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.
Your day, your patients, and the work waiting for you.
Video visits use your private visit service. The existing join window and clinical access checks still apply.
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 →Every piece works on its own. Together they write to one chart, one ledger and one calendar, on computers you own.
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 →
Answered the way we would answer them on the phone.
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.
Yes, on every build, on a computer in your own office. No AI tier, no per-note bill. A person approves anything that matters.
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.
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.
Yes, all of it, in the format the system keeps it in, with its full history. No export fee.
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.
Yes. Excelsior Medicine, a direct primary care practice in Reston, Virginia, runs on it every day.
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.
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
Investors and practice owners are fairly public about the problems they want solved. We read the ones closest to our work against the systems we already run. It is a useful test of whether what we built is what people need.
The share of physicians in private practice fell from 60.1% in 2012 to 42.2% in 2024, and nearly 80% are now employed by or affiliated with a hospital, health system or corporate owner, most often through a management services organization. Where private equity has bought practices, prices and utilization rose. The answer being asked for is software that runs the back office and brings patients in, so a physician-owned clinic can stay independent.
Purpose-built tools that only a handful of people will ever use are now easy to build and still hard to deploy and share, because sign-on, permissions and security are hard. This is the whole idea behind the framework: bespoke tools for one team, on hardware the team owns, with sign-on, permissions, exposure tiers and outbound control solved once.
Most compliance work is monitoring, flagging and keeping records. We built it into the stack: weekly scans of every running system, an audit trail written before the action, a tamper-evident evidence store and a trust page. Evidence as a by-product of operating, not a project before an audit.
Working with an assistant is still mostly a solo activity. Ours work in shared rooms, and a clinical check-in is already a three-party session: the assistant interviews, the patient confirms, the clinician accepts. Joining a running session mid-task is on the list.
Voice interfaces, home monitoring, coordination between the people who care for someone. The wearables bridge, on-premise speech and the patient assistant point this way, but the practice is family medicine, not eldercare.
Each problem was read in full from the people asking for it, then checked against systems that are running today, not on a roadmap. We are one physician-owned practice and one consultancy; we say where the gaps are before anyone asks.
Sources for every figure on the site are listed on the live Research page: physician practice ownership, private equity and prices, direct primary care, and the vendor prices and terms behind Own or rent.
Figures are quoted from the source itself; where we round, we say so. Vendors are named here, and only here.
We answer them ourselves, on the phone or by email.