Software development
Custom healthcare software,
built for Canada.
Middlemarch is a custom software and consulting firm specializing in large-scale healthcare solutions. From OpenEMR implementations to fully tailored platforms, we help enterprise providers modernize, integrate, and scale their digital operations, with a deep focus on compliance, performance, and clinical usability.
Our services
Build, support, advise
01
Custom software development
High-impact systems, tailored to enterprise healthcare.
Our work spans everything from clinical data platforms to internal operational tools, always tailored to the scale, compliance, and performance demands of large organizations. We don't just write code. We build systems that are secure, maintainable, and deeply aligned with the workflows of your providers and patients.
02
EMR platforms
OpenEMR and Openchart, two platforms to build on.
When a clinic needs an EMR it can actually own, we offer two platforms. OpenEMR is the mature open-source system we support at enterprise grade as a certified provider in Canada, with advanced integrations, custom modules, high-availability hosting, and regulatory alignment. Openchart is our own EMR, built by our engineers for clinics that want the same ownership on a more modern foundation. Different starting points, same destination: a system your organization controls, with our team behind it.
03
Tech consulting
Confident decisions on complex technology.
Whether you're undergoing a digital transformation, re-architecting legacy infrastructure, or integrating multiple clinical systems, our team brings deep healthcare domain expertise and a practical, systems-level approach. We help enterprise clients make strategic decisions that align with both technical and organizational goals.
What we build
The systems a healthcare organization actually runs on
Most of our work falls into a few recurring shapes: the software that sits between your clinicians, your staff, and your patients.
- Patient portals, online booking, and digital intake that feed your EMR instead of your fax machine
- Clinical data platforms and reporting layers that turn scattered records into answers
- Integrations between EMRs, labs, diagnostics, billing, and the systems you already run
- Internal operational tools for scheduling, task management, and the workflows off the clinical path
- Modernization of legacy systems, migrated carefully and without interrupting care
- Privacy and compliance tooling built for PHIPA, PIPEDA, and provincial requirements
AI in the clinic
Practical AI, without the hype
Most clinics don't have an AI problem. They have a time problem.
The strongest case for AI in healthcare today isn't a chatbot on your website — it's giving clinicians and staff their hours back. We integrate AI into the systems a clinic already runs, aimed at the work that eats the day: documentation, intake, referrals, and the paperwork between visits.
And because it's healthcare, the guardrails are part of the build, not an afterthought: privacy assessments up front, patient data handled to PHIPA and provincial requirements, a clinician reviewing anything that touches care, and an audit trail behind every automated step. Where AI genuinely isn't the right tool, we'll say so. A well-built form beats a badly applied model.
- Ambient documentation that drafts clinical notes for the clinician to review and sign
- Faxes and referrals read automatically and turned into structured data in your EMR
- Patient histories summarized before the appointment, not scrolled through during it
- Intake assistants that gather the story before the front desk ever touches the file
- Recall and follow-up automation that fills unused capacity in the schedule
How it works
How we quote custom work
Every custom project follows the same process, whether it's a small feature or a full module.
You describe it
Tell us what you need in plain language. No technical spec required.
We scope it
We map out exactly what needs to be built and put a fixed price on it.
You approve
You see the full price before any work starts. No surprises.
We build it
Our team builds directly in your system. You get updates throughout.
A few things worth knowing
Fixed price
Every project is quoted as a fixed amount. The price you approve is the price you pay, regardless of how long it takes us.
Your system
Work is done directly in your environment. You're not waiting on a vendor's release cycle; it ships into your system when it's ready.
Test in staging
Every project is delivered to a staging environment first. Your team tests and verifies before anything goes into production.
Engineering
Engineers who have built EMRs before
Healthcare software punishes inexperience. Data models that don't match how clinics actually work, integrations that fall over at month end, upgrades that break the front desk on a Monday morning. Our engineers have spent years inside EMRs and clinical systems, and it shows in what we ship.
This is a professional team, not a project shop. Senior developers who have built EMRs and healthcare platforms from the ground up, who know what a chart, a schedule, and a billing pipeline look like under load, and who write software that is still maintainable five years in.
It also means you skip the translation layer. You won't spend meetings explaining what an encounter is, why a claim got rejected, or why the fax machine still matters. When your clinical lead describes a workflow, our engineers already know the shape of it, and they'll ask the second question instead of the first.
What experience buys you
- Years spent building and running EMRs in production
- Deep fluency in clinical data: schedules, charts, labs, billing
- Senior engineers on every project, not a rotating bench
- Software in daily use by clinicians and front desks
- Security and privacy practices built for patient data
Why Middlemarch
Built by people who also run clinics
Healthcare is all we do
Compliance is table stakes
We operate what we build
Contact us
Interested in working together?
Send us some info about your organization and what you're trying to solve, and we'll be in touch shortly. We can't wait to hear from you.