicine.com/portal/messages
Excelsior MedicinePATIENT PORTALvoice on

Messages

Messages with your care team

Not monitored for emergencies. If something is urgent, call 911.

My home readings this week averaged 128/78. Should I keep the same dose?you · 08:12
Yes, that is right where we want it. Keep the dose and we will look again at your visit on the 9th.Dr. Alluri · 08:40
Thank you. See you Wednesday.you · 08:41
Write to your care team…Send
HomeVisitsGet readyMessagesExcelsior

Earlier that week: a question about a dose, answered by the clinician, filed to the chart.

Excelsior EHRSearch patients, codes, pages… ⌘KClinical workspaceRADr. AlluriFAMILY MEDICINE · MD
Nora Whitfield 0000421 draft note×
NW

Nora Whitfield member

MRN 000042 · 46y · DOB 1980-03-14 · Reston, VA
⚠ Allergies: PenicillinHypertension
MessageBillingScheduleCheck-in · review needed
OverviewStoryEncountersPrevisitVitalsLabsMedicationsOrdersDocuments
Note writer unsigned draft
S:Home BP averaging 128/78, no dizziness, no chest pain reported.
O:BP 126/80 · HR 68 · weight 82.1 kg
A:Hypertension, controlled on current dose.
P:Continue lisinopril 10 mg · recheck labs in 6 months.
Sign noteOpen Copilot
Proposals accepted3of 6
Edited0
Left the building0bytes
Billing · a ledger of every charge, nothing skimmedmade-up patient
A visit, start to finish

The platform fits the visit, because the visit shaped it

The software reads and drafts. The clinician decides. Nothing is signed, sent or filed by a machine.

Before the visit

The patient checks in, the chart gets ready

A clinician-written check-in gathers the history and screens for alarm symptoms first.

check-in3 of 3 answeredalarm screennone reportedmedsstill taking · 2since last14 BP readings
During the visit

Video on your server, listening on your hardware

Video runs on your own server. Listening, when the clinician turns it on, never leaves the building.

videoprivate · no third partylisteningon · on premisepatient sees"listening"transcriptclinician only
After the visit

A draft note waits for a signature

The assistant proposes; the clinician accepts, edits or discards, line by line.

proposals7accepted6edited1notesigned · rev 14
For the patient

A plain-language summary, published on purpose

Everyday words, sent to the portal only when the clinician publishes it.

summarydraft → publishedto-dos2 · on the phonenext visitbookeddata locationyour building
Prepared for what comes next

Take back control of your data, your costs and your license

Today, records leave the building by default, and per-seat, per-patient and metered-AI fees grow with the practice. We built it the other way around.

internet PRIVATE NETWORK · outward only unnamed · turned back allowed by name

Data containment

Your records sit on hardware you own, inside a network that dials outward only. Anything leaving is allowed by name, or it does not leave.

encrypted offsite backup, keys with you
rented · 400 patients$2,960/mo
ours · AI included$395/mo
rented · 1,200 patients$3,680/mo
ours$395/mo
seven vendors at their list prices · ours measured, plus what we pay

Subscriptions and API meters

Rent scales with patients, seats and tokens. Ownership does not. The AI runs on your own GPU for about the cost of a light bulb.

the full table is on Own or rent
yours the recordsthe practice's the hardwarethe practice's the patient relationshipthe practice's the code that runs itopen, with the practice the management companyclinician-owned

Your license, your business

Most practices were sold and rented back through a management company someone else owns. Ours is the clinician-owned version. If you ever leave, you take everything.

no revenue share, no term sheet

Read the fine print of a rented platform

from a widely used direct-care platform's published terms · sources on the Research page

Rented
$500 a month to export your own data, and only on the two top tiers 30 days to retrieve your records after you leave, then they are gone 30 days' notice and the price can change; your remedy is to leave "As is": no uptime promise anywhere in the terms AI on the higher tier, then per clinician, then per 50 members
Owned
$0 to export: the chart's storage format is the export format Forever: the records are on your disk, with their history No subscription to raise; hardware bought once or already yours Uptime is published on our Telemetry page, from our own monitoring AI on every build, on your GPU, no tier and no meter
Why practices choose it

Built for direct care, from inside a direct care practice

Four reasons physicians call, in the order they bring them up.

Every screen came from a visit.

Dr. Alluri trained in family medicine, then built the record he wanted to chart in, the check-in he wanted patients to fill, and the assistant he wanted to review, one visit at a time.

Walk through a visit →

Your data stays in your building.

The chart, the video, the messages, the model that drafts the note: all of it runs on machines the practice owns. Backups are encrypted before they leave, and the keys stay with you.

How containment works →

No per-patient rent on your own work.

A fuller panel should not mean a bigger software bill. No subscription, no revenue share, no per-seat AI tier.

See the numbers →

The proof is a working practice, not a slide deck.

Excelsior Medicine, a direct primary care practice in Reston, Virginia, runs on this stack every day.

Try the example portal →
Who it is for

Built for every kind of clinician-owned practice

Direct care first, because that is what our clinic is. Physician, nurse practitioner or physician assistant led, 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 Concierge and membershipRetainers, packages and hybrid revenue on your own merchant account.fits today Family and internal medicineThe record, the check-in and the visit were built inside a family practice.fits today Nurse practitioner and PA ledNothing here assumes an MD. The clinician who holds the license owns the stack.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 Behavioral health and therapyPrivate video, secure messaging and a record that never leaves the building.fits today Insurance-billing practicesNeeds a claims lane we have not built. We say so before you ask.not yet

Beyond medicine, the same discipline fits law, accounting and design practices that would rather own their systems.

Questions physicians 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 your hardware and run it with you.

Is AI included?

Yes, on every build, on your own GPU. No AI tier, no per-note bill. A person approves anything that matters.

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.

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 / Platform / Documents and wearables
Documents and wearables

Read on premise, paired by an opaque id

Uploaded documents are read and filed into the chart on the practice's own machines. Watch, cuff and scale readings arrive under an opaque id, never a name.

Start a conversation

running in our clinic today

EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOMedicine PLLC◧ agent
Excelsior Medicine · Documents · Shelves · Compliance evidence
OverviewObligationsSearchAuditShelves · Entity & LegalShelves · Agreements & BAAsShelves · Compliance evidence
Compliance evidenceExcelsior Medicine · owned + bound
Business associate agreement · practice ↔ MSOsigned · rev 3 · obligation tag: annual review
Risk analysis 2026draft · unsigned · on the launch list
Patient documents never appear here. They are read on premise and filed into the chart on the practice edge.
Ask the notebook. Every answer cites its sources.
The business side

The MSO's own papers, per business: entity, agreements, policies, evidence. Owned by one business, bound to others.

EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOFramework LLC◧ agent
Excelsior Framework · Documents · Overview
OverviewObligationsSearchAuditShelves · Entity & LegalShelves · Agreements & BAAsShelves · Compliance evidence
DocumentsExcelsior Framework · owned + bound
Shelves
shelfEntity & Legal
shelfAgreements & BAAs
shelfPolicies & Procedures
shelfCompliance evidence
shelfSigned records
shelfVendors
Needs attention: Risk analysis 2026 · draft · unsigned.
Excelsior Notebook

A notebook per business over its own papers, with a keeper. Ask it something; every answer cites its sources, and it says when they are silent.

EXCELSIOR · WORKSPACE · MSOlive · just readT0 · mesh + SSOFramework LLC◧ agent
Excelsior Framework · Notebook · msoopens in its own tab · its own sign-in
medicine
Excelsior Notebookone collection per business · a keeper each · local inference, no web
collection · Framework LLCfleet1,180 sources keeper up
collection · Framework LLCmso96 sources keeper up
answers0with sources, always
Ask the notebook
What does our BAA with the practice require each year?Which policies are still drafts?
Every answer cites the pages it came from. If the sources are silent, the notebook says so instead of inventing.
Ask about the MSO's papers…
The patient's side, live

What the patient sees: the documents they sent, read on premise, and the readings their devices send under an opaque id. Send a photo here and it appears in the chart's Documents tab below.

portal.excelsiormedicine.com/portal/documents
Excelsior MedicinePATIENT PORTALvoice on

Documents

Your documents
📷Mon 7 Sepmedication-bottle.jpg · 1 page read · medication · photoin your record
Add a document

A photo is all it takes. It is read on premise and filed to your record for your care team to review.

Send to my record
From your practice
◆NoticePrivacy practices✓ acknowledged Aug 15
◆AgreementMembership agreement✓ acknowledged Aug 15
HomeVisitsGet readyMessagesExcelsior
The clinician's side, live

The chart's Documents tab: the same photo, page-extracted. Vitals carries the same device readings.

Excelsior EHRSearch patients, codes, pages… ⌘KClinical workspaceRADr. AlluriFAMILY MEDICINE · MD
Nora Whitfield 0000421 draft note×
NW

Nora Whitfield member

MRN 000042 · 46y · DOB 1980-03-14 · Reston, VA
⚠ Allergies: PenicillinHypertension
MessageBillingScheduleCheck-in · review needed
OverviewStoryEncountersPrevisitVitalsLabsMedicationsOrdersDocuments
Patient documents

From the portal, read on premise

Each upload rides the message thread and lands here transcribed, page-extracted, tagged and dated. Nothing is coded automatically.

Docling extraction: available
📷
medication-bottle.jpgMon 7 Sep · 1 page read · medication · photo
Re-extract pagesExtract to chart
Media library
Approved clinician-side documents for this patient. Sign new drafts in the Gateway; upload outside records via Notes.
  • Visit summary · 9 Sepdraft
  • Membership agreementsigned · Aug 15
What it does

Documents and wearables, the way our clinic runs it

Four things worth knowing. Each one runs in our clinic today, not on a roadmap.

Documents

Uploads become chart entries

A PDF or photo is read on premise and filed as pages in the record, with the source kept.

running in our clinic
Wearables

Readings under an opaque id

Devices pair to an opaque patient id. The bridge never sees a name.

running in our clinic
Business documents

Per business, with history

The MSO's own vault keeps contracts, policies and evidence per business, with the same revision history as the chart.

running in our clinic
Nothing leaves

No document service, no cloud OCR

Reading happens on hardware you own. The network would refuse the upload anyway.

running in our clinic
In the visit

Where it sits in a visit

Upload

From the portal or the desk

Read

On premise

Text and tables extracted locally and attached to the record.

File

Into the chart

Filed as pages, with the original kept.

Everything documents and wearables

The full list, including what is not built

Green means it runs in our clinic today. Grey means it is on our list and not built yet.

Documents

  • PDF and image reading on premise
  • Filed to the chart with the source
  • Per-business business vault

Wearables

  • Opaque id pairing
  • Blood pressure, weight, activity
  • Readings visible in the health log

Containment

  • No cloud OCR
  • Outbound denied by default
  • Encrypted offsite backup, keys with you
Questions physicians ask

The short answers

Answered the way we would on the phone.

Which devices?

Anything the open wearables bridge supports; pairing is by opaque id.

Do documents get sent anywhere to be read?

No. Reading runs on the practice's machines.

Can the MSO see documents?

The MSO's own business vault, yes. Patient documents, no. They sit on the practice's edge.

Tell us what you’re working with

A sentence or two is plenty. We read everything and reply ourselves.

Get in touch