On one hand, it may seem that the use of a ready-made solution will be a less expensive choice, as the initial costs will be significantly lower than in those cases when you need to invest in the development. On the other hand, when it comes to the cost of implementing EHR, you should analyze the situation from the perspective of the long run. When you use an off-the-shelf product, usually, you should be ready to pay subscription fees on a monthly or annual basis. In the case of your own custom solution, you do not have such a responsibility. Moreover, as ready-made platforms always offer very limited integration and scalability options, you may need to use and support some additional solutions. Custom systems are associated with high initial costs but they ensure better flexibility.