The HITECH act then the COVID-19 pandemic both significantly sped up the adoption of electronic health records across the US. While most hospitals had implemented EHRs by 2021 to enhance their productivity or receive Medicare perks, the level of satisfaction with the solution remains quite low, especially in smaller healthcare facilities.
One of the reasons for this is that most popular EHRs were developed not as clinical tools but as billing systems for enterprises. We gathered the opinions of EHR developers about the main disadvantages of out-of-the-box solutions and what can be a good alternative for healthcare professionals who want a better user experience.
Issues with off-the-shelf EHRs
There are three common difficulties with platform-based EHRs.
A cumbersome interface
The top EHR interface-related challenges include chaotic screen transitions and numerous mouse clicks.
While those issues may look trivial for developers, they are a serious disruptor for clinicians who have to re-focus multiple times in a row. Moreover, the need to interact with such effort-intensive EHR systems can cause clinician burnout, according to the Mayo Clinic study mentioned above. The researchers matched SUS scores with burnout rates and found that the lower the SUS score, the higher the burnout rate and vice versa:
Being burnt out, clinicians can mix up patient data like height and weight in interface fields. This leads to diagnosis and treatment mismanagement and eventually, patient harm. To prevent such issues, many providers rely on electronic records management software, which doesn’t solve the initial problem entirely.
A rigid system
All industries are experiencing a rapid digital transformation right now. Organizations discover opportunities for new services and adopt recent tech innovations. When your EHR – one of the central hospital systems – is incapable of properly interacting with other software and evolving alongside your practice, it sets back the entire organization. This is unfortunately the case for most out-of-the-box solutions, as they are not flexible enough to be updated frequently.
Poor clinical integration
When built and implemented with no connection to a particular clinical setting, an EHR system tends to ignore specifics, such as interactions and workflows that make the system efficient. According to the recent SOTI report on the state of mobility in healthcare, between 26% and 39% of healthcare workers enter patient data in the system manually, while 42% said patient-information systems are not well integrated.
The quality of EHR implementation (and personnel training as a part of it) greatly influences a system's effectiveness as well as staff satisfaction. However, it won’t make a huge difference if the system is inherently misaligned with the ecosystem.
Enter custom EHR: a solution tailored to a particular organization’s needs and available resources from the start.
Custom vs off-the-shelf EHR
Custom EHR is not a magic pill that is guaranteed to solve a healthcare organization’s issues. It’s crucial to consider the advantages and disadvantages of this type of EHR before rushing into its implementation.
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Custom EHR: what’s inside?
The best part of developing an EHR from scratch for your organization is that it can be equipped with features and integrations relevant to your practice, therefore, preventing the system from being overcomplicated.
General features
First and foremost, EHR is a tool for gathering, storing and sharing patient information. Thus its basic set of features should include patient profiling and capabilities for secure data acquisition, access, and transfer for doctors and patients.
Patient profiling
Thanks to the profiling features, healthcare professionals can have a 360-degree view of a patient. However, it is up to you to decide which type of information your practice requires. EHRs can store:
- Demographic information: gender, age, place of residence, social security number, etc.
- Examination notes
- Supplementary data, such as laboratory test results, medical images, etc.
- Previous diagnoses and current health conditions (e.g. injuries, surgeries, allergies, chronic illnesses, etc.)
- Prescription history, drug intolerance and side effects reports
- Immunization history
- Financial details, including insurance policy numbers, subscription plans or billing information, etc.
While you don’t have to add fields for all of the aforementioned types of data, it is crucial to discuss the possibility to expand the patient profile later on with your EHR vendor.
Automated data acquisition
Clinicians don’t have to work overtime to input patient data into the system because today, the process can be almost fully automated. There are multiple tools for gathering information besides manual input:
- Integrations with patient portals, so patients can manage their health data themselves
- Integrations with wearables, remote patient monitoring gadgets, and other smart medical devices that provide real-time reports about the patient’s condition
- AI-supported systems that automatically convert data from one format to another and facilitate receiving patient data from other EHRs, EMRs, or alternative record-keeping systems
- Modules that allow voice data entry
Keep in mind that while some of these may be expensive to implement, these tools might prove cost-effective in the long run by preventing personnel burnout and life-threatening mistakes.
Dashboards for healthcare personnel
Medical workers should be able to access all the data they need in one centralized place, without the hassle of opening multiple windows and performing hundreds of operations. Such dashboards for authorized clinicians can enable:
- Reviewing, managing, and updating patient profiles
- Automatic reminders about upcoming appointments, vaccinations, and prescription refills
- Notifications about receiving lab tests, medical images, diagnoses from other specialists, incoming information requests from insurance companies or other departments and organizations, unusual readings from RPM devices, etc.
Some customized EHRs allow medical staff to set up database access and trigger specific actions from their dashboard.  For example, nursing EHRs are optimized for bedside notetaking and the display of daily patient procedures on the dashboard. Thus, different departments and specialists can be equally satisfied with the EHR.Â
Practice-specific add-ons
There are a plethora of additional features that might be helpful to specialists in a particular organization. They may be added to the EHR via custom modules or third-party integrations:
- Scheduling and reminders
These features help staff manage their tasks effectively by providing a task management dashboard and connecting it to the appointment scheduling functionality. You can also enable notifications so neither doctors nor patients forget about an appointment, vaccination, re-fill, or other procedures. - Analytics and reporting
This functionality enables healthcare workers to see patterns in patients’ conditions and predict potential risks. It also helps assess a particular treatment, analyze and forecast the effectiveness of the prescribed treatment, and find connections between patients’ state of health and other factors (for example, their demographics). - Telehealth
You can integrate your EHR with video or audio conferencing tools to facilitate primary care virtual sessions. - Billing and financial management
Financial modules make it easier for specialists to charge for their services by integrating appointment scheduling modules with billing, insurance and subscription plan management systems. - Medical information resources
You can enhance the quality of care by outfitting your EHR with built-in compendiums about various health conditions, international disease classification, medical research, drug usage, controlled substances, and other valuable information. Make sure it is easy to access and navigate to save your personnel’s time.
The above list is not exhaustive, because every practice is unique and its EHR can be just as distinctive: functionality and interface of a dental EHR will differ drastically from a surgical EHR. Discuss your needs and ideas with your software provider to learn what features are feasible to embed right now and what would be better to integrate down the line.
Custom EHR development process
Healthcare providers that consider a custom-made EHR are oftentimes discouraged by seemingly complicated development and implementation processes. But it doesn’t have to be this way. With careful pre-deployment planning, a clear project plan and a defined roadmap, and transparent communication between the vendor and healthcare provider, you can succeed in your EHR implementation.
Full-cycle EHR adoption consists of three major stages:
1. Discovery
During this phase, you prepare the ground for your custom EHR implementation, including its interface, features, and capabilities. The best way to plan it all out correctly is to assemble a team consisting of a project manager, a business analyst, clinicians that represent all end-users, and an IT department expert. Together, they can decide which EHR workflows should be updated or automated, and how its interface should look to be considered friendly for users with different technical backgrounds.
At this point, you should also conduct an audit of IT and human resources you have on hand and whether it would be enough to support your ERP’s intended functionality. Sometimes, companies need to upgrade their hardware or software or even perform a complete revamp of the existing IT ecosystem before they can integrate EHR into it. These aspects are important to clear up before setting the budget and drafting the development roadmap. By the end of this step, the development team finds a solution that fully covers or even exceeds the client's expectations, creates system architecture and comes up with the basic design, defines the tech stack and gives recommendations about the necessary changes to the organization’s hardware and software.
2. Development
Custom EHR development takes from 4 to 12 months depending on the provider, the scale of the organization, and the system’s complexity, and consists of four major steps:
- Creating the roadmap and preparing assets
A detailed plan with well-defined milestones will help you and the development team stay on the same page from the get-go. The roadmap should include plans not only for the EHR system’s development but also for upgrades of existing software, hardware and network, data migration, integration of EHR into the ecosystem, and personnel onboarding. It is also crucial to set some time and budget aside for unpredicted events. - Creating a custom EHR solution
At this stage, the most essential modules like patient profile and specialist authorization are developed into a working prototype. To enrich the system’s functionality, our team introduces the possibility of various integrations as a concomitant step. It varies a lot in length and cost depending on the quantity and complexity of the integrations. When the working solution is ready, it is presented to the clinician group for initial feedback. The development team then evaluates the feedback and makes changes to processes and the system if needed. - All-round quality assurance
A custom EHR solution stores sensitive information, so ensuring its compliance and security is crucial before going live. Depending on the area you’re operating in, your EHR software may need to comply with HIPAA, GDPR, PIPEDA, and other standards that ensure patient information protection. Therefore, we develop the solution with the needed level of compliance. Also, to achieve the best results, relevant tests are conducted throughout the entire development and implementation cycle, with final quality assurance (for example, user acceptance testing) to complete the project. Our team employs both functional and non-functional testing.
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3. Implementation into the hospital ecosystem
Once the custom EHR software is fully developed and tested, its quality and security is assured, and feedback from clinicians is taken into consideration, the system is ready to be integrated with other medical software. This step is vital for the overall success of the EHR implementation, particularly the smoothness and security of the data transfer and the system’s performance. That’s where custom-made EHR solutions shine, as they are developed for the particular hospital environment from the beginning.
At this stage, the new EHR also gets populated with data. It might be transferred from the old software or paper records, entered manually or with the help of AI-supplemented text conversion tools. In any case, data migration is a complex and highly important step that demands precision and accuracy.
Once your EHR system is fully operational, you can proceed with personnel training. First and foremost, aim to train basic users, not experts. Start with educating the personnel on basic EHR commands, provide necessary security training, and then conduct more in-depth sessions for those who need additional skills. As for the format, there are a variety of options including live presentations, training software with personalized questionnaires, peer-to-peer mentorship, etc. Check what your vendor has to offer, what your facilities are equipped for, and make the training process comfortable for the participants.
Custom EHR cost factors
Every healthcare provider that opted for a custom EHR wonders how much it is going to cost. The cost varies a lot even for out-of-the-box EHR solutions, and more so for custom-made ones. Although the research by Software Path suggests that a provider should expect to pay around $1,000 per EHR user, this number is very relative.
There are six major factors that determine a custom EHR system’s cost: whether your hardware should be updated, is the system being developed from scratch or based on popular open-source EHR software, the number of features and integrations, how challenging the data migration to your new system is, the number of specialists to be trained, and the type of support you choose.
Although the upfront EHR system cost might be higher than expected, keep in mind that healthcare practices typically reduce their spending in other aspects after installing it. Such cost-cutting actions as getting rid of excessive laboratory testing and duplicate order entry, scheduling clinical procedures more efficiently, and optimizing prescriptions help cover the cost of the electronic health records system within a couple of years.
Get a competitive edge with a custom EHR from Itransition
Our experts will develop a custom EHR system with a tailored feature set and high levels of scalability and flexibility to enable your company’s growth and evolution.
Custom EHRs in real life
Custom software is more than just another tool that you have on your hands. Some medical providers use custom EHRs as a means to offer truly unique and innovative services.
Telemedicine-ready EHR enables fully remote care
Triptych Technologies Inc. requested our assistance with a bold futuristic project: an EHR and patient portal software that utilized innovative methods of data input (voice, smart pen, etc.) along with teleconferencing capabilities.
Together we created Sapiocare – a solution that automates scheduling patient appointments, keeping medical history records, and forming billing reports without the integration of a specific payment system. It is instead integrated with televisit software and platforms for natural language processing and voice recognition to enable voice input, an Automated System of handwriting recognition and Apache cTakes clinical text analysis to allow data input with a smart pen and paper. The EHR has been tested for an extended period of time and is proven to be highly functional and fully secure.
EHR with pre-visit chart prep proves the value of prevention
Summit Health contacted AthenaHealth, a popular healthcare software vendor, for a tailored EHR that would close knowledge gaps about services delivered outside the healthcare network. The AthenaOne solution with a custom pre-visit patient chart helped the provider not only close those knowledge gaps, but enhance patient care by reducing the waiting time for appointments, supplying physicians with crucial information before the patient’s visit, and thus boosting patient engagement. For chronic care patients in particular, changing the order of operations has been supremely beneficial.
You don’t miss things, because you’ve got the information on care received outside of Summit documented, screenings completed, and the preventative services teed up. As providers start addressing the patient’s chronic conditions and acute issues, they don’t miss the care gaps that also need to be addressed.
EHR with customized patient profile enhances psychiatric care
Betts Psychiatric is an Oregon-based psychiatric services and medication management provider with under 20 members of staff. Mr. Betts, the practice’s owner, needed an EHR that would let his specialists know their patients better to provide more personalized care, which is crucial in psychiatry. At the same time, he didn’t want an elaborate solution over-complicated with features, as those are expensive and take more time to implement.
Betts Psychiatric went for Valant software that can be integrated quickly and flawlessly with one’s healthcare systems, including billing and patient portals for collecting valuable data. It offered all of the essential EHR features like appointment scheduling and note-taking, making routine easier for the practitioners. At the same time, it enables patients to fill out symptom rating scales and outcome measurements through the patient portal before every appointment and then creates easy-to-read graphs that depict the evolution of symptoms over time, which makes a huge difference for the patients motivating them to stick to therapy and medication regimens.
Patients don’t always realize how well they’re doing from when they first came to see us, unless they can see it on a graph or something that’s factual. Valant software allows us to provide the quality of care that saves people’s lives.
To crown it all
Healthcare providers are under a lot of pressure to adopt electronic health records right now, both from regulatory organizations, the government, and their competitors. Despite a large amount of evidence suggesting that EHRs enhance patient care, boost company efficiency, and help improve profitability, practitioners are anxious to adopt this solution. While some are concerned about its high cost, others are worried about security, and there are also those who see mainstream EHRs as unfit for highly specialized clinical environments.
Custom EHR can be the key to dissolving some of these concerns. The ability to choose only the necessary features for their software gives clinicians more control and makes operating the system easier. Although they might be more expensive than off-the-shelf ones, they deliver a return on investment quickly thanks to being highly effective in the medical setting.
