Regulatory fluency, honestly, more than flashy demos. Ask whether they’ve handled protected health information before, whether they know HIPAA inside and out, and whether HL7 and FHIR are things they’ve actually implemented rather than just heard of. That experience shows up fast once a project hits real patient data.

A general vendor can write functional code. A healthcare-focused one knows why a login screen for a nurse needs to work differently than one for a billing clerk, and why “move fast and break things” is a terrible idea when the thing you break is a patient record. Domain knowledge changes the whole approach, not just the compliance checklist.

Yes, and this is where a lot of value gets missed. Good partners help redesign the workflow itself, scheduling logic, staff handoffs, intake processes, not just wrap the old process in a new interface. Software that ignores how a clinic already runs tends to get ignored right back by the staff using it.

Mainly time zones and regulatory alignment. A US-based team is already fluent in HIPAA, state-level health data laws, and US insurance and billing systems, which cuts down on translation problems, both language and legal. That said, plenty of teams abroad, including ours at Zenesys, work within US compliance standards daily and coordinate closely with US business hours.