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Beginning in 2019, all eligible professionals and hospitals in the USA are required to use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interoperability Program (the requirements were updated in the 2019). The certified EHR technology also may help with all your MIPS reporting, but for Advancing Care Information category, it’s necessary. The Advanced Alternate Payment Models (Advanced APMs) also require use of certified EHR technology. There are sixty 2015 Edition health IT certification criteria, which are organized into eight categories. ONC-Authorized Certification Bodies (ONC-ACBs) certify health IT products that have been successfully tested by an ONC-Authorized Testing Laboratory (ONC-ATL) to theses certification criteria. In order to qualify for these criteria, the EHR technology developer is required to conduct their own testing and submit a form to the test lab. The following test labs have been authorized by ONC: Drummond Group; ICSA Labs; UL LLCWeb; SLI Compliance, a Division of Gaming Laboratories International, LLC. Send us your request for information to get a quote. Contact us to know how our EHR/EMR experts could help you with EHR certification 1. Clinical Processes Criteria 1-3. Computerized Provider Order Entry (CPOE) The CPOE certification criterion splits into three separate categories with each criterion focused on one of three order types: medications, laboratory, and diagnostic imaging. This supports health IT developers to develop order-specific CPOE adaptations and provide more implementation flexibility. To meet the 2015 Edition Base EHR definition, providers must possess technology that has been certified to at least one of the following:  CPOE-Medication; CPOE-Laboratory; CPOE-Diagnostic Imaging CPOE-Medications allows clinicians to place orders electronically for transmission to the intended recipient such as a pharmacy. CPOE for medication ordering can reduce errors related to poor handwriting or the transcription of medication orders. CPOE can also enable automated drug-drug and drug-allergy interaction checks. In addition, medication information is updated in the patient’s medical record and becomes easily available for follow-up visits. Regulation Text §170.315 (a)(1) Computerized provider order entry—medications— Enable a user to record, change, and access medication orders. Optional. Include a “reason for order” field. CPOE-Laboratory allows clinicians to place orders electronically for transmission to the intended recipient such as a laboratory. In using CPOE for laboratory orders, orders are incorporated with patient information, which can then be transmitted quickly to the laboratory. Regulation Text §170.315 (a)(2) Computerized provider order entry—laboratory—  Enable a user to record, change, and access laboratory orders. Optional. Include a “reason for order” field. CPOE-Diagnostic Imaging allows clinicians to place orders electronically for transmission to the intended recipient such as a radiology department. In using CPOE for diagnostic imaging, orders are incorporated with patient information, which can then be transmitted quickly to the radiology department. This also enables computerized decision support to aid clinicians in choosing the best imaging to order. Regulation Text §170.315 (a)(3) Computerized provider order entry—diagnostic imaging— Enable a user to record, change, and access diagnostic imaging orders. Optional. Include a “reason for order” field. Criteria 4. Drug-drug, Drug-allergy Interaction Checks for CPOE. CPOE drug interaction capabilities gives real-time information on contraindications and/ or possible medication interactions at the time of ordering, minimizing the potential for adverse events or pharmacy call-backs. This capability can provide clinical decision support by displaying multiple types of information, including: drug-disease interactions, drug-allergy interactions, drug-frequency ranges, drug-dosage ranges, drug-drug interactions, drug-renal function dose adjustment, drug-laboratory monitoring requirements, and drug-age dosage adjustments, which can improve medication safety and effectiveness. Regulation Text §170.315 (a)(4) Drug-drug, drug-allergy interaction checks for CPOE— Interventions. Before a medication order is completed and acted upon during computerized provider order entry (CPOE), interventions must automatically indicate to a user drug-drug and drug-allergy contraindications based on a patient's medication list and medication allergy list. Adjustments.  Enable the severity level of interventions provided for drug-drug interaction checks to be adjusted. Limit the ability to adjust severity levels in at least one of these two ways: To a specific set of identified users. As a system administrative function. Criteria 5. Demographics Proper patient identification, patient safety, and efficient practice management require capturing accurate demographic information. Maintaining these data is essential for these purposes and supports population health activities. The demographic certification criterion supports the capture of patient health information with the granularity necessary to help clinicians identify opportunities for care improvement. This criterion confirms that a user can record, change, and access patient demographic data such as race and/or races, ethnicity and/or ethnicities, preferred language, sex, sexual orientation, gender identity, and date of birth. Regulation Text §170.315 (a)(5) Demographics— Enable a user to record, change, and access patient demographic data including race, ethnicity, preferred language, sex, sexual orientation, gender identity, and date of birth. Race and ethnicity.  Enable each one of a patient's races to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(2) and whether a patient declines to specify race. Enable each one of a patient's ethnicities to be recorded in accordance with, at a minimum, the standard specified in § 170.207(f)(2) and whether a patient declines to specify ethnicity. Aggregate each one of the patient's races and ethnicities recorded in accordance with paragraphs (a)(5)(i)(A)(1) and (2) of this section to the categories in the standard specified in § 170.207(f)(1). Preferred language. Enable preferred language to be recorded in accordance with the standard specified in § 170.207(g)(2) and whether a patient declines to specify a preferred language. Sex. Enable sex to be recorded in accordance with the standard specified in § 170.207(n)(1). Sexual orientation. Enable sexual orientation to be recorded in accordance with the standard specified in § 170.207(o)(1) and whether a patient declines to specify sexual orientation. Gender identity. Enable gender identity to be recorded in accordance with the standard specified in § 170.207(o)(2) and whether a patient declines to specify gender identity. Inpatient setting only. Enable a user to record, change, and access the preliminary cause of death and date of death in the event of mortality. Criteria 6. Problem List The problem list contains the patient’s current health problems, injuries, chronic conditions, and other factors that affect the overall health and well-being of the patient. The problem list may also contain other information such as when an illness or injury occurred, as well as when or if it resolved. Accurate active problem lists have been a pillar of efficient and effective primary care for years, providing a snapshot of a patient’s current health issues. Regulation Text §170.315 (a)(6) Problem list— Enable a user to record, change, and access a patient's active problem list: Ambulatory setting only. Over multiple encounters in accordance with, at a minimum, the version of the standard specified in §170.207(a)(4). Inpatient setting only. For the duration of an entire hospitalization in accordance with, at a minimum, the version of the standard specified in §170.207(a)(4). Criteria 7. Medication List  Along with an active problem list, having the electronic list of active and historical medications helps streamline visits, allows for the most efficient use of clinical staff, and makes on-call coverage safer and easier. Many practices develop a more comprehensive medication list by including over the counter drugs (OTCs), vitamins, and herbal or other types of nutritional supplements. In addition, having a current medication list for patient review at each patient visit helps patients to engage more fully with their care. Regulation Text §170.315 (a)(7) Medication list— Enable a user to record, change, and access a patient's active medication list as well as medication history: Ambulatory setting only. Over multiple encounters. Inpatient setting only. For the duration of an entire hospitalization. Criteria 8. Medication Allergy List  Maintaining a list of known medication allergies for each patient is essential for safe patient care. Having this information available electronically allows for easy review when prescribing new medications to a patient. Regulation Text §170.315 (a)(8) Medication allergy list— Enable a user to record, change, and access a patient's active medication allergy list as well as medication allergy history: Ambulatory setting only. Over multiple encounters. Inpatient setting only. For the duration of an entire hospitalization. Criteria 9. Clinical Decision Support (CDS)  Clinical decision support provides relevant knowledge and person-specific information, intelligently filtered or presented at appropriate times, to increase quality of care and enhance health outcomes. CDS can be developed for multiple users, including clinicians, staff, and patients. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include contextually relevant reference information, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support including drug-disease interaction checking, alerts, and reminders, among other tools. Regulation Text §170.315 (a)(9) Clinical decision support (CDS)— CDS intervention interaction. Interventions provided to a user must occur when a user is interacting with technology. CDS configuration. Enable interventions and reference resources specified in paragraphs (a)(9)(iii) and (iv) of this section to be configured by a limited set of identified users (e.g., system administrator) based on a user's role. Enable interventions: Based on the following data: Problem list; Medication list; Medication allergy list; At least one demographic specified in paragraph (a)(5)(i) of this section; Laboratory tests; and Vital signs. When a patient's medications, medication allergies, and problems are incorporated from a transition of care/referral summary received and pursuant to paragraph (b)(2)(iii)(D) of this section. Evidence-based decision support interventions. Enable a limited set of identified users to select (i.e., activate) electronic CDS interventions (in addition to drug-drug and drug-allergy contraindication checking) based on each one and at least one combination of the data referenced in paragraphs (a)(9)(ii)(B)(1)(i) through (vi) of this section. Linked referential CDS. Identify for a user diagnostic and therapeutic reference information in accordance at least one of the following standards and implementation specifications: The standard and implementation specifications specified in §170.204(b)(3). The standard and implementation specifications specified in §170.204(b)(4). For paragraph (a)(9)(iv)(A) of this section, technology must be able to identify for a user diagnostic or therapeutic reference information based on each one and at least one combination of the data referenced in paragraphs (a)(9)(ii)(B)(1)(i), (ii), and (iv) of this section. Source attributes. Enable a user to review the attributes as indicated for all CDS resources: For evidence-based decision support interventions under paragraph (a)(9)(iii) of this section: Bibliographic citation of the intervention (clinical research/guideline); Developer of the intervention (translation from clinical research/guideline); Funding source of the intervention development technical implementation; and Release and, if applicable, revision date(s) of the intervention or reference source. For linked referential CDS in paragraph (a)(9)(iv) of this section and drug-drug, drug-allergy interaction checks in paragraph (a)(4) of this section, the developer of the intervention, and where clinically indicated, the bibliographic citation of the intervention (clinical research/guideline). Criteria 10. Drug-formulary and Preferred Drug List Checks  An automated drug-formulary and preferred drug list enables a clinician to more easily and effectively identify medications approved (or preferred) to be prescribed for a patient based on the patient’s health insurance or health system/hospital policy. This can help reduce unforeseen medication costs when the patient picks up their prescriptions and inform discussions between the patient and clinician at the point of prescribing. Regulation Text §170.315 (a)(10) Drug-formulary and preferred drug list checks— The requirements specified in one of the following paragraphs (that is, paragraphs (a)(10)(i) and (a)(10)(ii) of this section) must be met to satisfy this certification criterion: Drug formulary checks. Automatically check whether a drug formulary exists for a given patient and medication. Preferred drug list checks. Automatically check whether a preferred drug list exists for a given patient and medication. Criteria 11. Smoking Status  Tobacco use and tobacco-related illness represents the single greatest preventable health risk to patients in the United States. There is clear and compelling evidence that clinician interest in a patient’s tobacco use can be an important first step in durable cessation, and the simple act of asking and recording a patient’s use of tobacco can have a profound benefit. Clinicians can also use this information to tailor discussions and specific care plans with a patient.  Regulation Text §170.315 (a)(11) Smoking status— Enable a user to record, change, and access the smoking status of a patient. Criteria 12. Family Health History  Capturing family health history electronically can help to inform clinical decision support (CDS) for screening and prevention of illnesses or conditions that a patient may be at increased risk for due to their family health history. In addition to potentially reducing costs and improving population health, capturing this information once can improve efficiencies by minimizing the collection of duplicate information across settings.  Regulation Text §170.315 (a)(12) Family health history— Enable a user to record, change, and access a patient's family health history in accordance with the familial concepts or expressions included in, at a minimum, the version of the standard in §170.207(a)(4). Criteria 13. Patient-specific Education Resources  Patient-specific education is designed to help patients both understand and make better decisions about their health. These resources may come in the form of articles, videos, and images, all of which allow the patient to better understand their health and make informed health decisions.  Regulation Text §170.315 (a)(13) Patient-specific education resources— Identify patient-specific education resources based on data included in the patient's problem list and medication list in accordance with at least one of the following standards and implementation specifications: The standard and implementation specifications specified in §170.204(b)(3). The standard and implementation specifications specified in §170.204(b)(4). Optional. Request that patient-specific education resources be identified in accordance with the standard in §170.207(g)(2). Criteria 14. Implantable Device List Integrating unique device identifiers (UDIs) into certified health IT supports clinicians to better track the safety and performance of devices used by their patients regardless of setting or specialty. In the event of a product recall this information can help clinicians to identify all potentially affected patients. It can also allow clinicians to identify trends in outcomes related to a particular device. Having implantable device information available across the patient’s care continuum can help clinicians to make the best care decisions.   Regulation Text §170.315 (a)(14) Implantable device list— Record Unique Device Identifiers associated with a patient's Implantable Devices. Parse the following identifiers from a Unique Device Identifier: Device Identifier; and The following identifiers that compose the Production Identifier: The lot or batch within which a device was manufactured; The serial number of a specific device; The expiration date of a specific device; The date a specific device was manufactured; and For an HCT/P regulated as a device, the distinct identification code required by 21 CFR 1271.290(c). Obtain and associate with each Unique Device Identifier: A description of the implantable device referenced by at least one of the following: The “GMDN PT Name” attribute associated with the Device Identifier in the Global Unique Device Identification Database. The “SNOMED CT® Description” mapped to the attribute referenced in in paragraph (a)(14)(iii)(A)(1) of this section. The following Global Unique Device Identification Database attributes: “Brand Name”; “Version or Model”; “Company Name”; “What MRI safety information does the labeling contain?”; and “Device required to be labeled as containing natural rubber latex or dry natural rubber (21 CFR 801.437).” Display to a user an implantable device list consisting of: The active Unique Device Identifiers recorded for the patient; For each active Unique Device Identifier recorded for a patient, the description of the implantable device specified by paragraph (a)(14)(iii)(A) of this section; and A method to access all Unique Device Identifiers recorded for a patient. For each Unique Device Identifier recorded for a patient, enable a user to access: The Unique Device Identifier; The description of the implantable device specified by paragraph (a)(14)(iii)(A) of this section; The identifiers associated with the Unique Device Identifier, as specified by paragraph (a)(14)(ii) of this section; and The attributes associated with the Unique Device Identifier, as specified by paragraph (a)(14)(iii)(B) of this section. Enable a user to change the status of a Unique Device Identifier recorded for a patient. Criteria 15. Social, Psychological, and Behavioral Data  The capture of social, psychological, and behavioral data (also known as social determinants of health) can help to provide a more complete view of a patient’s overall health status. This in turn can help the clinician make more appropriate decisions, enhancing patient care and outcomes. This information can also help the health care team to identify patients with elevated risk factors and reduce health disparities. Examples of this type of information include financial resource strain, education level, amount of stress, depression, physical activity level, alcohol use, recreational drug use, social connection and isolation, and exposure to violence (i.e., intimate partner violence). This data can improve care coordination and lead to the identification of appropriate social supports and community resources. Regulation Text §170.315 (a)(15) Social, psychological, and behavioral data— Enable a user to record, change, and access the following patient social, psychological, and behavioral data: Financial resource strain. Enable financial resource strain to be recorded in accordance with the standard specified in §170.207(p)(1) and whether a patient declines to specify financial resource strain. Education. Enable education to be recorded in accordance with the standard specified in §170.207(p)(2) and whether a patient declines to specify education. Stress. Enable stress to be recorded in accordance with the standard specified in §170.207(p)(3) and whether a patient declines to specify stress. Depression. Enable depression to be recorded in accordance with the standard specified in §170.207(p)(4) and whether a patient declines to specify depression. Physical activity. Enable physical activity to be recorded in accordance with the standard specified in §170.207(p)(5) and whether a patient declines to specify physical activity. Alcohol use. Enable alcohol use to be recorded in accordance with the standard specified in §170.207(p)(6) and whether a patient declines to specify alcohol use. Social connection and isolation. Enable social connection and isolation to be recorded in accordance the standard specified in §170.207(p)(7) and whether a patient declines to specify social connection and isolation. Exposure to violence (intimate partner violence). Enable exposure to violence (intimate partner violence) to be recorded in accordance with the standard specified in §170.207(p)(8) and whether a patient declines to specify exposure to violence (intimate partner violence). 2. Care Coordination Criteria 16. Transitions of Care  A transition of care summary and referral summaries provide essential clinical information for the receiving care team and helps organize final clinical and administrative activities for the transferring care team. This summary helps ensure the coordination and continuity of health care as patients transfer between different clinicians at different health organizations or different levels of care within the same health organization. This document improves admissions, discharges and other transition processes, communication among clinicians, and cross-setting relationships which can improve care quality and safety. This certification criterion will rigorously assess a product’s ability to create, receive, and properly consume interoperable documents using a common content and transport standard (e.g., Consolidated Clinical Document Architecture (C-CDA) and Direct Edge Protocol, respectively) that include key health data (e.g., name, date of birth, medications) that should be accessible and available for exchange. Regulation Text §170.315 (b)(1) Transitions of care— Send and receive via edge protocol— Send transition of care/referral summaries through a method that conforms to the standard specified in § 170.202(d) and that leads to such summaries being processed by a service that has implemented the standard specified in § 170.202(a); and Receive transition of care/referral summaries through a method that conforms to the standard specified in § 170.202(d) from a service that has implemented the standard specified in § 170.202(a)(2). XDM processing. Receive and make available the contents of a XDM package formatted in accordance with the standard adopted in § 170.205(p)(1) when the technology is also being certified using an SMTP-based edge protocol. Validate and display— Validate C-CDA conformance – system performance. Demonstrate the ability to detect valid and invalid transition of care/referral summaries received and formatted in accordance with the standards specified in § 170.205(a)(3) and § 170.205(a)(4) for the Continuity of Care Document, Referral Note, and (inpatient setting only) Discharge Summary document templates. This includes the ability to: Parse each of the document types. Detect errors in corresponding “document-templates,” “section-templates,” and “entry-templates,” including invalid vocabulary standards and codes not specified in the standards adopted in § 170.205(a)(3) and § 170.205(a)(4). Identify valid document-templates and process the data elements required in the corresponding section-templates and entry-templates from the standards adopted in § 170.205(a)(3) and § 170.205(a)(4). Correctly interpret empty sections and null combinations. Record errors encountered and allow a user through at least one of the following ways to: Be notified of the errors produced. Review the errors produced. Display. Display in human readable format the data included in transition of care/referral summaries received and formatted according to the standards specified in § 170.205(a)(3) and § 170.205(a)(4). Display section views. Allow for the individual display of each section (and the accompanying document header information) that is included in a transition of care/referral summary received and formatted in accordance with the standards adopted in § 170.205(a)(3) and § 170.205(a)(4) in a manner that enables the user to: Directly display only the data within a particular section; Set a preference for the display order of specific sections; and Set the initial quantity of sections to be displayed. Create. Enable a user to create a transition of care/referral summary formatted in accordance with the standard specified in § 170.205(a)(4) using the Continuity of Care Document, Referral Note, and (inpatient setting only) Discharge Summary document templates that includes, at a minimum: The Common Clinical Data Set. Encounter diagnoses. Formatted according to at least one of the following standards: The standard specified in § 170.207(i). At a minimum, the version of the standard specified in § 170.207(a)(4). Cognitive status. Functional status. Ambulatory setting only. The reason for referral; and referring or transitioning provider's name and office contact information. Inpatient setting only. Discharge instructions. Patient matching data. First name, last name, previous name, middle name (including middle initial), suffix, date of birth, address, phone number, and sex. The following constraints apply: Date of birth constraint. The year, month and day of birth must be present for a date of birth. The technology must include a null value when the date of birth is unknown. Optional. When the hour, minute, and second are associated with a date of birth the technology must demonstrate that the correct time zone offset is included. Phone number constraint. Represent phone number (home, business, cell) in accordance with the standards adopted in § 170.207(q)(1). All phone numbers must be included when multiple phone numbers are present. Sex constraint. Represent sex in accordance with the standard adopted in § 170.207(n)(1). Criteria 17. Clinical Information Reconciliation and Incorporation (CIRI)  CIRI allows clinicians to reconcile and incorporate patient health information sent in from external sources to maintain a more accurate and up-to-date patient record. This process can help reduce errors that are especially common among patients who use multiple pharmacies, have co-morbidity factors, and multiple health care clinicians. The Consolidated Clinical Document Architecture (C-CDA) document, shared with clinicians from external sources such as hospitals, Health Information Exchanges (HIEs), or other clinicians, allow the clinician to import and reconcile health care information into their own patient record.  Regulation Text §170.315 (b)(2) Clinical information reconciliation and incorporation— General requirements. Paragraphs (b)(2)(ii) and (iii) of this section must be completed based on the receipt of a transition of care/referral summary formatted in accordance with the standards adopted in §170.205(a)(3) and §170.205(a)(4) using the Continuity of Care Document, Referral Note, and (inpatient setting only) Discharge Summary document templates. Correct patient. Upon receipt of a transition of care/referral summary formatted according to the standards adopted §170.205(a)(3) and §170.205(a)(4), technology must be able to demonstrate that the transition of care/referral summary received can be properly matched to the correct patient. Reconciliation. Enable a user to reconcile the data that represent a patient's active medication list, medication allergy list, and problem list as follows. For each list type: Simultaneously display (i.e., in a single view) the data from at least two sources in a manner that allows a user to view the data and their attributes, which must include, at a minimum, the source and last modification date. Enable a user to create a single reconciled list of each of the following: Medications; medication allergies; and problems. Enable a user to review and validate the accuracy of a final set of data. Upon a user's confirmation, automatically update the list, and incorporate the following data expressed according to the specified standard(s): Medications. At a minimum, the version of the standard specified in §170.207(d)(3); Medication allergies. At a minimum, the version of the standard specified in §170.207(d)(3); and Problems. At a minimum, the version of the standard specified in §170.207(a)(4). System verification. Based on the data reconciled and incorporated, the technology must be able to create a file formatted according to the standard specified in §170.205(a)(4) using the Continuity of Care Document document template. Criteria 18. Electronic Prescribing  Electronic prescribing (e-Prescribing or eRx) is a fast, efficient way to write/re-order and transmit prescriptions. Electronic prescribing may also have pre-set fields so all the required information for prescriptions are entered and automatically stored in the patient’s record for easy review during follow-up visits or for transitions to other clinicians. Prescriptions can be automatically transmitted to a pharmacy of preference, resulting in increased overall patient satisfaction and convenience. Clinicians can also send and receive other prescription-related messages with the pharmacy, including prescription cancel requests as well as requests for a patient’s medication history. Using an electronic system also provides guided dose algorithms to assist clinicians. Regulation Text §170.315 (b)(3) Electronic prescribing— Enable a user to perform all of the following prescription-related electronic transactions in accordance with the standard specified in §170.205(b)(2) and, at a minimum, the version of the standard specified in §170.207(d)(3) as follows: Create new prescriptions (NEWRX). Change prescriptions (RXCHG, CHGRES). Cancel prescriptions (CANRX, CANRES). Refill prescriptions (REFREQ, REFRES). Receive fill status notifications (RXFILL). Request and receive medication history information (RXHREQ, RXHRES). For each transaction listed in paragraph (b)(3)(i) of this section, the technology must be able to receive and transmit the reason for the prescription using the diagnosis elements in DRU Segment. Optional. For each transaction listed in paragraph (b)(3)(i) of this section, the technology must be able to receive and transmit the reason for the prescription using the indication elements in the SIG Segment. Limit a user's ability to prescribe all oral liquid medications in only metric standard units of mL (i.e., not cc). Always insert leading zeroes before the decimal point for amounts less than one and must not allow trailing zeroes after a decimal point when a user prescribes medications. Criteria 19-20. Common Clinical Data Set Summary Record – Create and Receive   A transition of care summary and referral summaries provide essential clinical information for the receiving care team and helps organize final clinical and administrative activities for the transferring care team. This summary helps ensure the coordination and continuity of health care as patients transfer between different clinicians at different health organizations or different levels of care within the same health organization. This document improves admissions, discharges and other transition processes, communication among clinicians, and cross-setting relationships which can improve care quality and safety. This certification criterion will rigorously assess a product’s ability to create and receive interoperable documents using a common content standard (e.g., Consolidated Clinical Document Architecture (C-CDA)) that include key health data (e.g., name, date of birth, medications) that should be accessible and available for exchange. Criteria 21. Data Export  Data export provides access and ability to export patient data for use in a different health IT system or a third party system for the purpose of a clinician’s choosing. This facilitates the accessibility and exchange of data, ensuring critical data is included when creating and exporting key patient health information, including name, sex, date of birth, problem list, medication list, functional status, reason for referral, and other vital information. Criteria 22-23. Data Segmentation for Privacy – Send and Receive  Sensitive health data is often exchanged via fax or paper-based methods, or excluded from data exchange altogether, meaning a clinician may not have all the relevant data at the point of care. This can lead to lower quality of care for the patient and can also lead to redundant, unnecessary, or harmful care. This criterion confirms that health IT is capable of sending and receiving a tagged transition of care summary document with privacy metadata that expresses the data classification and possible re-disclosure restrictions placed on the data by applicable law. This standard improves patient safety, the comprehensiveness of treatment, and quality of care, as well as supports and enables the delivery of more effective care to sub-groups of patients. Criteria 24. Care Plan  The care plan can help improve coordination of care by providing a structured format for documenting patient information such as goals, health concerns, health status evaluations, and interventions. Inclusion of this information is essential to incorporating the patient’s perspective, improving outcomes, and represents an important step toward realizing a longitudinal, dynamic, shared care plan. 3. Clinical Quality Measurement Criteria 25. Clinical Quality Measures – Record and Export  Clinical quality measures (CQMs) can help clinicians understand and improve the quality of health care for their beneficiaries. CQMs are also used by CMS and other health care organizations for quality improvement, public reporting, and pay-for-reporting programs for specific health care clinicians. This criterion ensures that health IT systems can record and export CQM data electronically (eCQM). The ability to export eCQM data can help a clinician or health system to view and verify their eCQM results for quality improvement on a near real-time basis. The export functionality gives clinicians the ability to export their results to multiple programs, such as those run by CMS, states, and private payers.  Criteria 26. Clinical Quality Measures – Import and Calculate  This criterion supports streamlined clinician processes through the importing of CQM data in a standardized format, reducing the need for manual patient data entry. It also ensures that health IT systems can correctly calculate eCQM results using a standardized format. Criteria 27. Clinical Quality Measures – Report  This criterion supports eCQM reporting using consensus-based industry standards (Health Level 7 Quality Reporting Document Architecture (HL7 QRDA)) and also supports better alignment with the reporting requirements of CMS programs by providing a baseline for interoperability of eCQM data. The requirements for reporting to CMS are included as an optional provision within the criterion because not all certified health IT is intended to be used for CMS reporting. Additionally, the HL7 QRDA standards are program-agnostic and can support a number of use cases for exchanging CQM data.  Criteria 28. Clinical Quality Measures - Filter  The filter functionality included in this criterion supports the capability for a clinician to make a query for eCQM results using one or a combination of data captured by the certified health IT for quality improvement and quality reporting purposes. It can also aid in the identification of health disparities, enable care quality improvement, and support clinicians in delivering more effective care to their patient populations. This certification criterion requires a Health IT Module to be able to record data (according to specified standards, where applicable) and filter CQM results at both patient and aggregate levels. These filters include, but are not limited to, practice site address, patient age, patient sex, and patient problem list. 4. Privacy & Security Criteria 29. Authentication, Access Control, and Authorization  Maintaining the confidentiality of patient health information is an important responsibility for clinicians. This certification criterion supports patient information to be safeguarded by requiring that health IT only permit access to patient health information by users who have valid credentials and only allowing credentialed users to access the types of information legitimately needed to perform their duties.  Criteria 30. Auditable Events and Tamper-Resistance  Applying privacy and security safeguards help protect patient information and can help clinicians avoid common security gaps that lead to cyber-attack or data loss. This certification criterion requires that by default, actions related to health information are recorded, such as who has accessed a patient’s information, and when, where, and how that access occurred. This capability (coupled with other Privacy and Security criteria such as “Audit Report(s)” and “Auditing Actions on Health Information”) enables a practice to review audit logs and thereby regularly monitor access to patient information and detect unauthorized access. This criterion also confirms that health IT is capable of preventing such audit logs from being changed, overwritten or deleted.  Criteria 31. Audit Report(s)  Audit report(s) enables a user to create reports of events recorded in audit trails and audit logs (see “Auditable Events and Tamper-Resistance”). Periodic reviews of audit reports provide many benefits such as preparing evidence during investigations of suspected or known security breaches, detecting unauthorized access to patient health information, and investigating patient complaints or employee concerns about suspected unauthorized access to patient data. Criteria 32. Amendments  Under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, patients may request corrections and amendments to their patient health information. This certification criterion supports the capability for clinicians to easily append the amendment to a patient’s health record, or provide a link that indicates an amendment’s location. Criteria 33. Automatic Access Time-Out  Automatic access time-out prevents unauthorized users from viewing or accessing electronic health information from unattended system devices (e.g., laptops, tablets) after a predetermined period of inactivity and requires a user to re-enter their credentials (e.g., password, pin number) in order to resume or regain access. Criteria 34. Emergency Access  During critical situations, clinicians may need emergency access to a patient’s health information to quickly provide crucial services and emergency care. Having access to patient data such as treatment history, known allergies, and medications can make the difference between life and death for patients. Practices can use this capability to assure that an identified set of users can access electronic health information during an emergency. Criteria 35. End-User Device Encryption  Patient health information can be breached when unencrypted end-user devices (e.g., laptops, tablets, smartphones) are lost or stolen. This criterion focuses on the capability of certified health IT to encrypt and decrypt electronic health information managed by certified health IT on end-user devices if the electronic health information remains stored on the devices when they no longer connected to the certified health IT. Criteria 36. Integrity  Ensuring that a patient’s record is secured, protected and contains accurate data is essential for both patient safety and quality of care. This certification criterion helps assure that data is not compromised during electronic exchange by creating a message digest verifying that the exchanged health information has not been altered. Criteria 37. Trusted Connection  Establishing a trusted connection provides assurance that electronic health data being exchanged will remain private and secure when transferring from point A to point B. This assurance is often displayed as an icon or symbol (such as a “lock”) depending on the technology.   Criteria 38. Auditing Actions on Health Information  This certification criterion supports the recording of auditable events (see “Auditable Events and Tamper-Resistance”) for the purpose of creating audit logs that help a practice monitor access to patient health information and detect unauthorized access.  Criteria 39. Accounting of Disclosures  This certification criterion ensures health IT can record disclosures made for treatment, payment, and health care operations. This includes recording data such as the date, time, patient identification, user identification, and a description of disclosures as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Rules (see 45 CFR 164.501).  5. Patient Engagement Criteria 40. View, Download, and Transmit to 3rd Party  This certification criterion supports patient access to their health information, including via email transmission to any third party the patient chooses (including to any email address, so long as the patient is properly advised of the risks of doing so) and through a second encrypted method of transmission (which could be accomplished with Direct or by another encrypted means). This allows patients to be more engaged in their care and enhance care coordination and management. Criteria 41. Secure Messaging  Secure messaging enables a clinician to send messages to, and receive messages from, a patient in a secure manner to ensure appropriate access and secure exchange of health information. Criteria 42. Patient Health Information Capture  This certification criterion supports clinician acceptance of health information from patients which can advance patient engagement and activation, as well as support the use of patient generated health data (PGHD) in shared decision-making. This can help provide health information to clinicians and help address health disparities in populations that are less likely to execute health care planning documents. 6. Public Health Criteria 43. Transmission to Immunization Registries  Immunization Registries provide a consolidated, reconciled source of individual level immunizations. Immunization registries are typically part of larger Immunization Information Systems (IIS) that offer services beyond the registry. IIS are managed by state and jurisdictional public health departments. They provide public health information on vaccine coverage in their communities, inform public health immunization policy and programs, and provide information to inform the outbreaks of vaccine preventable. For clinicians, IIS provide information that otherwise may not be found in their local health IT. IIS help prevent over vaccination, and provide information that can be helpful in determining “catch-up” schedules for missing vaccination. Criteria 44. Transmission to Public Health Agencies – Syndromic Surveillance  Syndromic Surveillance Systems (SyS) collect individual level data from hospital emergency departments, urgent care clinics and, in some jurisdictions, other clinicians. SyS are managed by state and jurisdictional public health departments. SyS were originally built to help identify potential bio-terrorism events. The data are also useful on providing indicators on many infectious diseases, food borne diseases, situational awareness during public health responses and other types of surveillance. SyS often include the ability to interoperate with additional statistical tools used by epidemiologists and researchers. Many states and jurisdictions are sharing de-identified data across boundaries. Criteria 45. Transmission to Public Health Agencies – Reportable Laboratory Tests and Values/Results  As part of state and local disease surveillance, laboratories are required to report on laboratory tests and results for “Reportable Diseases.” Reportable diseases differ by state, but there is a core set found in all public health departments. The electronic transmission has improved the timeliness and quality of reports. The elimination of “re-keying” data not only improves quality but frees staff resources for other tasks. Laboratory test results are sometimes the first indication of disease and in some cases support disease reporting from clinicians.  Criteria 46. Transmission to Cancer Registries  Cancer Registries have provided detailed information on cancer for many decades. Hospital cancer registries report up to “centralized” cancer registries that may be at the county or state level. This “upward” reporting continues onto the national level at the Centers for Disease Control and Prevention (CDC) where de-identified data is collected and analyzed. Automating the complex and detailed cancer reports using information found in health IT reduces burden on clinicians and their staff and provides timely and accurate data on both diseases and treatment. Criteria 47. Transmission to Public Health Agencies – Electronic Case Reporting  State and local health departments mandate that clinicians provide information on a list of “Reportable Diseases.” Reportable diseases differ by state, but there is a core set found in all public health departments. The electronic transmission of case information from health IT improves not only the timeliness and quality of reports but reduces “under-reporting” that can occur for many reasons. Electronic case reporting provides additional clinical information beyond the data found in electronic laboratory reporting. Criteria 48. Transmission to Public Health Agencies – Antimicrobial Use and Resistance Reporting  Antimicrobial use/antimicrobial resistance (AU/AR), unlike many other public health reporting processes, is reported directly to Centers for Disease Control and Prevention. This type of public health reporting reports and analyzes antimicrobial use and/or resistance as part of local or regional efforts to reduce antimicrobial resistant infections. This collection and analysis on antimicrobial use and antimicrobial resistance are important components of antimicrobial stewardship programs throughout the nation and can promote timely, accurate, and complete reporting, particularly if data is extracted from health IT systems and delivered using well established data exchange standards to a public health registry.  Criteria 49. Transmission to Public Health Agencies – Health Care Surveys  This certification criterion supports the transmission of health care surveys to directly to the Centers for Disease Control and Prevention. The National Health Care Surveys are designed to answer key questions of interest to health care policy makers, public health professionals, and researchers. This may include factors that influence the use of health care resources, and the quality of health care such as safety, and disparities in health care services.  7. Health IT Design and Performance Criteria 50. Automated Numerator Recording  Clinicians participating in certain Centers for Medicare and Medicaid (CMS) payment programs, such as the EHR Incentive Programs and Quality Payment Program, are required to submit certain percentage-based measures to CMS in compliance with the program's reporting requirements. This criterion aims to ease the burden of creating a report for submission to CMS, particularly for smaller clinician offices and hospitals. Automated numerator recording allows a health IT user to automatically create a report or file that enables a user to review the patients or actions that are included in a measure’s numerator.  Criteria 51. Automated Measure Calculation  Automated measure calculation allows a health IT user to electronically record the numerator and denominator for the CMS’ EHR Incentive Programs percentage-based measures and to create a report of the measures. This automation is intended to improve the accuracy of measure calculations and to reduce burden for clinicians and hospitals in calculating and reporting measures.  Criteria 52. Safety-Enhanced Design  This certification criterion focuses on health IT usability and safety. The criterion requires health IT that includes certain certified capabilities to demonstrate compliance with specified user-center design requirements. The capabilities identified are those that pose the greatest opportunity for error prevention and improved patient safety.   Criteria 53. Quality Management System  This certification criterion requires health IT developers to identify the quality management systems (QMS) used in the development, testing, implementation, and maintenance of certified capabilities. The QMS identified by the health IT developer must be consistent with federal QMS standards or QMS standards developed by standards developing organizations.  Criteria 54. Accessibility-Centered Design  This certification criterion encourages health IT developers to identify the accessibility standards used, and accessibility laws complied with, in the development of certified health IT. Clinicians, consumers, and other stakeholders benefit the application of user-centered design standards for accessibility to health IT and the compliance of health IT with accessibility laws as well as increased transparency around such actions. Criteria 55. Consolidated CDA Creation Performance  This certification criterion helps to ensure the interoperability of transition of care and referral summaries sent and received to and from external organizations. No matter how data is entered into health IT – via whatever workflow and functionality – the transition of care or referral summary should reflect the data accurately and not be missing data a user otherwise recorded.  Criteria 56-58. Application Access – Patient Selection, Data Category Request and All Data Request The “application access” certification criteria are split into three separate certification criteria (Patient Selection, Data Category Request, and All Data Request) with each individual criterion focused on specific functionality. The “application access” certification criteria require health IT to demonstrate it can provide application access to a common set of patient clinical data via an application programming interface (API). API functionality will help address many of the challenges currently faced by individuals and caregivers accessing their health data, including the “multiple portal” problem, by potentially allowing individuals to aggregate data from multiple sources in a web or mobile application of their choice.  8. Electronic Exchange Criteria 59. Direct Project  Despite the increase in health IT adoption, many providers and organizations still remain reliant on paper, phone, fax, and physical transport to exchange patient information. The Direct Project is a low-cost, practical, secure mechanism for exchanging health information electronically instead of relying on slow, inconvenient, expensive methods of exchange such as paper and faxes, providing a path to more advanced interoperability. Direct makes it possible for providers to securely email information to other trusted providers or parties, such as specialists, pharmacies, and laboratories. The Direct Project does not replace other ways of exchanging information electronically but rather enhances them.  Criteria 60. Direct Project, Edge Protocol, and XDR/XDM  Effective, efficient, and secure communications between health care providers is a key contributing factor to providing better patient care. Direct Project, Edge Protocol, and Crossenterprise Document Reliable Interchange/Cross-enterprise Document Media Interchange (XDR/ XDM) allows standard protocols, along with message formats and processing requirements to work together to securely transport health information electronically by including three distinct capabilities to support interoperability and all potential certified exchange options. 

✅ What is an open source EHR? Open source EHR is a fully functioning EHR/EMR system that you can start to implement today for free. Open source software is software with freely available source code. Unlike proprietary software, anyone can modify and distribute the code without licensing fees, as defined in the software’s license. The term “open source” does not imply that the data in an open source system is available to anyone. In fact, many argue that open source systems are safer than proprietary systems. Open source software generally provides greater flexibility to select and switch vendors and make changes to the software. Various successful open source health information technology and EHR projects exist and should be evaluated before creating a system or purchasing a proprietary system. Key Similarities and Differences between Open Source and Proprietary EHRs Similarities (same for both systems) Require planning before implementation (cost estimation, processes standardization, etc.). Require implementation (software customization, training of personnel, server setup, etc.). Require maintenance after implementation (software, creating and training new users, etc.). Require data and information security measures to prevent data leaks and other IT security threats. Require a legal framework (patient data confidentiality, security, interoperability, etc.). Differences Open source EHRs: Client can make improvements independent of vendor. Client can implement it without vendor. Client can use system if vendor contract ends. Client can look and try out system before implementation without vendor assistance. Client can get service from many vendors. Client can add functionality through source code updates and modifications. Proprietary EHRs: Company that owns software decides who can provide services, such as implementation or support. Client is unable to improve or update software until vendor releases a new version. Client may need vendor support to implement/customize functionality. Vendor may limit free trials to a few days. Vendor have multitude of business licensing models with variability in subscription terms and maintenance. In general, Open Source Software provides more power and options to the customer because the customer owns not only its own data, but also the system itself, which has many advantages. Advantages of Open Source EHRs: Very easy to acquire and test before implementation. Less vendor lock, meaning they aren’t required to use the EHR vendor for all changes to the system. More control over data. Reduced development and configuration costs. Increased interoperability. Most solutions include open and international standards. Reduced Vendor Lock Because modifications to an EHR system tend to be complex, many vendors of proprietary EHRs are known for charging high fees for this work, increasing their fees once the system has been implemented, or providing poor service. With an open source EHR system, the customer can choose whether to use a vendor or internal IT people to modify the system. If a vendor is chosen, the customer has more control over the vendor because the customer can change vendors without also losing the system. That said, given the complexities of maintaining a functioning EHR system, changing vendors is not easy either. For example, there may not be another vendor in the region for the system, or customizations or missing documentation would make changing vendors difficult. Despite these constraints, the use of open source EHRs provides more leverage to hospitals, governments, and other consumers in a market that is highly controlled by EHR companies. This is even more important for national or regional implementations where a Ministry of Health, for example, chooses a single system and by default creates a regulatory monopoly. If the system is not open source, the cost of changing the system is so high that the vendor is practically irreplaceable. There have been many cases of vendors using this position to their favor. As an example, consider the situation if two countries implement a national EHR system, with Country A using a proprietary system and Country B using open source tools to build their own. Country A has to pay the vendor for each update, and only the vendor can modify the functionality. As a result, Country A has to pay any fee set by the vendor. Country B is able to change or update its EHR system according to its budget and can use a vendor or an in-house IT team to make modifications. Increased Control of Data Customers of open source systems can have more say and control over how the data are stored and used. This facilitates, for example, the development or use of complementary programs to access that data for in-house reporting. A problem that arises frequently in proprietary EHR systems is that the customer lacks control of features, such as reporting functions, in the system. This was the case, where health centers had to pay every month to get their monthly report with updated data. A similar problem is that proprietary EHR customers cannot change the content of the report even if it is discovered that the report no longer fits the client’s needs. With open source EHR, a customer can modify functionality independent of the vendor to extract and view their data. So if the customer wants to examine specific data to determine how to better meet patients’ need or other purposes, the customer has the option of doing it themselves and not necessarily rely on the vendor as with many proprietary systems. All of this, however, is dependent on the customer having the appropriate technical access to their system. Reduced Developmental Costs and Flexibility to Expand Given that open source EHR is free to download and try for any length of time and proprietary software, if the vendor allows, often has short test periods, open source EHR systems have less risk. Furthermore, if the open source system has many organizations continually improving it by developing it, then the customer may get that additional functionality without having to pay for its development. Additionally, open source EHR systems have the benefit of allowing the customer to choose who builds additional functionality for them, so they are not bound to their current vendor. EHR systems are complex and have a high failure rate, but they are also an essential part of the workflow. Because of this, chang- ing EHR systems is expensive and getting it right the first time is difficult. Thus, organizations should want to have a system that they can modify and expand with as little cost as possible and a vendor who is flexible. Both of these occur more easily with open source EHR systems. To modify the system, for example, if the code is open source, the customer has options as to who develops it whether internally, through their vendor, or another vendor. Also, given that the customer has more options and is not locked into a contract with one vendor, the vendor has to be more flexible. Increased Interoperability Though both open and proprietary systems can use open standards, open source systems are more likely to use these standards. This is, in part, because people who work with OSS systems tend to be in favor of open standards, whereas proprie- tary vendors have a commercial interest in keeping clients from changing to another system. Proprietary vendors therefore tend to be wary of open standards. A review paper found that proprietary issues were in the top three reasons for lack of interoperability, after privacy and sustainability. Building your own EHR If your organization has decided to build its own EHR system or have its IT staff provide technical support for a system that will be built, using an open source EHR system as a starting point is the most logical choice. Most, if not all, open source EHR systems have already established the basic functionality required for a good system. This includes creating users, permissions, and reports. Additionally, many have created flexible frameworks to customize the system to the needs of the organization. In ge- neral, these functionalities have been tested over many years by different organizations to ensure they work, and it is harder to justify the expense involved in recreating them for the new system. For example, OpenMRS has spent at least US$8 million creating its system, and that money does not need to be spent again to reinvent the wheel. ✅ What are the top 3 Open Source EHR systems? There are over 30 open source EHR systems worldwide such as OpenEMR, Docmein, HealthKit, ERPNext, OpenMRS, one touch emr, FreeMED, GNU Health, Vista EHR, Bahmni, HospitalRun, CottageMed, OpenClinic, WorldVistA, GNUmed, FreeMedForms, ZEPRS, LibreHealth EHR, DoliMed EMR, nosh EMR, Care2x, EncounterPRO, Caisis, Solismed, RemoteClinic and more. Some systems were designed for specific countries, such as OSCAR for Canada, OpenMAXIMS and Ripple for the United Kingdom. Others are focused on specific medical specialties, such as Open Dental for dentists, Odoo Medical for primary care, and OpenEyes for ophthalmology. Here we review the systems designed for worldwide use. Top open source EHR systems (or medical software with EHR features) by monthly keyword search volume (Google USA, Semrush). Source: https://belitsoft.com/ We have chosen three universal EHR system (OpenEHR, OpenEMR, and OpenMRS), and one speciality-specific EHR (OpenDental) for the following reasons: There is the demand for these systems. These systems are built using the most popular programming languages.  These systems are mostly HIPAA/GDPR compliant. Some of these systems have ONC certification. 1. OpenEMR: Universal EHR An extremely popular free EHR/Practice Management software, reaching up to 3000 downloads per month, OpenEMR is much more than just a barebones record store. It has all the major features expected of an EHR: OpenEMR Core Features HIPAA compliance Compliance with the HIPAA requirements is a must for any EHR. Achieving it requires securing several parts, which include OpenEMR itself, servers (Apache, MySQL, PHP), and network (firewall, router, https, certificates, etc). OpenEMR developers make it a priority to keep OpenEMR updated with the most recent security options. Belitsoft specializes in delivering easy to manage HIPAA-compliant solutions and technology services for medical practices of all sizes. Contact us if you would like to get a HIPAA risk assessment and analysis. Access control is the first Technical Safeguard Standard of the HIPAA Security Rules. Assigning roles to different EHR users helps to delineate their access to the information/pages/options according to their positions. That will ensure the patients’ data will only be accessible to the authorized employees. The Administrator of an OpenEMR instance can add users to a set of appropriate user access groups. EHR Interoperability standards support (HL7 FHIR) OpenEMR provides Basic FHIR EHR Interoperability standard support that allows to export/import all the patient data about patients in RESTful API format. OpenEMR also provides Basic FHIR Support using SMART on FHIR implementation or HAPI FHIR implementation to integrate EHRs with other health IT systems. Meaningful Use Stage 3 Compliance OpenEMR Version 5.0 is compliant with 2014 Edition CEHRT. The current version of OpenEMR (5.0.2) partially satisfies the criteria of 2015 Edition CEHRT, and the OpenEMR development team is working to meet the new requirements without referring to specific timelines.  Remote access The OpenEMR software suite is a web-based application that allows users to access patient data from any computer. Mobile compatibility Users are able to access OpenEMR via mobile devices, both on Android (up to v9) and iOS (up to v12). The usability of pages could be constrained by the screen size, so the user would have to work in a landscape mode to ensure the best performance. Other features: Medical Records with demographics, vitals, FHIR/CCDA compatibility, and even voice recognition; Scheduling, with multiple facilities support, SMS/email notifications, messaging system and more; E-prescribing, including pharmacy dispensary module; Billing, including flexible coding system, claims management, insurance tracking etc.; Clinical decision rules; Reporting, including sales, prescriptions, referrals and more; Patient portal and a secure API (Application Programming Interface) to integrate third-party portals. OpenEMR is written in PHP, one of the most popular programming languages. This gives you a wide array of options when choosing a company to customize the system for your practice, because there are many developers who have been working with this technology for years. It is also well-documented, which makes customization easier for the programmers and cheaper for the practice. Another thing worth mentioning is that OpenEMR is distributed under GNU GPL (General Public License).  The reviews of OpenEMR are mostly positive. Judging by what the users say, its advantages are: Low cost of ownership; High speed; Many customization options; User-friendly interface; Free technical support; However, there are drawbacks too: The practice needs an in-house IT team or an outside vendor to customize OpenEMR and support it; Lack of learning resources for end users; Support is often slow to respond; Billing and insurance modules need extra work; Additional customization is required for specialty practices (e.g. Orthopedics or Mental Health). 2. OpenMRS: Universal EHR This system is a relative newcomer to the EHR/EMR market. Since its inception in 2004 it has been in use all over the world, including the United States.  While OpenMRS is mainly a foundation to build a full-fledged EHR upon, its reference web-application already provides many features “out-of-the-box”, for example: Web-Based EHR: this web application can run on your own servers or in the cloud (e.g. AWS); Medical Records (Patient repository): a medical records store with demographics, encounter data etc.; Scheduling: processing and managing appointments and provider schedules; Patient workflows: entering patients into clinical programs and tracking their recovery through each stage of that program; Reporting, a system of customizable reports; Security, including authentication and role-based access; HL7 support: ability to import HL7-formatted data; OpenMRS's Active Visits Dashboard. Source: openmrs.org/demo/ OpenMRS is written in Java, the most popular programming languages. OpenMRS has modular architecture and offers a number of add-ons to customize the system to your practice’s workflows and requirements. As OpenMRS was mostly intended to be used outside of the USA, it is not ONC-certified by default. However, with a competent development company at your side, you can build your own EHR system that satisfies the ONC criteria and gets the verification needed to participate in the incentive program. There are few reliable reviews of OpenMRS, but the users consider it easy to use, praise its price (or lack thereof) and enjoy the control over the records it gives. However, they also note that it is hard to set up without programming knowledge and lacks mobile apps.  OpenMRS is a free EHR. It is distributed under Mozilla 2.0 license. 3. OpenEHR: Universal EHR OpenEHR is a set of specifications and tools for making custom medical software. EtherCIS is the leading open source implementation of the openEHR standard in action. It is a clinical data repository that consolidates data from various clinical sources, such as an EMR or a lab system, to provide a full picture of the care a patient has received. OpenEHR uses Java, PHP, and JavaScript, which are all popular languages. Which means there is less chance of becoming vendor-locked when using a custom system - there are many companies working with these languages. The specifications and source code for OpenEHR can be downloaded for free. However, some assembly is required before you can have an EHR/EMR of your own. This could be done either by your in-house IT-team or by a custom software company. In either case, this is a cost to be included in your budget. OpenEHR is distributed under Apache 2 license. Why not VistA EHR VistA is being in the service of the Department of Veterans Affairs (VA) since the late 70’s. Under the Freedom of Information Act (FOIA) most of its source code was released as public domain, which prompted companies and development teams to create derivative systems, also known as distributions: OSEHRA VistA, OpenVistA, WorldVistA and others.  As there are many versions on the market, describing the features of each would take too long. However, there are core functions shared by the most popular ones: Health information (patient records), including diagnoses, vitals, allergies etc.; Scheduling; e-Prescribing; Billing; Clinical decision support; Electronic communication (messaging); Patient support, e.g. patient portal or educational materials; Reporting and population health, for example, immunization reports. Some distributions, like OSEHRA VistA, can be downloaded for free. Others are paid. The default version available to the general public, FOIA-VistA, is not ONC certified. Some of its code has been redacted pre-release, so many features don’t work as planned. The popular OSEHRA VistA has most Meaningful Use criteria fulfilled, but doesn’t have official verification. However, a number of distributions, do have certification. VistA might seem outdated, however it gets a lot of praise from its users for functionality, speed and security. The different distributions of it, though, haven’t gathered many public reviews. VistA and its distributions are primarily written in MUMPS or M - a programming language, used mainly by companies working in the Healthcare domain, like EPIC, Medicare and Allscripts. It is rather rare - SourceForge, a major open source community, has only 37 MUMPS projects, compared to over 54.000 Java or 34.000+ PHP counterparts. This means that there is only a limited pool of development companies to choose from for implementation and customization, leaving you in danger of becoming vendor-locked. As mentioned previously, VistA is a public domain software. However, its distributions use different licenses. For example, WorldVista is covered by GPL, while vxVistA 15.0 is under Apache 2.0. 4. OpenDental: a Specialty-Specific EHR Formerly known as “Free Dental,” OpenDental is a specialized practice management/EHR system for dental health clinics. It is used both in the USA and abroad: in Australia, the Netherlands, etc. The full function version of OpenDental is only available under the commercial license because it includes royalty bearing, licensed materials from the American Dental Association (ADA), the Code on Dental Procedures and Nomenclature (CDT). OpenDental is a Practice Management Software OpenDental boasts a powerful suite of features, including, but not limited to: OpenDental is designed to be used as a desktop software. There is no Web Version of Open Dental that will run in a browser by default. But some customization allows you to connect to Open Dental any time, anywhere using a supported internet browser and your mobile device; Medical Records (Patient records): name, contact info, insurance/billing data etc.; Scheduling: appointment calendar, color-coded entries, popup alerts, mass contact option etc.; E-prescribing: single/multiple drug prescription, printable patient instructions, audit trails etc.; Billing and claims management: invoice generation, billing template creation, claims validation and history etc.; Reporting: customizable insurance reports, accounting reports, evaluation reports, and more; Patient portal: customizable patient portal; Treatment plans: creation and management of single or multiple treatment plans, with changes in procedures reflecting in tooth charts; Charting: perio, ortho, 3D teeth charts integrated with prescribing, treatment plans and other modules; Medical image processing: integration with radiography, scanning, and digital cameras. OpenDental is both ONC-certified and HIPAA-compliant, so its users are eligible for incentives under Promoting Interoperability program.  Being a popular tool for dentists, OpenDental has gathered a fair number of mostly positive user reviews (with a rating of 4,7/5 on Capterra), that are available to the general public. Among its advantages are:  Professional and empathetic customer support; Customization options; Ease of use; Features that support all aspects of a dental practice; Regular improvements to the system. However, the reviewers also mentioned a few flaws with this EHR: Steep learning curve; Lack of cloud deployment option; Scalability problems for large practices. OpenDental is built with C# and a powerful .NET framework. This technology stack, endorsed by Microsoft, is very popular, so you won’t have to worry about the lack of professionals to support your system. 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What is gamification Gamification implies integrating game mechanics and design techniques into non-game experiences. This process motivates audiences participation and engagement while making mundane tasks more fun and interactive. ‘If you want somebody to do something, go to the next screen, or get them to physically go to a place, use the location services, have them check-in, and give a happy little exploding confetti reward for that on the phone, and you’d be shocked at how effective that is.’ Amanda Havard, Health: ELT CEO For more information on gamification as a whole and the mechanisms behind its effectiveness, see our article. In the context of health IT, gamification is typically employed in medication adherence, medical education-related simulations, fitness and wellness apps. The strategy is to use rewards for users who complete mandated tasks, and typically works in the following ways: By filling a progress bar to measure success. Thus, developers invoke progress-related instinct. ‘An estimated 50% of patients with chronic diseases do not follow the prescribed treatment. Gamified health tracking creates an environment that keeps the patient from straying from the appropriate therapy path.’ Dr. Bertalan Meskó, Director at the Medical Futurist Institute By allowing users to share progress and results with their friends/other players or designing an “honor roll”. Thus, developers create a competitive spirit to stimulating the use of the service. Fitness App. Reword Unlock by Olha Hurenko Source:dribbble.com/shots/4492657-Fitness-App-Award-Unlocked By awarding points, medals, stars, achievement badges or giving virtual currency during each stage of progress. Thus, developers create a sense of accomplishment and increasing motivation levels. Kenko Health Avatar by Yoann Baunach Source: dribbble.com/shots/4288089-Kenko-The-avatar-of-your-health In specialized health apps targeted to older users, individuals with movement or sensory impairments, gamification experiences are created using real-time biofeedback from motion-capture sensors and gesture-control technology. ‘Games don't need to be complex. We tapped into dance as a form of engagement.’ Dr. Doug Elwood, Executive Health and Wellness Leader An often overlooked benefit of gamified healthcare applications is their potential for gathering relevant patient data. Software like this motivates users to give more feedback which, in turn, helps companies find trends, make products that address the needs of the target audience better, and even create new business models. However, due to legal restrictions in countries like Germany and France, gathering data requires the attention of the corporate lawyers, as well as developers. Moreover, it presents an ethical and a cybersecurity challenge.  Gamified healthcare is a big deal: one report predicts the market for it to reach 4.2 billion dollars by 2022. Another one forecasts it to grow to a whopping 13.5 billion dollars by 2025. Look how gamification techniques can be used in e-learning projects. Or get help to implement game elements in your app. Gamifying healthcare: case studies The move to gamification of healthcare, however, seems to be a welcome one. According to PwC’s Top Health Industry Issues of 2017 report, 78% of respondents aged between 25 and 44 said they would use some form of gamification in their treatment. What software healthcare solutions are more relevant? Fitness and nutrition apps Self-management chronic condition and medication apps Healthcare apps for kids Physical therapy and rehabilitation apps Emotional health apps Motivating Wheelchair-bound Patients to Exercise Many people suffering from spinal trauma or dysfunction and having to use a wheelchair are also at risk of cardiovascular diseases. Exercise is difficult for them and the fact that they are sitting for most of the time only exacerbates the situation. Daily activities don’t help maintain the necessary level of activity. Fortunately, there is GameWheel - an interface that allows connecting wheelchair to the computer as a controller in specialized games. According to a study by scientists from several American universities, it proved effective in both motivating the patients to exercise more and in making the periods of exercise more productive. The study participants used GameWheel to play a racing game where pushing their physical push on the wheel translated to the speed of the car on the screen. As a result, the heart rate, oxygen consumption, and ventilation were higher in the players than in their non-playing counterparts. Moreover, some reported that they were so absorbed in the game, that they forgot they were exercising. Helping Cancer Patients The “Re-Mission” game series has proven to be effective in helping children and young adults suffering from various forms of cancer. Re-Mission: Nanobot’s Revenge Not taking their medicines on time is a widespread problem in patients - up to 50% of them either fail to take the drugs regularly or don’t file the prescription at all. In the case of life-threatening diseases, it becomes extra important to solve. That’s why a non-profit HopeLab Foundation has commissioned a serious game to address the issue. “Re-Mission” put the player in control of the “Roxy” nanobot that was to fight cancer with chemoblaster, radiation gun, antibiotic rocket, and other weapons derived from actual medical treatments. It proved to be a huge success, so “Re-Mission 2”, a suite of free-to-play online games was launched. These games improved the treatment adherence rates, and also increased the patients’ self-efficacy - confidence that the disease can be defeated. Fitness and nutrition apps Apple’s 2014 App Store review of 100+ health apps proved a direct correlation between gamification elements embed and high user ratings. MyFitnessPal used the highest number of gamification techniques. We all know Fitbit as one of the early innovators in the wearables game. However, the company is positioning itself as the go-to device for employers. Fitbit has almost 1.500 corporate wellness program customers including BP, IBM, and Bank of America. Most of them give their employees Fitbit devices to track their workout progress and health habits. Source: play.google.com/store/apps/details?id=com.fitbit.FitbitMobile Fitbit is an example of how corporate partners are becoming more involved in mHealth apps. Such tactics, therefore, allows employers to reduce employee healthcare costs by improving lifestyles or providing instant access to non-emergency care. However, one of the most striking examples of how companies accepting healthcare gamification is Apple. They award Apple Watch and iPhone users with badges for accomplishing workout tasks like hiking and cycling or surpassing daily totals like calories burden. Source: macworld.co.uk/how-to/apple/apple-watch-activity-achievement-badge-3658788 Awarding badges is part of Apple’s continued push into healthcare. The Health app on iPhone, Workout app on Apple Watch and Activity apps on both have distinct functions but can define user’s health status in details. The strategy helped Apple boost Apple Watch sales and own 2017 wearables market. Source: imore.com/apple-watch-and-activity-tracking-what-you-need-know Unlocking wellness achievements turns into a naturally popular behavior. The wild success of Pokémon Go demonstrated how willingly people play achievement-oriented games simply for the fun of earning points. Importantly, Pokémon Go proved that game playing is not always about passive experience - players are required to walk around and keep moving. ‘A lot of fitness apps come with a lot of "baggage" that end up making you feel like "a failed Olympic athlete" when you're just trying to get fit. Pokémon Go" is designed to get you up and moving by promising you Pokémon as rewards, rather than placing pressure on you.’ John Hanke, Pokémon Go CEO Yet Pokémon Go does get people moving more but the effect doesn’t last. In fact, the market offers more than 9.000 healthcare-related apps. Many of them are downloaded, used once or twice, then forgotten. The exercise-tracking startup Pact pursues a highly-motivating policy among people looking to improve their health. Users make pacts promising to exercise or eat healthier. Source: play.google.com/store/apps/details?id=com.gympact.android&hl=en By failing to meet their target, users have to pay a monetary penalty between $5 and $50, while those who succeed get a part of the payment. Smartphone location data and photos taken in gym serve as the evidence. Players can specify how much they would be fined if they failed to meet a pact. This money then goes to a collective pool that allocates payouts among those who do reach their goals. The powerful driving force of this mHealth app is that users can actually lose money when they fall off track. Unfortunately, even when players held up their part of the pact, the company allegedly failed to provide the funds promised. Pact must return about $1M as of September 2017. Self-management chronic condition and medication apps By helping patients understand their chronic conditions better and by simplifying medication management using gamification, patient compliance rates can be increased to achieve better outcomes. Gamification techniques can make the tedious and repetitive tasks of treating a chronic illness rewarding and more engaging. Diabetes is considered the “the disease of the 21st century”. The 2016 study revealed that many experts support the idea of creating an enjoyable experience for patients living with this chronic disease. ‘Naturally people like to be rewarded. Thus, if this [gamification] is applied to the self-management of diabetes, it would be very effective. [...] it will change the view and the experience of self-management of diabetes for the patient.’ from Gamifying Self-Management of Chronic Illness: A Mixed-Methods Study ‘Positive reward is enjoyable in whichever form it comes. This will help patients’ self-esteem.’ from Gamifying Self-Management of Chronic Illness: A Mixed-Methods Study Indeed, having diabetes requires self-management skills vital to prevent the complications associated with the disease and maintaining the healthy life. Gamified apps can help patients self-manage in a more efficient and entertaining manner. They also give them the opportunity to be appreciated for their efforts and to positively compete with one another. Now, what gamification elements are most commonly used? Tracking measures of blood glucose, insulin, food intake, and other related info. Getting feedback based on the entries. Being notified when blood glucose measures fluctuate. Glooko provides a remote patient monitoring platform for diabetes that enables users to connect any glucose meter, insulin pump or CGM. The company also offers a FDA-approved app to help patients manage their care and control outcomes. Source: play.google.com/store/apps/details?id=com.glooko.logbook mySugr is an another example of a gamified solution for diabetes management. The company is remarkable that they developed a separate app for children (mySugr Junior app). Mango Health mobile app reminds patients when it time to take their medicines and records each dose. It also automatically warns users about dangerous interactions between drugs and supplements or with food and drink. By taking medications properly, patients earn points to be redeemable for gift cards or charitable donations. Source: play.google.com/store/apps/details?id=com.mangohealth.mango&hl=en Unfortunately, gamification cannot diminish the seriousness of diabetes or any other chronic disease. Patients need help not only to enhance their illness self-management but also to be understood and supported by other victims. Gamified healthcare apps for kids Younger users usually do not understand the importance of long-term therapies or medications, regarding their illnesses as short-run miseries. They do not want to swallow bitter pills or have shots, do not want to be in therapy or stay in the hospital. Gamification can help children forget they undergoing medical treatment, teach them responsibility for their health. Inspired by Minecraft, Pfizer (a pharmaceutical company) launched a video game aimed at educating younger hemophilia patients, aged 8 to 16, about the importance of adhering to their treatment plans. Hemocratf is a simulated environment where players interact with the “village doctor” to learn how their treatments work. Kids are challenged to monitor factor levels and self-infuse to help control bleeding if needed. ‘These new digital innovations can be integrated into everyday routines to help empower people with hemophilia to learn about and track different aspects relevant to their disease so that they can have informed conversations with their healthcare providers.’ Dr. Kevin W. Williams, CMO of Pfizer Rare Disease, said Zamzee (acquired by Welltock) developed an activity tracker and rewards system for children to get them moving and complete quests based on their physical level. In a randomized controlled study, kids using Zamzee were nearly 60% more active. Young players collect points by moving and completing challenges. Earned points can be exchanged for virtual rewards, like equipment for their on-site avatars, or physical rewards, like pink duct tape sent to their address. Physical therapy and rehabilitation apps After a serious injury, it is difficult and time-consuming to reach even an agreeable level of independence regarding movement or other activity. Gamification takes a chance to reimagine the physical therapy experience. Reflexion Health offers a patient-facing telerehabilitation solution known as VERA. This platform controls the movements of patients practicing physical therapy exercises. The system works in patients’ homes allowing them to watch an animated instructor model on TV or PC. Motion tracking technology compares patients’ performance with the sample and gives guidance and correction suggestions if needed. As VERA helps patients recover function over time, it is essential to encourage, measure and report patient engagement and objective performance of their progress. ‘This focus on developing an ongoing relationship with specific patients, along with the framework it requires and the metrics it produces, are major differences from broadly-released, “fire-and-forget” games for health.’ Mark Barrett, Lead Software Engineer at Reflexion Health The GlassOff program is developed to eliminate dependency on reading glasses by enhancing users brain’s image processing function. The recovery process consists of several sessions that are mini visual recognition games. Working through GlassOff exercises takes about 12 minutes. It’s recommended to follow the program 3 times a week for 3 months. The app automatically reminds users when it’s time for the next session. Source: play.google.com/store/apps/details?id=com.glassesoff.android Emotional health apps Happify toolset helps users improve their emotional well-being, overcome stress and anxiety that have a negative impact on daily life. Their app has 30+ tracks to choose from and tracks user progress to see how their skills compare. Each track is based on scientific research from neuroscientists and psychologists at Harvard, Stanford or Penn. ‘After six to eight weeks, 86% of users who use the program for the recommended time and dosage come back and say they feel happier and much better.’ Ofer Leidner, Co-Founder of Happify Source: play.google.com/store/apps/details?id=com.happify.happifyinc&hl=en Looking for an attractive healthcare business model? Find your inspiration in our articles: Top 20 healthcare SaaS companies from New York How to design a healthcare app Top healthcare mobile apps using React Native How can gamification help your business Employers, insurers, and healthcare providers are focusing more energy on keeping people out of the hospital by helping them manage their own health. Thus, the market demands high-quality and complex solutions that make getting healthy more fun. Gamification delivers proven and tangible results. By applying gamification elements into the product, businesses have experienced an increase in engagement across social media and website traffic generated. To bear all the valuable fruits of gamification, businesses have to understand the environment to which it is applied. In other words, specific gamification techniques need to be tailored and adapted by this specific audiences. Already in favor of gamification in your healthcare app? Fill our online “get a quote” form to start.

Contact us to learn how our EHR experts could help you with EHR transitioning and selection, EHR implementation, training or support! The cost of implementing an EHR system EHR adoption and implementation costs include purchasing and installing hardware and software, converting paper charts to electronic ones, and training end-users.  The maintenance of an EHR can also be expensive. In fact, physicians frequently cite upfront costs and ongoing maintenance costs as the largest barriers to the adoption and implementation of an EHR. The financial incentives built into the HITECH Act are designed to defray some of the costs associated with EHR adoption, especially for smaller organizations. Physicians with more than 30% of their patients paying with Medicaid are eligible for up to US$63,750 in incentives over a 6-year period. On the other hand, physicians accepting more Medicare patients are eligible for up to US$44,000 over a 5-year period as long as they can meet the “meaningful use” criteria starting the first year. Hospitals are also eligible for incentives under the HITECH Act. The base amount to each hospital that complies with the meaningful use criteria will be more than US$2 million. Request a custom price quote for your EHR System. Use the form with EHR Features list here to describe the project and we will get in touch with you within 1 business day. EHR Implementation Case Study: HealthTexas Provider Network The total cost of implementation of an EHR for a five-physician practice through the first year was $232,885 (including maintenance costs). The trusted source EHR Implementation Cost Breakdown Expenditures First-year costs Hardware costs (fixed) $25,000 Hardware costs (variable) $35,290 Software license, hosting, etc. (variable) $85,500 Network implementation team (fixed) $28,025 Practice implementation team (fixed) $7,413 Practice end-user (variable) $51,657 Total per practice $232,885 Total per physician $46,577 EHR Implementation Case Study: Belleville Family Medical Clinic The total cost of implementation of an EHR for practice with six resident physicians through the first year was $220,800 – $260,800 (including technical support). The trusted source EHR Implementation Cost Breakdown Expenditures First-year costs Vendor costs: software, interface, training $51, 500 Hardware costs: database server, desktop computers, printers $67,000 Other costs: wiring, remodeling, surge protectors, etc. $12,000 Project manager: half time for nine months $24,000 Project team: a portion of regular compensation accounted for by estimated time devoted to the project $60,000 – $100,000 Training time: staff $6,300 Total per practice $220,800 – $260,800 Total per physician $36,800 – $43,467 EHR Implementation Case Study: 14 solo/small-group primary care practices in 12 states The financial costs (min-max) per FTE physician per year was $20,419-75,567. Variations in financial costs reflect exceptional heterogeneity among small practices in pre-EHR hardware and in technical and negotiating skills. The trusted source EHR Implementation Cost Breakdown Expenditures Financial costs (min-max) per full-time equivalent (FTE) physician per year Software, training, and installation costs $8,475 - $32,607 Hardware costs $5,261 - $23,600 Revenue losses from reduced visits during training and implementation  $0 - $20,000 Software maintenance and support $1,200 - $3,800 IS staff and external IT contractors  $0 - $5,556 Initial data abstraction costs and extra telecommunication costs. $0 - $12,394 Total per physician $20,419-75,567 Software included license or maintenance costs for EHR or related software (for interfaces, databases). Installation included vendor and contractor costs for installing software.  Hardware included computer equipment (desktop computers, laptops, servers, storage), related ancillary equipment (printers, scanners, monitors), and networking (routers, wiring). Revenue losses at implementation were attributable to provider productivity decreases resulting from reduced visit schedules.  IS staff and external IT contractor costs included increases resulting from the EHR.  EHR Implementation Plan To ensure efficiency, there is a series of steps the provider’s staff must follow to ensure proper implementation and handling of the EHR system. 1. Assemble the implementation team These people will make sure the new EHR is adopted on time and budget. The team should include medical professionals, administrators, compliance specialists and technical specialists (if applicable to your practice). The American Medical Association (AMA) recommends to appoint people to three key positions: Project Manager The PM’s primary job is to serve as a liaison between the practice and the EHR vendor. Their duties also include monitoring the project timelines and running the day-to-day activities of the team. A PM could be either a member of your own team, a vendor’s employee, or a third-party specialist. Lead Physician This position should be occupied by a medical professional, preferably from your own hospital. A Lead Physician should make sure that the needs of doctors and nurses - the end users of the new EHR - will be addressed during the implementation process.  As building a custom EHR implies working with a focus group from clinical staff members to gather requirements and test the system, a person from that group would make a great Lead Physician. They already have experience in communicating their needs and providing feedback. Lead Super User The Lead Super User should be a tech-savvy person who knows the clinical workflow of your practice. Whenever a medical professional has a problem with the new EHR this is the person they contact. The Lead Super User along with their team (in larger practices)  will have received training with your custom system and will transfer this knowledge to their coworkers. There should be at least one super user for each of your offices. In small organizations, this position could be combined with PM. This is also true for implementing custom-built EHRs, as the creation of forms and workflows would be done at the development stage.  The Office of National Coordinator for Health IT (ONC) suggests a similar approach, but defines a more extensive leadership team, including Nurse Champion, Lab Staff Lead, Billing Lead and others. Whether you do need to fill those positions depends on your organization’s circumstances and goals. 2. Adapt workflows AMA strongly recommends reviewing your clinical workflows before implementing a new EHR. Otherwise, the problems caused by their inefficiency will only get worse.  As this is a medical issue and not a software-related one, your doctors and nurses would be far better qualified to give you advice on how to proceed with changing the workflows. The EHR can and should be adapted to accommodate them. 3. Prepare the Hardware  This stage includes preparing all the physical tools that will work with the EHR, from the servers (if you’ve chosen an on-premise system) to the tablets, desktop computers, and patient-facing registration screens. It is typically done either by the practice’s in-house IT team or by a third-party company, independent from the EHR provider. If there is a need for it, the same company can also be hired to provide continuous hardware support. Off-the-shelf systems have a set of technical requirements that the vendor will give you, while in custom EHRs this matter would be discussed between you and the development company in advance.  4. Customize EHR software Even if the EHR you’re implementing is tailored to your medical specialty (e.g. orthopedics or mental health), it needs extra tuning to adapt to your practice’s workflow. This part also includes ensuring whether your software provides adequate protection of the patients’ data, so feel free to check out our HIPAA-compliance checklist. In turnkey systems customization starts before the actual development process and is included in the quote. The contractor works with a focus group of stakeholders (typically, clinical and business staff) to determine the challenges and ways to solve them. Then, over the course of the development process, this group tests the system’s functionality and provides feedback so that it can be improved. As a result, the EHR is form-fitted to your practice’s needs and a number of core personnel are already familiar with it, decreasing the time needed for training. In off-the-shelf EHRs this is done in the beginning of the implementation stage. The vendor’s team will adapt their product to your requirements and workflows. The costs will depend on the rates of the company that supplies your EHR.  5. Migrate Information This stage includes the transfer of both clinical (diagnoses, treatment plans, allergies, etc.) and non-clinical (e.g. insurance) data from your old system to the new one. Transition is risky - corrupted or incomplete records might deny your employees access to the new EHR’s functions or even present a health risk to your patients (especially in case of allergy or drug interaction information). ONC makes a compelling case for tasking your outgoing vendor with data transfer and even suggests including it as a provision in your contract right from the start. Besides saving you money and giving you confidence, this way you won’t become hostage to the inefficient system, should you decide to switch to a different provider later. The information should be presented in an accessible way, for example FHIR format, so that the new provider can easily migrate it to their system. Alternatively, the outgoing vendor can give you the documentation and/or software that will allow your in-house specialists or the incoming vendor to handle the transfer themselves.  As the change takes time, make sure to keep access to your old EHR until your new system is up and running, so you will be able to continuously provide care to your patients. You should also check whether you are legally required to maintain access to the old records, as this varies depending on the state you’re based in. For example, Indiana requires keeping the records for 7 years, while in neighboring Ohio the healthcare provider “must retain medical records for 6 years since the date of discharge”.  6. Choose the implementation strategy There are two major approaches to adopting a new EHR, whether you are switching from the old system, or implementing a new one from scratch: “The Big Bang” (immediate approach) and incremental. Both have their inherent pros and cons.  7. Plan for downtime You can have the most secure and reliable EHR possible, but it is all for naught if your internet cable is cut by a stray excavator or the power is out due to a hurricane or ice storm. Your provider might discover a security vulnerability that requires an immediate fix. Or shutting the system down might be necessary in the case of a cyberattack to control the damage from it.  That’s why your practice needs to prepare procedures for both planned and unplanned EHR downtime. It can be a part of a Medicare-required continuity of operations plan.  The emergency procedures should cover communication with the staff and the patients, patient processing, documentation, billing, prescriptions, and procedures for entering the information back into the EHR once it’s up again. Each location in your practice needs a copy of the plan (or several).  While the organizational issues would be better addressed by your practice’s leadership, your EHR vendor can help set up the backup procedures and assist in restoring the information. As with other emergency procedures, you should periodically conduct drills so your staff is prepared for the moment the real disaster strikes.  8. Conduct EHR training ONC recommends three ways you can teach your employees to work with a new EHR: Super users. This is a trickle-down approach, which implies training a core group of employees that will, in turn, train their coworkers. Role-based. Everyone gets the training depending on their position within the practice: doctors learn only the part related to patient processing; billing staff - financial reporting, payments, insurance etc. Process-based. “Suppose we have a patient complaining about his broken leg. This is how we would handle it with the new EHR…” Off-the-shelf systems providers have knowledge bases that are accessible to their customers and dedicated implementation specialists to conduct onsite and offsite training.  A  custom EHR development company, like ours, can set up online courses to help with onboarding of your current and future staff.  How We can help with implementing a custom EHR Data migration. We can work together with your outgoing vendor to speed up the transfer of records from your old system to the new one. Backup procedure preparation. We can advise you on how to make your system ready for emergencies and quickly restore lost data in case of malicious acts. Super user training. We thoroughly document the software we build and can use it to teach the core group of your employees who will then impart their knowledge on their colleagues. Long-term education and onboarding. We can set up a complete training course that will help your current staff refresh their knowledge of your custom EHR and your new employees to quickly become proficient with the system. Additional resources The ONC Health IT Playbook contains extensive information on EHR implementation, including sample articles for contracts with a vendor, data transfer advice and workflow optimization. AMA has a training module dedicated to switching from paper records to EHR. The HIPAA compliance checklist will help you secure both the EHR and your practice in general. The GDPR-compliance checklist is applicable to organizations processing the information of EU citizens, but also contains useful data security practices.

We create/customize and implement HIPAA/GDPR-compliant EMR/EHR applications and other healthcare software solutions like telehealth for healthcare businesses from the USA, Canada, Israel, the UK, and other European countries. We have already grown companies just like yours. Get a Free Quote The recent public health emergency resulting from COVID-19 has accelerated the implementation of healthcare service delivery through telehealth. Clinicians can now provide more services to beneficiaries via telehealth. As you probably know, the Centers for Medicare & Medicaid Services has expanded access to Medicare telehealth services. Features of Telemedicine Enrich your healthcare application with real-time communications adding Telehealth features. E-visits and medical consultations. The main idea of telehealth is to connect patients and physicians around the world quickly and securely through live video. This enables two-way, face-to-face interactions on a computer or mobile device with high-quality video and audio.  Secured communication can be held by a wired or wireless Internet connection.  Some solutions also allow screen sharing and multiway video so 3rd parties (such as caregivers or translators) can also participate in a virtual consultation. All the additional attendees are added by the doctor. Define session time slots. Choose how long your telemedicine consultations should last. Define a suitable time slot to schedule the meeting with the patients. Manage your time.In the case of contingencies, сonfirm, cancel, or re-schedule telemedicine appointments to suit your availability and manage your time effectively Reduce No-Shows. Lower no-shows by confirming telemedicine appointments and sending notifications about the upcoming telemedicine sessions.  Define pricing. You have the opportunity to price and charge patients (or keep it free) for telemedicine sessions. Moreover, while hosting a webinar you can set the fee for joining the meeting. Online payments.You can collect all the payments for your telehealth sessions in advance to confirm participation. Online billing.Generate bills for video consultations to track the revenue generated for telemedicine services and provide complete financial management of your practice. We stand for providing the highest quality of healthcare services delivered while using telemedicine features. That’s why we considered the opportunity for the providers to access patients’ health records during video sessions to help with the diagnosis. All the recordings are available for the doctors to clarify the assignments in the future. Consultation Notes. Create notes during your sessions with patients in order not to lose goals, medications prescribed, invoices, follow up appointments, or care plans you may have discussed. ePrescriptions.You will be able to prescribe the medications during your telemedicine sessions and send the prescriptions by email or with a paper-printed letter to patients without the need for them to visit the practice. Consultation summary. Share a summary via email with patients, including key aspects discussed during your session, for better medication adherence. Adding telemedicine features can improve your abilities in following up with the visitors on their progress. Patient-initiated. Patients can book follow-up appointments to their clinic visits or online consultations and consult with you via video sessions. This will definitely save the providers’ time compared with written communication.  Moreover, the patients can clearly see the type of appointment while checking their schedule so that they can plan their visits or video calls. Provider-initiated. Book follow-up telemedicine sessions for patients who may not be able to visit you at your clinic. Text consultations. This particular feature allows doctors to exchange text-based messages with patients in real-time before, during, or after an appointment. These messages are secure and HIPAA compliant to ensure your practice is following all regulations. Adapting an existing WebRTC Solution to the Current EHR/EMR System Web Real-Time Communication saves your time if you need the telehealth functionality as soon as possible. Its mission is to "enable rich, high-quality RTC (real-time communications) applications to be developed for the browser, mobile platforms, and IoT devices, and allow them all to communicate via a common set of protocols". Advantages of WebRTC WebRTC ensures rapid implementation of the audio/video conferencing features without hiring a huge team. You can customize the interface of your telehealth app to align with the interface of your existing EHR/EMR system. You don’t need to redevelop your existing system, as only one new module with an intuitive user-friendly interface would be added. WebRTC allows audio and video streams to work inside web pages by allowing direct peer-to-peer (P2P) communication, eliminating the need to install plugins or download native apps.  The technology is available on all modern browsers as well as on native clients for all major platforms. WebRTC provides web browsers and mobile applications with real-time communication via simple application programming interfaces (APIs).  In our case WebRTC is interesting as a means to connect existing communication providers to the EHR/EMR system through API, creating a time- and cost-saving solution for telehealth services.  This way of implementing telehealth features on the one hand ensures you get a reliable and secure communication channel and on the other hand doesn’t demand any significant changes in your current system.  The only condition to perform such integration is the presence of an open API in the customer’s EHR, but even the absence of it can be fixed by developing a special add-on. How to Choose the Best WebRTC Provider To take all the advantages of this method, you must choose the WebRTC provider carefully to prevent expensive refactoring and/or re-architecting when the load on your WebRTC solution grows. All the major WebRTC platform providers want to make it easy to start using their product. This means it is free for the initial low volume. As the implementations scale-up in volume or the use-case goes beyond minimal functionality, the costs go up as well and for very high volumes, they charge a lower pay-as-you-go rate. The major differences among providers often come down to which facet of communications they emphasize as their bread-and-butter. Some (like Agora) emphasize real-time hi-res video. Twilio tries to strikea balance between voice and video communication. Thus, it pays to consider exactly which WebRTC capabilities your project will use in both near- and far future before committing to a provider. Find a platform with the right strengths for better results – and ultimately, lower costs. Our experience allows us to claim that we’re able to adapt for your telehealth needs the next popular WebRTC communication platforms: Twilio; Agora; Vidyo; Zoom; GoToMeeting; ClickMeeting; Vonage; VSee. Twilio Webrtc Provider Twilio Programmable Video covers all the bases with API’s for voice, video, and messaging. Twilio places a special emphasis on user verification and security. The services are priced individually, starting at $0.0015 per minute/participant. All services are offered as pay-as-you-go, with no contracts and no minimum fees. Twilio also has a special Healthcare solution that is presented as a flexible and comprehensive answer to the modern challenges. Doctor On Demand uses Twilio Programmable Video Agora Webrtc Provider Agora offers a wide set of services, with hi-res video being the star of the show. WebRTC services are priced by type of service. Video of 720p or less costs $3.99 per 1000 minutes (or $0,00399/minute), while hi-res commands a $14.99 for the same time ($0,01499). All pricing is pay-as-you-go with no upfront cost, and the first 10 000 minutes per month are free. DrFirst and Agora partner to add telehealth to Backline HIPAA-compliant care collaboration platform Vidyo Webrtc Provider Vidyo provides multi-party video APIs for the web, mobile, and native endpoints. A fixed $65/month pricing point will bring you ongoing support and includes up to 6500 minutes of real-time communications. It also presents a Healthcare solution with special video conferencing capabilities. Telehealth Solutions Powered by Vidyo. Source Zoom Webrtc Provider Zoom provides a full set of services needed to conduct video conferences for businesses of all sizes. The recent solution was launching a special Healthcare plan that costs $200 per account with 10 hosts. What Zoom’s Customers Say. Source GoToMeeting Webrtc Provider GoToMeeting presents a set of subscription plans that differ in their features. Prising starts from €10.75 for a professional account, for enterprises there’s an option to set custom plans depending on the amount of employees. ClickMeeting ClickMeeting is another solution that is priced upon your chosen subscription plan. Depending on features included the prices start from $25 and may be adjusted individually according to your business needs. Vonage Webrtc Provider Vonage offers interactive video, video broadcast, voice (via SIP), and text messaging (via SMS/chat). A monthly base fee of $9.99 includes 2000 subscribed minutes (it is per receiver, and the sender does not pay for upstreaming their video). Higher volumes are priced in tiers starting at $0.00475/subscribed minute for the 2 000-100 000 minutes and thereafter decreases to $0.00400/subscribed minute for the 5M minutes. Vsee Webrtc Provider VSee provides a specialized telehealth solution for clinics in basic ($45 per month) and enterprise (the price is set individually depending on the number of employees) subscription plans. The difference is in features included into the plans. VSee also provides Telemedicine Kit. Source Integrating WebRTC with your app The time needed for integration of the WebRTC solutions mentioned above is set individually according to the complexity of the current customer’s EHR/EMR system and the set of features, chosen according to the subscription plan. In general all the process can be done in 1-3 months. Summarizing all the above, using WebRTC solutions is the best way for those customers which need Telehealth features ASAP  without any excessive effort on “reinventing the wheel”. This technology already has many high-quality platform providers, so the competition among them will grow stronger, intensifying their deeper specialization in the market. By building a comprehensive use case for your project, you’ll be able to find the provider that offers the best overall value proposition not only in terms of cost per subscribed minute, but for the ongoing costs of further scaling development and adding new features. Anyway, our company is always ready to help you in achieving your business goals in the most suitable way.

Benefits of Hiring an Offshore Healthcare Software Development Company Creating an in-house team for custom healthcare software development comes with drawbacks, including financial burdens, the need to hire specialists, expenses for office space and employee training, a limited pool of local talent, and a lengthy hiring process. Working with freelancers for healthcare app development has potential downsides such as unverified skills, difficulty in ensuring adherence to industry regulations, lack of prioritization, and communication challenges. Working with an app development agency for healthcare app development offers several benefits, including the flexibility to hire contract workers on a pay-as-you-go basis, the ability to work with a team from anywhere, the option to set the scope of work and assess progress, and assurance of software developer's skills and quality of work through the vetting process. The offshore agency can handle the entire project or provide dedicated developers with the required skills. Common Offshoring Challenges and How to Fix Them Communication Barrier Effective communication in software development is not so dependent on physical proximity as it may seem.  It is achieved when developers prioritize the needs of customers and adhere to established processes for documenting, negotiating, and fulfilling customer requirements. Lower Productivity compared to on-site Workers It is important to partner with an offshore software development company that invests in finding and training top talent. A good indicator of a company's commitment to this is the number of certified developers they have.   In-house IT Department Resistance Outsourcing can be introduced gradually, starting with smaller projects that are not desirable for the in-house IT department. As benefits become evident, resistance is likely to diminish. Time Zone Differences Time zone differences can be both a blessing and a challenge in offshore development. It's important to find a partner with overlapping work hours to balance the advantage of round-the-clock work with effective communication. Which Health Companies Benefit the Most from Offshore Software Development? Digital health startups with a limited budget Startups often have innovative ideas for the digital world but struggle with a limited budget. Many of them get stuck at the MVP stage with a product that falls short of its potential. Outsourcing to offshore software developers helps them build the product at a lower cost. Healthcare businesses lacking technical expertise Founders with great ideas may not have technical expertise, making it necessary to partner with a software development company that has the required skills. This way, businesses can find and hire the best team. Healthtech product companies looking to speed up time to market Time is critical in the software industry. If a company takes too long in the development stage, they risk losing its edge to competitors who launch similar products. Offshore outsourcing eliminates the time required for hiring and training, allowing businesses to have the best team working on their project from day one. When to Outsource Healthcare Software Development from an Offshore Vendor Brainstorming phase If you have a general idea for the medical app but need help with the technical aspects, partnering with healthcare software consultants can be beneficial. They provide businesses with a dedicated and reliable team for the idea and product consultation. Development stage Once the idea and structure of the healthcare app are in place, it's time to connect with a software development partner to start the journey. After development Even after the health app has been released, maintenance support may still be needed. Partnering with a development firm can help with app updates and maintenance. How to Hire a Good Offshore Healthcare Software Development Company Offshore software development companies build custom healthcare software solutions including patient portals, EMRs, clinical decision support tools, and mobile apps for patient engagement, remote monitoring, and telemedicine. They use programming languages such as Java, C++, and Python and databases such as MySQL and Oracle. When it comes to offshore healthcare software development, it is important to look for the right developers who have both coding skills and healthcare business domain expertise. Consider working with a reputable healthcare app development company that can help you navigate the industry trends and compliance requirements. Compliance and Security To ensure compliance with laws, regulations, and standards, look for developers familiar with HIPAA (for US market), GDPR (for EU data exchange), and PIPEDA (for Canadian data privacy). For the safety of your business, its stakeholders, employees and clients, it's vital to choose a trustworthy vendor who follows the widely recognized security protocols. Verify the location of their servers and enforce stringent security policies. Sign an NDA before your first interaction with a team. This will ensure that they do not share your ideas with a third party. Have a contract that outlines the transfer of IP rights and code ownership upon the project completion. Knowledge of integration standards For a smooth integration with healthcare systems, look for developers with knowledge of integration standards such as Health Level 7, HL7 Fast Healthcare Interoperability Resources, ANSI X12n 5010, NCPDP SCRIPT, DICOM, and HL7 v3 Clinical Document Architecture. Additionally, look for developers with expertise in semantic vocabularies like ICD9/10, LOINC, RxNorm, and SNOMED-CT, and integration frameworks like Healthcare Information Technology Standards Panel and Integrating the Healthcare Enterprise. Deep Expertise Choose mobile developers who have cross-platform expertise, as this will ensure your app runs on major platforms and reaches a wider audience. Consider a full-service app development provider that includes design, programming, testing, deployment, and maintenance. A competent project manager is also key to the success of the development team, so consider a reliable technical partner with comprehensive project management capabilities. For revenue cycle management, look for developers with an understanding of billing schedules, payment models, and denial workflows. In terms of data security, look for developers with experience in encryption tools, libraries, secure coding practices, and standards such as SOAP and REST frameworks. One-on-One Meeting When selecting a development team, request a one-on-one meeting to discuss their expertise, experiences, and portfolios. Negotiate and sign a contract that covers confidentiality, software development life cycle, troubleshooting, after-sales support, availability of developers, payment terms, property rights, and usage of the project in the company's portfolio. Why Offshore Healthcare Software Development with Belitsoft Belitsoft boasts 17+ years of experience in providing technical solutions for healthcare startups and enterprises of all sizes. From idea evaluation to design, development, deployment, and maintenance, our team offers a full-service approach, helping companies incorporate transformational solutions and focus on their priorities, while handling complex technical tasks efficiently. Full Range of Services A typical healthcare software project may require designers for intuitive design, QAs for testing and debugging, and developers. If the project is complex, you may need to find an architect. We'll provide any tech talent required for a successful project outcome. We provide all types of programmers, including cloud computing, big data analytics, IoT, AI, and ML developers with relevant experience. Our recruitment team conducts technical interviews and evaluates soft skills to ensure the right candidates are selected. We'll assemble the required specialists and organize the workflow in a way that's convenient for you. We also handle all secondary activities (such as training recruits), making it easy for you to manage and communicate with the developers even if they're located in our office. This saves you time and resources compared to local recruitment. Flexible Teams We can help you hire a healthcare software developer or build an offshore team to manage your healthcare application development. Our offshore teams are easy to scale up or expand with additional IT specialists as needed. Affordable Offshore Developers Location is crucial for successful offshore software development. You hire developers in countries with thriving IT industries in Eastern Europe, giving you access to a large pool of professional software development specialists. Contact us even if you need someone with unique skills or industry-specific experience. By hiring in countries with lower rates, you can save on salaries, taxes, and operational costs. Our location and professional recruitment team allow us to provide top-notch tech talent at affordable rates, often reducing project development costs by up to 40%. How Much Does Offshore Healthcare Software Development Cost?The cost of offshore healthcare software development varies based on several factors such as the app type and complexity, platforms supported, UI/UX requirements, and back-end processing. A simple app with minimal features will cost less compared to a complex app. The cost also depends on the technical complexity of the project, project scope, deadlines, and tech stacks used. The vendor may offer additional services such as QA testing and post-release support, but these are usually charged separately. The more resources required for a project, the higher the cost will be. Get a personalized quote for your project

Essentially, a healthcare LMS is a dedicated learning platform. Hospitals, health tech, and medical device companies use it to provide training on healthcare industry standards, medical product and device usage, and other pertinent topics. Whether for HIPAA compliance exams, mastering novel equipment, or staying updated with regulatory changes, a healthcare LMS simplifies onboarding, continuous training, and certification processes. Criteria for Finding Top Healthcare LMS What to Teach: Comprehensive Course Catalog A diverse course catalog that includes HIPAA, FDA, and OSHA compliance, specialized medical product instruction, and industry-sponsored CE/CME content is key to a good LMS. Administrators can then select relevant courses and assign them to the appropriate group of medical professionals. How to Teach: Personalized, Relevant Training Not every course is suitable for all hospital employees. The assignment engine within the Learning Management System provides a solution enabling administrators to allocate courses based on specific criteria, such as department, job title, expertise, and proficiency levels. Tailoring content to each participant's role and requirements, training becomes both meaningful and efficient. How to Assess: Progress Tracking & Certification Once training starts, it's essential for key stakeholders to monitor the learners' progress and completion rates. The LMS requires tools that reflect learners' performance, completion, certification, and compliance tracking. These tools give your healthcare organization a data-driven edge in managing training programs and meeting industry benchmarks, including Medicare, Medicaid, CHIP, HIPAA, HITECH, FDA, GDPR, and the False Claims Act. How to Improve Outcomes: Incorporating Advanced Features But what happens if the training doesn't meet expectations? If courses aren't completed punctually, if talent retention programs are ineffective, or if onboarding lags? A versatile LMS will offer advanced features and analytics to identify these issues, allowing for timely interventions and adjustments. To significantly enhance learning effectiveness in the healthcare industry, we can integrate the following features into your LMS: Gamification. We integrate game-design elements into non-gaming contexts. Examples include awarding points for completed lessons, introducing a leaderboard, or unlocking extra levels upon course completion. Research has shown gamification helps improve learning outcomes, increase precision, and motivate the learners to excel—metrics that can directly impact patient care and save lives. We use our years of eLearning expertise to help in choosing and implementing gamification elements that will work in each individual case. For more information on gamification and its applications, refer to our relevant articles: Gamification in eLearning and Gamification in Healthcare. AI-powered Chatbots. Our team integrates AI-driven chatbots into your LMS to provide instant learner support, answer queries, and guide learners through their training journey. Chatbots enhance accessibility and efficiency by offering immediate assistance whenever needed. Social Learning. We help foster collaborative learning experiences by integrating social learning features into your LMS. This enables learners to share insights, collaborate on projects, and engage in discussions, creating a dynamic and enriching educational environment. Microlearning Modules. We recommend breaking down complex concepts into bite-sized modules that can be consumed on demand. Medical professionals can work toward their continuing medical education credits during moments, such as a traffic jam, morning commute, or any available 5-10 minute window. Microlearning promotes knowledge retention, making learning accessible and manageable, even for busy schedules. Real-world Simulations. Using VR and AR to simulate real-world scenarios for practical training is one of the top eLearning trends. Learners can apply their knowledge in a controlled environment, boosting their confidence and readiness for actual situations. Key Healthcare LMS Features Security & Compliance When it comes to your healthcare Learning Management System (LMS), we understand that safeguarding patient data and ensuring regulatory compliance are non-negotiable priorities. Our team ensures security and adherence to standards at every juncture. We strictly adhere to regulations, like the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. Data segmentation, audit trails, and secure user authentication mechanisms are implemented to preserve patient data confidentiality. Our system includes secure file uploads, encrypted messaging, and role-based training to guard against unauthorized access and potential data breaches. We also believe in a multi-faceted approach to security. This includes data encryption, access control, and user authentication. Through regular audits and assessments, secure hosting, and data minimization practices, we maintain a vigilant defense against potential threats. Moreover, robust data backup and recovery strategies, compliance with regional regulations, and a well-structured incident response plan add an extra layer of security to the LMS. eLearning Standards Compatibility Unlike EHR/EMR systems, where interoperability is a problem that is still hard to solve, LMSs have the edge with unified eLearning standards simplifying data exchange. We apply: SCORM to standardize learning content formats xAPI for communicating data about learning activities among different systems, not just LMSs LTI to plug-and-play external learning content, software, tools, and more One significant advantage of these standards is the accessibility of learning materials. If your LMS is SCORM-compatible, for example, adding a SCORM-packaged course becomes a matter of a few clicks. Another benefit lies in advanced tracking capabilities. The versatility of xAPI, for instance, is evident in its wide-ranging monitoring and reporting features. An example of its utility is MedStar Health's initiative, where they employed xAPI to track resuscitation medic training, connecting it to apps, including a defibrillator simulator. Mobile support Healthcare professionals have diverse technological preferences, so it's important to make content available on various platforms. While many still rely on desktop setups, the growing trend leans towards mobile devices like smartphones for convenience. Here, the Learning Management System steps in by providing content that is accessible across a spectrum of devices and platform types, including iOS, Windows, and Android. This flexibility ensures that healthcare personnel can access training materials in sync with their preferred learning styles and habits. Integrations Integrating an LMS with third-party tools and applications via APIs brings considerable benefits. For instance, embedding the LMS with EHR software provides contextual training during patient record evaluations, promoting informed clinical decisions. Similarly, integrating with healthcare CRM systems and patient portals, we provide a consolidated ecosystem that offers immediate access to patient-specific educational materials and treatment protocols. API-driven integrations personalize the learning experience and extend the LMS's scope beyond healthcare training, empowering medical professionals with real-time information and elevating patient care. 3 Best Learning Management Systems for Healthcare in 2023 Based on G2 reviews, we'll list the top 3 healthcare LMS solutions in 2023. Relias Review Rating: 3.9/5 from 345 reviews Pricing: Сustom quote on demand, reportedly starting at $25 per license Relias assists organizations in addressing knowledge gaps with over 5,000 courses. Topics span from central sterile processes to wound assessment, with regular checks by 135+ accrediting bodies for compliance. Drawbacks: Some G2 users find the interface cumbersome and report issues like interrupted course playback. The video courses lack captioning, and there are inconsistencies in Relias' mobile applications. Users have also mentioned the system's limited interoperability, especially when importing courses and data. Healthcare LMS interface: Relias Docebo Review Rating: 4.4/5 from 366 reviews Pricing: From $1,600/month ($19,200 annually) per PC Docebo, suitable for expanding mid-to-large healthcare organizations, especially those undergoing expansion. While it doesn't focus exclusively on healthcare, it offers 80,000+ courses, blending general with healthcare-specific content, accessible across mobile and desktop devices. Drawbacks: Its vast range of features requires a learning curve, especially for non-tech savvy users or those unfamiliar with LMS platforms. Some LMS administrators have mentioned that it took them a month to become proficient with the platform. Like most ready-to-use solutions, Docebo comes with restrictions, including limited widgets and notification types, affecting user experience. Healthcare LMS interface: Docebo Absorb LMS Review Rating: 4.7/5 from 239 reviews Pricing: From $800/month ($9,600 annually) with an added $16 per active user annually. Absorb presents a cloud-based enterprise learning platform specifically designed for the healthcare industry. This platform equips clinicians with training, offers intelligent reporting tools for performance tracking, personalizes learning paths, and incorporates tests and assessments. The platform is flexible, allowing for tailored user experiences. Users can choose between mandatory or optional courses, while administrators gain insights into course completions and evaluations. Plus, Absorb supports extensive integrations with third-party software like Okta, Salesforce, and Zoom. Drawbacks: Large organizations should be cautious when considering Absorb. The vendor charges for every active user, which can result in significant costs, especially for larger companies. Some users have reported annual expenses reaching up to $25,000 under the Enterprise plan. In addition, limited API integrations have been flagged as a concern for those aiming to establish a robust system network within their enterprise. Healthcare LMS interface: Absorb Ready-Made vs. Custom LMS for Healthcare The healthcare sector has an array of LMS choices. While some might lean towards off-the-shelf solutions, there are compelling reasons to consider custom-made products: 100% match with your company's and patients' specifics. Ready-made healthcare LMS platforms aim to cater to a vast audience across various industries and scales. This broad focus often results in generalized systems that don't cater to individual companies and patients, which is a concern for most users. As a result, your training becomes less effective. Prioritizing and managing patient data security. The healthcare industry requires rigorous data protection standards. With a custom LMS, healthcare providers can implement bespoke security measures, encryption techniques, and access controls that comply with regulations like HIPAA. Such a proactive approach facilitates quicker responses to threats, allows for comprehensive security audits, and ensures smooth integration with existing systems — all while upholding patient confidentiality. Long-term cost savings through license fee elimination, reduced customization expenses, and streamlined integration and scalability at no extra cost. A customized LMS boosts training efficiency, lowers support and maintenance costs, and adapts to industry changes, resulting in improved ROI and patient care. Potential for commercialization. Building a custom LMS often stems from the inability of ready-made solutions to address specific needs. Your solution may interest other organizations with similar requirements. A proprietary LMS, with its unique branding, user experience, and features, can therefore become a valuable commodity in the market. Belitsoft Expertise in Action: UK Medical Practitioner Case Countries such as the USA, UK, and Canada mandate continuous learning for healthcare professionals. As a provider of both custom healthcare software development and LMS development services, we have created many similar products. Take, for example, our collaboration with a UK-based dentist. He sought creating a custom LMS for dental professionals, aiming to enhance their expertise, stay current with the industry, and effortlessly fulfill continuous education needs. Here's how we shaped his vision: Content Selection: We created an LMS with diverse dental courses, ranging from cutting-edge technologies to industry regulations. Personalized Learning: We tailored learning pathways to address the unique needs of dental professionals, leading to impactful learning outcomes. Progress Tracking: We integrated sophisticated tools for progress monitoring and evaluations, ensuring practitioners could monitor their growth and stay compliant. Enhanced User Experience: We emphasized usability, providing a sleek interface, clear navigation, and interactive features for effective learning. Belitsoft offers support beyond LMS creation and helps clients with various challenges: Custom LMS Development. If none of the existing LMSs fit your requirements, we develop a new one from scratch aligned with your specific requirements. LMS Customization. To modify an open-source LMS, we add the features you require or adapt the UI to fit your brand. Course Creation. According to your request, we produce educational content across a spectrum—from lectures to simulations and learning games. Consulting. With 17 years in eLearning and over 5 in healthcare, we guide you in LMS choices, training structuring, and data protection. GET A FREE QUOTE How We Create an Effective, Competitive LMS for Healthcare: Our Time-Tested Approach Stakeholder collaborating Engaging with stakeholders offers a comprehensive understanding of your organization's multifaceted needs. This includes technical necessities, operational considerations, and user-centric requirements. This collaborative approach ensures that our custom LMS solution is not only technically robust but also aligns seamlessly with your healthcare organization's objectives, compliance requirements, and user expectations. To grasp the diverse needs of your organization, we engage with stakeholder groups: System Administrators & Technical Support. Vital for daily software operations, their insights guide the technical and user experience aspects. Heads of Business Areas. Their input ensures alignment with corporate policies, compliance mandates, and branding. corporate policies, ensuring compliance, security, and consistent branding. Users (Medical Professionals). Direct user feedback is invaluable for tailoring user-centric features. Defining Key Functionalities An effective LMS is defined by its features. Our approach ensures a solution that meets business, user, technical, and security needs. Key functionalities might encompass: compliance with recent standards like AODA & WCAG, multilingual support advanced user privacy and security For existing LMS upgrades, we: examine the current system's alignment with business, technical, and security needs investigate evolving software trends in the niche and evaluate available solutions understand the software tools utilized by comparable organizations Developing an MVP With a clear grasp of needs and potential challenges, we define priorities for the development phase. Typically, this entails starting with a Minimum Viable Product (MVP) that houses the most essential features. This strategy ensures quick deployment, early user feedback, and forms a basis for future enhancements. Create training that perfectly fits professionals' busy schedules and brings notable results. Let's discuss the ideas. Frequently Asked Questions

Contact us to know how our EHR/EMR experts could help you with custom EHR/EMR development or selection, EHR integration, EHR implementation, EHR data migration, training or support! Epic EHR Disadvantages Epic is the most widespread health record software with 28% of the market. It is used by many large hospitals across the US. However, it doesn’t mean that the system is perfect: Bugged Updates Scott from Metro West was disappointed with the extra bugs each new update to Epic brings: “Their support is unhelpful. I work with EPIC exclusively at SSM facilities and could not be more disappointed. EVERY TIME, not sometimes, there is an update we are left with catastrophic problems with the system that persist for days. I do not understand why they cannot troubleshoot updates before they go live. If I was this effective in my job I would not have it anymore.” Confusing Records Lisa from Wellness First calls Epic a “messy” EMR. It was quite complicated to work with: “The least likable thing about this software is how it ties everything into continuation. For instance, if you need to print an X-Ray report you have to print literally the entire record as it seems to always pick up where you left off, if you are seen on one day and come back in two weeks they just pick up where they left off so the notes are just confusing, what visit went with what. I don't like that at all about Epic” Dorothy from The Family Foot Care Group didn’t like the amount of time she had to spend on working with this EHR: “There is little benefit to patient care because of time in front of the computer is unusually demanding. This is ideally suited for the government gathering of information in public health data. It is not primarily for improving patient care, in fact, the opposite occurs.” Karen, a physician working for a large medical practice, thought of Epic as a health risk: “I am a physician and consciously avoid health care facilities that use EPIC for my own care because I think it is so bad. Access from home on call but any software does this. It is actually very cumbersome to log in from home.” She has further elaborated on that: “Insufficient space to list all the problems Great for people with OCD who just like to click boxes. Clunky, cumbersome, slow, cluttered and poorly designed screens After 7 years it just keeps getting worse. I have used much better EHRs in other settings.” Low-Quality Training Audrey, a pediatric nurse, disliked the inadequate training she and the other users have received: “Why does it take weeks and weeks of training by red-shirts and we still don’t know what we’re doing? VERY user-unfriendly. I would never recommend this.” She has later expanded on it: “Too busy...like an unmedicated ADHD child. Not user-friendly. Not intuitive. Too many ways to perform one task. Half the time the trainers don’t know what they are doing. Too many updates. This program slows down my patient interaction. Honestly, I could go on and on and truly believe this is an over-hyped EMR.” Cerner EHR Disadvantages Cerner has the second-largest share of the US EHR market - 26%. The company’s products are installed in over 27,000 locations all over the world. But, as a pre-built system, it doesn’t exactly fit everyone’s needs: Poor Training Raul from Granville Family Health was disappointed with the training Cerner has provided: “We transitioned to Cerner works in Nov 2016 in our output office. On sit, Cerner support had not been trained on our version and was not helpful. On one occasion the on-site support taught us workflow for prescription refills that was improper and left scores of prescriptions unfilled. The issues with the system are so widespread that each day presents a seemingly new issue. Chart tabs disappear... migrated medical history and allergy information is inaccurate. Lack of functionality was and 2 months in still is absolutely shocking... I would strongly encourage other health systems to go a different direction for your bottom line and for patient safety.” Cumbersome UI Josh from St Francis Hospital thought that this EHR was developed by people who have never worked in a clinical setting: “The software is poorly designed, difficult to navigate, and generally feels like it was designed by engineers who have never worked in a healthcare setting. The software is not intuitive to use, creates extra steps to execute simple orders, and is filled with programming glitches that can't seem to be fixed by their "extensive" support staff. I found many of the MD support staff to not even understand or be able to navigate the program because they use Epic in their daily practice. Overall the software feels dated. The design team should spend some time using Apple products to learn about the ease of use.” Moreover: “The software is difficult to use. It is not intuitive. Simple commands require multiple steps to execute. You are required to manually "refresh" to send orders, even after signing. It has created more work for the doctors at my institution, taking simple tasks that previously could be performed by support staff and making them an additional responsibility of the MD.” Gary from Carmel Care PLLC also had a few things to write about it: “While the output of the EHR is definitely readable, and there are many modules available, this is one of the least user-friendly EHRs on the market today, in the opinion of this user.” Buggy e-Prescribe Feature Nicolas from Puerto Rican Family Institute had trouble with prescription of both controlled and non-controlled substances: “Amazingly poor UX/UI layout, and often confusing. The customer services has been a nightmare all along.  For more than two months initially in March 2016 when we wanted to start this system we were forced to keep calling in prescriptions to pharmacies & writing controlled medicines for 5 days because the system wasn't working - and Cerner telling us they didn't know what was the problem. Later on when we were eventually able to e-prescribe non-controlled substances still we were forced to get an NY State waiver for controlled substances because the company couldn't get it resolved in more than a month longer. Worse, they blamed our IT team here when it was clear it wasn't the case. This was more frustrating as this was happening while we're busy seeing patients.  Support was spotty at best, often the IT people were forced to resolve the problems themselves, or improvise, while the agency I'm working was paying Cerner money. Even now (10/18/2016), the e-prescribe system, that claims it has a renewal option for old medications, it doesn't work for controlled substances (some do, some don't), so many of us always have to rewrite as a new prescription for all the controlled medicines.  I'm a psychiatrist but I've also got some formal training in UX/UI design, and to write code, so I'm probably better understanding computers than the usual MD, and even for me, the system was an impossible crazy task.  I also work with other e-prescribe systems in other agencies and comparing apples to apples, the other systems are much cheaper and much, much better, and very much easier to use. It's amazing the kind of poor service you can get paying big bucks! And here, this is one glaring example. Buyer beware!” Allscripts EHR Disadvantages Allscripts is within the TOP-5 most popular EHRs in the US. With its 6% of the market, it is among the staples of medical software. However, there are users who had unpleasant experiences with it. Bad Customer Support and Unfair Pricing Helen from Women’s Care OB/GYN Inc. called Allscripts “EHR from hell.” She expands on it in the review: “Terrible customer support, always have to wait for them to call back. Price gouging, charging extra for everything. Charging extra for what is supposed to be part of meaningful use. DO NOT USE THIS COMPANY! RUN AS FAST AS YOU CAN!” The other disadvantages she has mentioned were: “very slow, freezes frequently, error messages. Poor customer support. Every time there is an update, we have issues afterwards. I have been using the system for 2 years and it's still creating lots of extra work.”  Teresa from Parkway Medical Group, PC, also doesn’t like Allscripts: “Not happy with the Allscripts System. I have been with the company for 16 years, started with Tiger then Allscripts Myway, now Allscripts Pro. Unable to get problems resolved in a timely manner. Problems understanding the customer service, overall language barrier. They ask when I call in (Have you checked the Allscripts Portal for the answer first before call customer service) We are a busy 4-physicians office and don't have time to search for the answer to our problems) We need an answer so we can continue on with our daily duties.” Other issues Teresa mentioned included: “Problems with e-Prescribe, allowing the physician to free text diagnosis, doesn't show social security numbers (which would be very helpful for the referral clerks), If correction needs to be made in PM the corrections do not cross over to EHR, so you have to go in and do an addendum” Locked Contract Pam from Greenville Health Care Center has had to resort to drastic measures to move from Allscripts to another vendor: “There is a long term cost for literally everything you want to do or change. Their contracts are so lawyered up they are impossible to get out of. We just terminated our service and we have struggled through with them since 2008. They were our first EHR company. They have now sent me my billing information through 2026. I left a voicemail Monday which as of yesterday afternoon had not been returned. I sent an additional email yesterday in regard to the bill which has not been answered. I also left my cell number since I would be out of the office and so far no word from anyone to discuss our bill. My practice is closing and opening up under a new name and tax ID. Not sure how to handle their bills for the next 9 years.” Dysfunctional Updates Roy from IU Health Arnett felt immensely relieved after the practice has switched to another vendor. He wasn’t a big fan of Allscripts’ complexity: “I used it for two years and so-called updates caused so many problems the company I worked for had to offer classes on how to use it all over again.” There were other issues he has mentioned in his review: “There can be three or four places to enter the ordered screens (like colonoscopies) and only one will show up on the dashboard. The program crashes a lot.” Scott from Surgical Associates of North Texas also mentioned his displeasure with the system’s updates: “Constant "upgrades" that didn't do anything to improve productivity, only made it more difficult to complete my daily work. Customer support was terrible. The biggest drawback, now in hindsight, is how incredibly expensive it is. We started with them early when there weren't many options. I'd keep hearing from other docs how much they were paying for their EMR's and be thinking "no way, they must not have what we've got". Turns out, I was the one being had. I now spend less than half of what Allscripts charged me, and get office management and billing support as well. I have trouble understanding how they are still in business with their model.” Price-Gouging Amber from Iowa ENT expressed her displeasure with a long review: “It is so ancient. Not sure how they can say they are one of the best or leading in EHR?? Complete lie! Has any of the faculty or developers of this company ever seen any other EHR?? I'm guessing not. Maybe they should see some other EHRs or have experienced providers help them!  You also get nickel and dimed on everything even when you pay major dollars to have the program and have to continue to pay for services, monthly fees, and for every upgrade and added the feature. Their customer support is horrible because half the people don't know what they are doing.” In her opinion, the disadvantages of Allscripts were: “Everything from the layout, templates, workflow, e-scribing, how only one person can be in the note and you have to steal it or take it over in order to do your part. I can't even create a note on someone I saw last week because another provider had two charts open on this patient that needed to be finished. AND...I can't even view any of these open notes either even when I am following up on this patient and need to see some things. You have to enter each prescription and send it separately.  The search buttons for diagnosis, procedures, tests, education are horrible. You need to be able to find one thing with multiple names medical and layman, most commonly used. The nurses should be able to put in their vitals and go into medication, history, social, family, etc...at the same time I am getting into the HPI, exam, diagnoses and plan. I should be able to see the entire note, every section, on one page so I don't have to do a ton of clicking to try and see everything. I want to see the entire note.  I should also be able to see the problem list, medications, and other things off to one side. If someone is trying to open a section I am in the program just needs to let them know about it by saying "so and so is in this section right now do you really need to take it over as it wouldn't save anything." This was helpful with the last EMR I had at my last job as I could even ask the person it said was on if they could get out of the section if I needed them to.  When you have a template, you should be able to select something, but still alter it. E.g. if you choose one of the already made master list options you can't even put anything before or after or in between the sentence. Even when entering days or weeks to some of these sections you should be able to free text and even put 2-3 weeks or whatever you need to put in there. It should be very easy to make templates and edit things.  Have any of these developers ever went into a medical office to even see how busy and complicated it is. It needs so much work. It is SO old school!! I seriously am so frustrated, I can't even understand how this business is still successful?? I'm honestly going to spread the word on this program as it is the worst investment ever. Also when running reports it doesn't capture everything. Also it isn't very helpful for meaningful use.” Billing Issues Nancy from FASV, PC, tells her story of working with Allscripts: “We are a small three doctor practice. Signed with Allscripts in 2013 as Bon Secours Hospital was contracting with them and offering to subsidize portion of the cost. Three years of struggling with customer support issues ranging from the downed system to billing disputes.  Our bookkeeper hired in Jan 2016 contacted Allscripts in January & was told the account was in good standing only to receive a notice in April 2016 that we owed "reopened invoices" in the number of dollars. We continued to pay current invoices and disputed the amount until they provided us with an audited AR history of our account. They responded by putting our account on hold preventing us from doing business.  We agreed to pay the disputed amount out of necessity in order to continue to see patients and generate income. They refused to provide us with an audited AR history of our account to review the charges only providing data in an excel spreadsheet.  Additionally, one of our partners is leaving the practice due to life-threatening health issues. Allscripts is refusing to let us out of the 2 years remaining on her license.” Expensive Interfaces Dick from Northern Michigan Laboratory offers his own perspective on this EHR: “Allscripts touts connectivity as a strength. Of all the EHRs with which we connect, Allscripts takes the longest and at the highest cost. It appears Allscripts views interfaces as a cash cow for them.” Low Uptime Nancy from Smaldore Family Practice Associates also has a few words to say about Allscripts: “Constantly get errors and system downtime. Some of the diagnoses descriptions do not match the ICD-10 book. We recently had an EHR upgrade and the following day after the upgrade, our system was down. Found out that they did not test before initiating the upgrade to clients.” Jim from Foot and Ankle Clinic aptly tells people to “Run, don’t walk away from this garbage product.” This is why: “Awful! The server is constantly down. Customer service takes 3-4 hours to resolve complaints. The representative they assigned to help us because of our constant issues does not return texts or phone calls. There are constant errors once inside the software (that is once in a blue moon when you could actually sign in). The fees continue at monumental cost once the software is paid off. I'm hiring an attorney. Did I mention it is awful?” Inflexibility Dennis from OMC Women Health Care calls Allscripts an “inflexible system.” He claims that it: “Does not accept different file types (PDF, Jpeg) to be imported into the encounter. Too many clicks to accomplish simple tasks. Not Intuitive. Opening multiple windows is not allowed. Free text entry limited: No formatting, limited character entry.” Inefficient Data Entry Buffy from Liberty Hospital gives a nurse’s viewpoint: “The Allscripts EHR we are using is terrible, to say the least. Nothing populates to anything else in a meaningful way. If I give insulin, it should populate the diabetic flow sheet. But I have to double chart everything. It isn't capable of connecting to our telemetry, so again, another entry.  The physical assessment is ridiculously laborious to chart. It takes nearly 20-30 minutes just to open my patient’s chart. As I move from room to room to chart at the bedside (per directive), the log in and out time is very long.  Once charting, there are far too many descriptors that mean nearly the same thing. The list of possible findings is so long that it takes forever to look through and it's not in any particular order that I can see (such as alphabetical descriptors so it's easier to find what I'm looking for). It forces you through some things line by line, while completely skipping others so I have to manually go back. For example - in the skin assessment, I am line by line forced through everything each time. But in the cardiac section, it skips right over the telemetry parameter if the patient's assessment was WDL. If I've added a tele parameter I probably want to use it.  There are so many columns across the page it's mind-numbing to look at and often leads to people inserting data in the wrong column. If a parameter is accidentally clicked but is quickly realized not to be the one I meant to click, there is no way to delete it, this leading to yet another grayed out but space-taking place. If there has been no data entered in a parameter, we should be able to delete or have an undo action option.  In short, we are healthcare providers, not IT professionals. I should never be spending more time charting about the care I am providing than actually providing care. And the worst part is that with all the endless clicking of boxes, I chart less meaningful things than I did paper charting! I have yet to find one person who likes our system.” eClinicalWorks EHR Disadvantages eCLinicalWorks has been on the market since 1999 and boasts an impressive userbase of more than 850,000 medical professionals. Some of those users, though, find drawbacks in the system. Inefficiency Jay Joseph from Sparks Family Medicine considered eClinicalWorks a “money loser.” According to his review, this EHR was very time-consuming to work with: “I have been using and developing EMR software since its inception. I even wrote my own EMR version using Microsoft Office Access in the mid-1990s.  The sales pitch is not made to the clinical user who does all the input but to the back office manager who keeps regular hours, does not see patients, and does not take calls. They make a fancy pitch on how they can make the business part of the medical office run easier and can save time for the office manager. Then they charge extra for the clinical part to run easier.  I used to be able to see 30 patients a day; one day I even saw 52. Now it is a real struggle to see 15. The Rx function is a real time-consumer. I need to look up what I want to do in my MPR, and then, if I am lucky, translate it into ECW speak. The ICD-9 codes do not match what is commonly used in the majority of other ICD-9 descriptors. I can find a better ICD-9 description of my diagnosis using Google.” Billing Issues Andrea from Monroe Pediatrics had a lot of issues with the billing part of eClinicalWorks: “They are so fraught with billing problems, I have owned my practice for almost 18 years and they have almost bankrupted my practice, as soon as one billing problem is fixed we find another one. The representatives and Case manager at E Clinical say they have never seen anyone with so many problems, but somehow I don't believe them. When, now, going on 4 months into the process I am still only collecting 30 % of what I should be collecting, and I have borrowed more than the practice is worth to keep the cash flow going, and I ask them why I should pay them... They threaten to cut off clinical support. This was the biggest mistake of my life.” Bugs and Overpriced Data Transfer Mark from Mark W. Niedfeldt, MD, kept being disappointed with eClinicalWorks even after he moved away from this system: “Terrible customer service. Outdated platform. Expensive. What's not to like? When I left I paid them $5000 to get my records to transfer into my new EMR, they sent me a hard drive with data in random arrangements and corrupted data. Nice.” He also highlighted other problems: “Wow, where to start. This is a spaghetti programming system that is so screwed up it will never work correctly. Every time there is an update, multiple things stop working. If you have problems good luck getting someone who speaks understandable English or even someone to respond to your issue. You may get a response several days later at 9 PM. The only people there who speak good English are the salespeople (shocker). Until I went with a different EMR I didn't realize how many workarounds I had been putting in place.” Glitches and Low Usability Robert from PromptCareMD stated that he has “Never used more glitchy software, nor a more poorly designed UI.”  The list of problems he had was extensive, to say the least: “ As others have stated, the initial 5 day training period was mostly used by their staff to fix their own glitches and get the software to a base functional state.  2.5 of the 5 days training period was used to fix things like scripts which simply didn't work. So much of the provider training time was a total waste. We were then charged additional money to have them come back and spend more time with us.  Content is not provided. We were told the system can be used for urgent care. After all, one fo the largest chains in the country uses ECW. They didn’t tell us that the chain spent a significant amount of time and money customizing the system to suit the urgent care need.  ECW is unable to provide suggestions for how their software should function in an urgent care environment. asking them which flow would be ideal for their software is a useless question.  Their software was designed by folks who have never heard of UI/UX or Human factors. As others have noted there is no consistent use of symbology between screens. There are often multiple ways to do the same function on one screen. Sometimes the label "close" means one thing one screen but another on another screen.  Tech support is obscene. We were unable to unfavorite certain meds from our list. It took them weeks to months to figure out why.  Multiple sections of the software are labeled "procedures". One area results in a CPT code being auto listed on the billing screen; one area does not. Many other illogical quirks exist as well. Good luck trying to teach every new provider these types of quirks.  If you are an RCM customer, many of the features they use to market themselves are simply nonfunctional. Patients of RCM clients can't use the patient portal to make payments since as an RM client, the software does not correctly send balance data to the portal. But if you call the "portal department", they are unaware of this problem. The web-based version of their software to this day (early 2019) does not receive correct balance information for patient accounts. So, even if the providers and the medical assistants use the web-based version, you still have to maintain the desktop version for the front desk staff. The UI is totally different between the two systems, so you effectively have to train your staff on two different systems. Ridiculous.  Their entire development team and tech support team is in India. Consequently, we had to spend significant time fixing the kiosk application since literally every screen in the app had typos, grammatical mistakes, and phrases that simply didn't make sense. I screencapped them to have proof. They simply didn't understand why I couldn't use the kiosk app as it was delivered to me. This means they never even bothered to have one of their US-based staff look at the product before it was released.  They wanted to change the pricing scheme in the middle of our contract due to legal issues they had in NY. So, they changed it in their favor without discussing it with me. Their financial analyst then used seasonal data, and ignored the peak season in doing so, to justify their new price. Had they been intellectually honest and used a full year of data, it would have altered their conclusion about what the new pricing scheme would have cost me. Dishonesty like that has no excuse.  Despite asking them if the price we would be paying for the software included everything as an RCM customer, and them replying yes, they then proceeded to charge me hundreds of dollars extra for each provider per year to use the escript controlled substance feature. So yet another set of conversations resulted in a reduction in price for a period of time.  I can’t even count the number of conversations I've had with tech support, their own billing dept, as well as their practice liaisons who knew nothing about urgent care. I want the year of my life I've spent with them on the phone back.” Bad Customer Support Gina from Mid Ohio Medical Management considered eClinicalWorks too complicated even for their own team: “The program was so compartmentalized...each individual only knew about their part. One would spend weeks troubleshooting an error to find out that another had not turned on the feature.  The system is too complicated for those that programmed their parts! I then after approximately one year decided to transition to a more user-friendly emr...this process was just as problematic. They sent a disc that was not in the format needed and then refused to change it and refused to allow the new EMR company to access the EMR. We were told to download it in the format ourselves… when we tried, we had been disabled from doing so. We called to gain access from the project manager...again on hold for 45 minutes. Still waiting for a callback. Note that they are expecting pay for this 5th world EMR while we transition.  These people have unfair business practices and have been fined and sued repeatedly by the Department of Justice. Now I'm being held hostage paying for a suboptimal EMR that has done nothing but caused me grief.” Lots of Errors Jay from Alamo Heights Primary Care Physicians had several issues with the implementation of ECW: “ I had to hire staff for all the errors eclinical has. They do not have support. When an issue comes up you have to leave a ticket, they call u 1 hour later and then your staff has to use their time and their computer to be walked through how to fix it. meaning each issue takes 2-3 hours of your staff time. Nothing is simple.  We finished and went live on May 14, 2018. NOTHING WAS LIVE!! 2 months later we still cannot get electronic prescriptions done. None of my old EMR imported, None of the referring providers were in for 2 weeks. Try running a business with patients and no staff because your staff is on the phone with support. 3 out of their 5 days of the trainer on-site are a joke. That was an extra member who was on the phone the entire time fixing implementation issues. NO ONE GOT TRAINED> NOTHING WAS READY. oh and by the way I signed up in Jan 2018 so I gave them 5 months to get all the data and this together...” Terrible Interface Brian from Tufts Medical Center found that ECW was error-prone and had numerous usability issues: “ Very slow to startup, and uses a lot of resources on your desktop computer. Too many clicks. Too easy to make mistakes and lose work (where did my 5-paragraph note go?!).  Not easy to customize.  eCW often generates medical errors.  the interface is terrible--why can I only see 5 lines of typed text at a time? Why are there 5 buttons on a view that are all labeled the same thing? (No...use the "scan" button in the upper left, not the lower right).  too many mandatory fields that are not relevant (I just want to see his past vitals...I don't want to enter a pain score right this second...).  low-quality document and photo uploads (I think that's a wound...but it's so pixelated).  Easy to lose formatting in templates (if you click here, it's ok, but if you click over there, then all hell breaks loose).  Anything that is not done in a billable visit has to be done in a telephone encounter.  E-prescribe module is difficult to use and not consistent. (Sometimes you can type in a box, sometimes you have to click on a little number pad, the options for prescribing are in a weird order (alphabetical, ordinal), complex dosing, like a prednisone taper cannot be done.)” Illogical Workflow William from Medical Hills Internists largely attributed his early retirement from his group to this EHR and listed a number of serious issues he has faced: “ Illogical workflow. I could go on for a long time about this but I don't have the room.  The web version and desktop version are significantly different so if you go home to finish notes, which I have to do almost every night, you have to remember to do many tasks in two different ways. Here's one frustrating difference. You can fax prescriptions from the desktop version but can not from the web version which means if I have a controlled substance to send in I have to wait until the next day when I get back to the office and can use the desktop version. There are too many other cons to list. They are mostly numerous little things that slowly drive you mad. Morale at our office has been terrible since we changed to eCW.” Subpar Training and Meaningful Use Documentation For Robin from Johns Creek Surgery the problems with this EHR began during the implementation process: “Troublesome from the start. The training was awful and we paid for 2 separate training classes for our employees. They were charging us for things that they didn't even have set up. We finally hired an IT/Rn person that could help us with this program. Our employee is constantly telling ECW tech people what they need to do because they have no clue and we don't have the access to make the changes. We asked ECW many times to open our system so we can do what we need to and they stated that we would have to pay an additional $7000 to $10,000.” The final straw came when the practice members filed their Meaningful Use documentation: “This is our breaking point when ECW employees do not know how to do their jobs and now has affected the reputation of our Surgeons by reporting our MIP's to a government office as a group when we were clearly supposed to be reported as individual doctors. So instead of our MIP's score being above 90 on all our doctors they are now publicly scored as 7.17. This will now not only make us lose money we should have received from the government but can actually cost us money on our reimbursements.  We have spent all morning on the phone with QPP to try to correct this error and are getting no support for ECW. We have tried all morning to reach out to people at ECW and no one will take our call. WE ARE NOW TALKING THIS IS OUR SURGEONS REPUTATION THEY ARE AFFECTING!!!!!” Athenahealth EHR Disadvantages Athenahealth holds the 7th place among the Top-10 most popular EHR systems in the USA. It occupies 2% of the market. Billing and A/R Issues Jon from Dr. Jon's Urgent Care Center had issues that affected his practice’s financial health: “Billing follow up and working of A/R is terrible. After 4 months using Athena billing I can find no evidence that a single patient has been billed for their balance after insurance. Our Accounts Receivable is 50% higher than it has ever been in the 6 years we have been open.  There seems to be no one we can talk to except for client support, after a long wait on the helpline, and our account representative, who is available on the phone only by appointment, promises but does not deliver. The EMR is finicky and full of glitches. It requires countless clicks to get anything done. The embedded E&M coder is not reliable.” Heather from Anchorage Foot & Ankle Clinic has also faced problems with collections: “I was assured that this program had a lot of podiatry- based templates and that they were simple to modify. However, there are very few templates for my specialty, and trying to make or change a template is frustrating! It takes at least an hour to do one template. And, you cannot use the same template choice more than once in a template, so if you are trying to chart two feet, good luck!  The EMR takes forever to implement (11 weeks). I think that our implementation manager did not do a very good job of setting us up, so we have been having to try to learn everything on our own, which is frustrating and time-consuming when we are busy trying to see patients.  There is a lot of typing that has to be done during patient visits, which takes a lot of time and slows my pace and ability to see as many patients as I would like. Trying to just put in CPT codes takes forever. Also, save your work every minute because there is no auto-save on this program and I have lost so much information!  Do not believe it if you are told that Athena does your insurance credentialing for you. We have had to do it all ourselves. And you cannot pick and choose what claims are dropped for payment; it is all or nothing, so have a lot of working capital available while you credential. EFT (electronic funds transfers) have to be done through US Bank. We use Wells Fargo, so I have to do money transfers, which take a couple business days to process, and that is a real pain. We have also found out the hard way that unless we track each individual claim ourselves, secondary insurances may fall through the cracks, leaving money on the table that we have to find and process ourselves. I fear that our income is not going to improve (contrary to their claim that they improve collections by 8%) and, in fact, that we will potentially lose money.  Our paper usage has increased substantially. You cannot just scan documents into the program. You have to fax them to Athena, and they sort them and place them into the patient's chart. However, you have to have a front cover and back cover barcode for each fax you send them so that a one-page fax becomes three pages. E-prescribing is hit or miss, so I have to double-check that all e-scripts actually have gone through. Also, we get numerous complaints about how complicated the patient portal is.” Bad Customer Support Jake from Dr. Steven Kushner DO was sad about the decrease in quality of support his practice has received: “Over the past 5 years we have been a client, our practice has had numerous account managers and every time they re-assign us to a new one, they get worse and worse. Less knowledgeable about the product, less responsive to our emails and calls, etc.  They've stopped doing regular check-ins every quarter or even year like they used to. They don't help us implement new features like credit card processing, the patient portal, etc.  Customer care call center is okay to answer some specific how-to questions but they're not going to hold your hand through a long process like setting up the very unfriendly patient portal. The system as a whole has a very steep learning curve with tons of menus and buried settings. And there's no "HELP!" button on any screen, just have to go into their humongous help site with a million questions posted, just to find out what one field on screen means.” Christina from Boulder valley Foot and Ankle Clinic also had trouble with the customer support of Athenahealth: “Lack of knowledge when you call for support at Athena. Many times I call for assistance and they have no answer and have to get back to you. Inefficient.  They state you make more money with them since they have a high rate of patient collection. However, we have more patients than ever before with outstanding bills and Athena fails to follow up on patients and these unpaid balances.  There is no support for that. Once you sign up for Athena they drop your support and will switch you randomly to new managers to start all over since they cannot follow through. It takes weeks to have a support session with anyone that has some knowledge of the system. They have too many clients and not enough support. After a while, you become numb to it all and give up hope that it will ever be efficient and make practicing easier.” Complicated UI Jason from Jason Marchetti MD, struggled with the user interface of Athenahealth: “The system is not intuitive at all. I had to call customer support for just about everything including just to verify that I had done things correctly as I learned early on that even if it appeared like something was done correctly, it wasn't- I either wasn't in the correct "area" or I didn't then go to step 2 (for things that really don't need to have more than one step!) There are several areas in the system where you can leave notes that appear to be communication notes with the Athena staff- but NOOOOooo, these notes just sit there for your own amusement. If you want Athena staff to do something or be aware of something, you better call (and chances are you'll get customer support based in India FYI).” Uncaring Attitude Michael from South Florida Ear, Nose, and Throat witnessed the degradation of the company’s attitude towards its smaller clients: “It was once a good company. Now they make unacceptably frequent (and serious) mistakes. They have also absconded on responsibility by doing away with individual account agents. There used to be one individual responsible for our account, and we went to her with any problems. Now they have teams of useless agents that are responsible for everything as a group. Which means no one is responsible. And nothing gets fixed.” In addition, the changes cause the need for extra labor: “They have apparently gone cheap on programmers and customer service agents, outsourcing to somewhere in southeast Asia. What used to be quick and easy now is time-consuming and laborious. We've had to hire an extra employee because of one unfortunate change that Athena made two years ago, getting rid of the calendar sidebar so that you have to refresh every time you want to go from a patient’s chart back to the daily calendar to process all the patients. They promise over and over again they are working on fixing it. Two years later, they still have figured it out.” Unfit for Specialty Practices Kristin from CompreCare Lymphatics found out that Athenahealth couldn’t support her occupational therapy work: “Marketed as a product for multiple disciplines and specialties, however, does not support occupational therapy services. OTs are told to use PT templates and configurations despite (1) potential conflicts with documentation for reimbursement and (2) being initially told that OTs were a supported discipline.  Account managers are not useful as they refer back to the service center for all issues. It is an endless cycle. Not knowingly, we were not set up properly before launch, and despite repeatedly telling the AM that the system wasn't sufficient for us and that we had to work harder to make it work for us, 7 months later we find that ours is not configured as it should have been. There has been no response on this or even consideration of trying to keep a client happy by an account manager.  The system is severely lacking and counterintuitive, and if individuals make suggestions for improvement, they are "voted on" for consideration, even if the suggestions or requests are standard in the industry or required by governing bodies. Many requests and improvements are not made. We truly question is up to date and compliant.  Clients are told to create templates, or modify current (such as a standard facesheet), by coding them independently. Most medical practitioners (1) are not coders and (2) are not paying for a service that requires more time and effort than less. I was actually told by a higher level account manager that the solution could be to hire an outside coding agency to complete this task (vs it being standard in the existing product or have a dedicated person in Athenahealth that assists with coding needs).  The therapist reviews in the hub are not favorable. Individuals considering the purchase of the system would never know how many years of complaints and "make it work" scenarios exist. Unfortunately, changing EMRs is not simple and quick and is often costly. The billing portion is fair but mistakes are still made with submission requiring extra time in "hold" and delays in reimbursement. AthenaClinicals is just horrible. There is a definite environment fostered within Athena that is brush off, dodge issues, let clients figure it out, and if they leave "oh well."  We are disheartened and infuriated at the same time. If our practice had the same reviews, both public and internally, I would be very ashamed, take a step back, and wonder where things went wrong, let alone REALLY wrong. Bottom line: if anyone sees this who is considering Athena, regardless of discipline, go with another service provider. We as existing clients see A LOT in the community feedback on our resource hub. You will be entering something that you will then be prepared to get out of with excess cost.” That wasn’t the end of it: “The clinical documentation product is terrible. Supports physician-based practices vs rehab/OT/PT (though clients can see comments on product for all disciplines). Lack of quality templates that are compliant with regulatory agency requirements. Lack of feedback options. Lack of support. Account managers do not actually help to manage any issues you have with the product. Very time consuming to call in for support repeatedly. Athenahealth clearly does not review feedback on the community resource hub. Individuals that process Athenafax can be lazy and not process items with documents clearly identified with Athena identifiers/ printing, leaving in review for practice to handle (extra work). Honestly...too many cons to list.” Practice Fusion EHR Disadvantages Practice Fusion is the most popular cloud EHR in the USA, providing care to over 5 million people per month. It is still not without its flaws.  Contract Breaches Justin from Asclepius Health and Metabolic Specialists called Practice Fusion “unprofessional, unethical, incompetent.” His reasons were the following: “I gave them a list of my complaints, not the least of which was that my trainer couldn't even explain the use of templates on their system. Also, their knowledge base is completely unhelpful. Their response was to breach the contract by shutting down my access to the EMR. I have a full schedule on the next business day and now have no EMR. These people are criminals! Stay far away!!!!” As the downsides of the system, Justin mentioned that they were “Too many to list. Their customer service is unprofessional and unethical. They have answers to nothing. They always refer me to the suggestion board when I ask about why a feature isn't present that is a standard part of medical practice since forever. The suggestion board is where suggestions go to die. Seriously, there are good suggestions there from 5+ years ago that have been ignored. All of my suggestions, again part of medicine since forever, have sat there awaiting the moderator to clear them for over a month!” Contract You Can’t Get Out Of Suresh from Cornell Pain Clinic shared his negative experiences with the company: “I signed up for Practice Fusion on March 21st, 2019. Due to pending litigation, I was forced to delay the opening of my clinic and sent in an email as well as a physical copy of the cancellation notice on April 10th (well within the 30-day time window for cancellation without charge.  Despite several attempts to cancel service, the company continues to bill me citing I had a year-long obligation even though their contract clearly states that I can cancel within the first 30 days of signing up without any obligations. I recently received a notice that my account is being sent to collections in June 2019. I am trying to reach the company to find out why I am still being charged without any response from them. It seems their business model is to sign people up and keep charging them even after cancellation on one pretext or another. Horrible customer service and business practice! Judging by other customer reviews of a bad quality product I would dissuade anyone from signing up for their subscription software!” William from Open Bible Medical Clinic warns that it is “easy to get trapped in the system.” The exact reason for this is here: “Contract locks you into paying for a year regardless of problems encountered. Service agreement provides for contract cancellation without cause but the company refused to honor that and continued to withdraw funds from credit card in spite of my no longer using the system. I am a volunteer physician working in a safety net system paying for Practice Fusion out of my own pocket. They told me I needed to file a hardship request with Practice Fusion, however, when I did that they refused to consider it. Caution: BUYER BEWARE. These guys are ruthless.” Unprofessional Customer Service David from Tidewater also has something to say about the Practice Fusion customer service: “Our training rep was gone for many weeks during our time-limited training period. While he was gone, we had no one to speak with. When REP returned, if we ever heard back from him, it was several days after the fact. He would say that he was too busy because of all the calls that had accumulated. No kidding, that’s generally what happens when you take so much time off. The last straw with him was when we had him trying to solve an issue for us that lasted several weeks. He finally just gave up and said that it wasn’t his problem.  Then I found out that the prescription format is illegal in my state. Dispense as written must be on the bottom left and in PF it is reversed. I’ve filed multiple tickets on this simple issue, and get no valid response. It’s now been 6 weeks, and my emails now just go unanswered.” Michael from Beckham Clinical Services also listed customer service as the main drawback of this EHR: “We were not able to get past the horrific Customer Service experience while attempting to transition from ICANotes to PF. Could not move forward with setting up billing due to a clearinghouse issue which PF told us they would have to resolve and to call when we were ready to complete the transition. Called in to have a ticket submitted. I did not receive a response for over a day. We submitted another ticket and requested to speak to someone (Thursday morning). On Friday end of the day we received an email with links but no phone call. Links were not helpful. Submitted another ticket on Monday requesting to speak to someone. We received a call late Monday afternoon. The customer service agent was unapologetic that she did not know how to assist us and seemed indifferent to assist us to resolve the issue. At that point, we gave up on attempting to use Practice Fusion.” Poor Reporting Lisa from Metrocrest Community Clinic wrote about feeling relieved by the expected switch to a different system: “We have had Practice Fusion for over two years. We are very dissatisfied with customer support, poor product management, and lack of robust reporting capabilities.” There were other downsides she wanted to mention: “customer support - nice people that do not know the product, lack of robust reporting, the introduction of new features, and the overall product road map or lack of a road map” Buggy E-prescribing and Unreachable Support Agents Michael from Burien Medical Eye Care compared Practice Fusion to “being served a really awful dinner that you don't have to pay for.” Here’s why: “No customer service. Glitches are unavoidable, but customer service is a value decision by the management. If you create a "ticket" for someone to address, you're screwed if you don't happen to be available at the moment that someone calls you. Forget about getting anyone on the phone or an online "chat" no matter how long you care to wait. I've been in a queue for hours and nobody ever comes to the chat. The "e-prescribe" worked for about three days. After that, no local pharmacies could be found in its database.” CareCloud EHR Disadvantages CareCloud is a major EHR and PM solutions provider, managing millions of claims yearly. СareСloud has negative reviews. Anyone Can Access Financials Marie from West End Consultation Group had problems with access rights management: “Most EHRs and CRMs have the ability to create different access for different users and user types. Carecloud has a UserRights section that gives the illusion of being able to turn off access to different sections of a patient chart, but it is just an illusion. Any person who has access to the calendar/schedule for the day can click on a patient on today's schedule and have access to all financial information. Providers do not need access to billing but they do need to see the schedule of all patients being seen in the clinic on a day they are working. I would not recommend Carecloud EMR to any practice until they have figured out how to block access to financials from the schedule app.” Overcomplicated Interface and Lots of Paperwork Ann from Ann Kim MD lost quite a bit of money when working with CareCloud: “I am a solo practitioner in internal medicine. I used Athenahealth before Carecloud due to the college's recommendation. But the feels for non-closed loop orders were getting expensive so I looked for a program that won't charge me a dollar for each prescription. I was interested in Carecloud due to their App settings and made it look easy to document/chart.  I should have known when they were trying to get me to sign their contract that I was in for a big disappointment. They, the sales rep gave me a deadline to sign the contract with an appealing price if I sign before the timeline. He got me on the phone with the big boss, also the same thing,' it's the lowest price so sign now', like a used car dealer to seal a deal. I was a fool, $36,000 lost due to my stupid action signing that day. I will regret it for the rest of my life.  After 1 month of use, I knew this isn’t what I wanted to use going forward. I plan to make a youtube video showing how slow Carecloud is. Whenever a patient calls for an appointment or a refill, it takes a long time to pull up their charts and all patients complain ' why does it take so long to pull up my chart?' and we say it's our CareCloud program... But that's just the tip of the iceberg. Here are the reasons I gave them for terminating with them.  1 - Promise to incorporate clients' suggestions for improvement to their platform is an empty promise. We have offered them pages upon pages of suggestions, of which exactly NONE have been incorporated in their promise of "updates" every 3 weeks. When challenged on this, the company brushed us off, saying "do you know how many providers we take care of?" Pretty clear that we, as an individual client, are not important.  2 - It may look organized but when actually using it, it forces you to move back and forth all day long between different organizational icons. Even the simplest task of ordering a patient's lab requires at least 5 minutes. It is the farthest from "user-friendly" that we can imagine!!  3 - By definition, an EMR is an ELECTRONIC medical record. Despite this, any documents that require the provider to initial or sign (all home health documentation, labs to be reviewed, etc.) need to be printed, then hand signed, then re-scanned into the computer. Be prepared to have your support staff spend an extraordinary amount of time managing this challenge.” Subpar Training Chris from Advantage Physical Therapy was dissatisfied with the quality of training he was given: “Training was almost all videos and we were released from training before we even posted our first payment in the system. It logs us out between uses and often doesn't load back up. Patient statements are very confusing creating increased calls and patient dissatisfaction. To add or change appointments takes 6 or more clicks when it should take 1 or 2. It's difficult to see multiple schedules at once. Automatic reminders have limitations that cause us to have a higher cancellation rate than if it was customizable. Billing functions require fairly extensive manipulations of posts that are out of ordinary.” Connectivity Issues Brissa from Frisco Spine had complaints about the connectivity of CareCloud and the related problems: “Awful. Our original project manager left as soon as we launched the product. Then our lead contact left, then our sales rep, and they've continued to have HIGH turnover rates with their people, which is a HUGE RED flag for the overall reputation of the company.  They promised us all these changes would take place at the end of last year...has anything changed? No. We have had connectivity issues and when you call support they are completely useless and rude about the situation. It completely affects our operations and I would highly recommend you go elsewhere!” There were more problems she wanted to mention: “Where do I begin? There are CONSTANT issues with connectivity, slowness, workflows that are completely inefficient, and so forth.  We were sold on the reporting, but then come to find out, it only works if you use the billing side of the product. All other reports are not customizable and you're stuck with them. On top of that, you get manipulated into this 3-year contract, and when there are changes you have to go through an entire process. I can continue but there is not enough room in this box…” Underwhelming Functionality  Scott from Lafferty Family Care faced problems with both the EHR’s functionality and its legal conditions: “Terrible functionality. The vital signs will not even populate the note. You have to rewrite the past medical history, social history, family history, etc every time. They do not pull up many routine symptoms for a review of systems, diagnoses for past medical or family history, etc. And they automatically renew your contract each year for a year without a 60-days notice. So, if the frustration has become overwhelming because you finally realize they are not going to fix the glitches, and you are within 59 days of the end of the year term, they say "Too bad, so sad. You have to pay for a full extra year." No apologies. Do not waste your money on this software!” Deteriorating Customer Service Mila from Unique Pain Medicine was fine with CareCloud until the company abandoned them when the problems hit: “We purchased this system about 5 years ago and were very happy with its performance. Over the last 3 months, however, everything changed. The system fails every day on a continuous basis. Customer support is useless as they are reading off the script instead of actually trying to help. Noone is transparent as to what seems to be the problem and no one seems to be able to help. WE will be looking for other systems.” Barbara from Horizons Medical Care, PC has also faced this: “As I sit on hold for the 5th time this week, this system is always going down. Every time I've called in over the last month, I've been put on hold for over 25 minutes and a couple of times, I've been on hold over 45 minutes without ever talking to anyone. We can't even log in this morning. Some days we can't verify insurance through the Patient App. Other days we can't pull all of the diagnoses from the EHR portion of the system to the Billing portion. Horrible system. I'm not sure what system these other groups are using but it is not the system we have grown to hate!” Company Issues Affecting Users Steve from Randall Pain Management suffered from the internal turmoil at CareCloud: “We signed up and ended up going through the worst experience with any EMR and wasted $ and lost many, many hours of production.  We were starting implementation and to shorten the story, basically found out the hard way that CareCloud was in turmoil. Our original rep quit, they had no idea what they were doing and found out they had really not had pain practices as they stated. We were to be used for their beta project and it was a NIGHTMARE! STAY AWAY, I'M TELLING YOU!  I read these same reviews as well and went with them, but I can't even begin to tell you how bad it got. To this day, I still get bills even after them knowing for 8 months. I had one of their upper personnel call me and apologize and ask me to stay and still they can't get it right. I'm telling you they have internal issues and they are TERRIBLE!!” Disruptive Updates Melissa from Hand and Reconstructive Surgery had many problems with CareCloud: “I have had nothing but problems with this software. Tonight, I am trying to finish my chart notes from a busy day. It's 7.30 PM on the West Coast. They are doing yet another update and the note I was working on, (about 10 minutes of work) is gone...yet again. This is a recurring theme with them. I can't wait to see what doesn't work now when we try to use the system tomorrow.  Normal functions don't work routinely. I can't schedule patient appointments for any time other than on the quarter-hour. I've given up calling the helpline because every time there is a problem, you always wait on hold for at least 10 minutes, but usually more like 30. Then they want to remote into your computer. Which I never have time for during a busy clinic. They don't seem to understand this. Then when you demand to speak to a supervisor about something, they say they forward it on to someone, but then you don't hear back from them.  I have told them I am leaving for another company. I never gave them a date that I am leaving. But they shut off my access to my patient information and no one in my practice can access anything. I will be using the billing portion of the software (which my biller hates by the way due to multiple issues) in order to follow up on the revenue billed with them until my contract is up at the end of the year.  I will be switching to another EMR in a couple of months. I would advise you to find another company and don't even give this company your money. If for some reason you do, you need to have some type of clause in your contract that will allow you to be released from the contract if you are not happy. Companies that require you to pay out the remainder of your contract if you decide to leave should be a big red flag. Those that have a high turnover rate and need to keep your money from the contract should be a big concern for you. And, you would expect to see social media blow up from this. And after all the new reviews I'm seeing, with the same complaints from different practices, I'm guessing this is just the start with this for CareCloud. I honestly can't see how they will be around much longer if they continue to provide such poor service and operating platform for their customers.” DrChrono EHR Disadvantages DrChrono is a popular platform, serving thousands of medical professionals and over 17 million patients. Medicare Documentation Issues Charles from Wellness & Prevention, Inc. had trouble preparing the Medicare-related paperwork: “Many promises were made prior to going on board and I was highly excited about getting up and going. There were a lot of difficulties reaching technical support for immediate and not so immediate issues. My staff had to spend many man-hours to get the proper paperwork for billing of Medicare once we found out that they were dragging their feet. We could no longer wait on them getting everything in order. The issue with Medicare still has not been completely resolved to date and Medicare is one of our major carriers.  Had we not intervened the present progress would not have been made. There were numerous emails and telephone calls placed only to get the usual response that they were sorry for the inconvenience and would solve the issues. You can believe that there were no problems charging the credit card on a monthly basis. The initial monthly contract agreement increased substantially and the service never came up to par.  I am totally disappointed in the company and will not be renewing my contract. Ample time was given to vent my frustrations on the phone and at the end of the conversation, I would be told the usual which is that they would resolve the issues. I can honestly say that DrChrono has caused us a lot of frustration, valuable time and waste of my money. Like others have mentioned, Buyer Beware.” Overpriced Support David from The Weingarten Institute for Neuroscience felt disappointed with the support DrChrono provided: “Absolutely horrible service. They're GREAT during the sales process (of course), and they were initially helpful in setting it up, but they very quickly cut you off from regular support and try to charge you hundreds of dollars for support. We were a new company, not ready to implement all the features immediately, but when we got around to being ready to implement additional features, they told us that our support period had ended and it would now be (if I recall properly) $150/hr for support.  There is NO phone number to call. Their ticket/email service regularly failed to answer questions, or answered completely different questions than we had asked. They took several days (or even weeks) to send canned responses that did not address the questions, which then required us to write back, which then took MORE time for them to respond, and then they would respond with fairly useless answers or just "sorry, our product won't do that, but we'll pass it on to our engineers for possible future additions."  If you make the mistake of signing on with this company, READ THE CONTRACT VERY CAREFULLY. If you start out on a more expensive plan and decide to downgrade, THEY WILL CHARGE YOU THE HIGHER RATE FOR THE ENTIRE YEAR. Cancel early? CHARGE YOU THE WHOLE YEAR. Terminate a provider? CHARGE YOU FOR THE WHOLE YEAR. We hired an NP in January. They renewed the contract in August. We terminated him in December. They want to charge us for his account until next August.” While he liked the UI, there were more problems he wanted to mention: “Almost every time I wrote to the company with a problem, their answer (when I finally got one, which takes forever) was initially to blame me and my staff followed finally by an admission that we weren't doing anything wrong, but that their product didn't currently have those features or didn't work that way.  The way the product works also puts you at very high risk for data loss, which has happened to us multiple times. There is no local storage of the data, so if you lose internet connectivity after writing a big section of a note, your changes will all be lost. This, of course, is a stupid way to design EHR software.” Carleigh from Iris Wellness Center has also faced similar troubles: “It's confusing. Complex. Not easy to use. The implementation team didn’t even know how to use features and would send us to specialists who were booked for days on end.  When reaching out after signing a contract good luck getting help. We feel like we have become a number and not a customer or an asset to them. It is one of the worst companies I have experienced since 1999. What happened to quick, helpful and efficient customer service? It was on the front end to make us a customer and to sign a ridiculous contract. Once in, they disappear and say they can't help. They just send you from person to person. Then the person at the top is unavailable. It’s 2019. This is the worst company I have used since Comcast. Even then Comcast is better.” Unfit for Aesthetic Medicine Darren from RefinedImage learned that DrChrono is not the best option for his medical specialty: “This product was sold to us as being targeted towards aesthetics practices. Garbage. In virtually every instance medical aesthetics employees are commission-based and there are no provisions for that in the system.  You can also not effectively have your product inventory managed unless you never discount your products, and never pay commission to anyone who sold them. If you do, be prepared for lots of additional paperwork to keep track of it all. All of our complaints fell on deaf ears, and all attempts to get out of the contract even after explaining thoroughly what the issues were, resulted in ridiculous fees.  We were a new startup & trusted them when they said it had everything we would need. Now that we are in operation, it's a different story. I don't mind there being a misunderstanding in the sales department so long as they make it right, but they won't, so my review stands at 1 star, and only 1 because the option of 0 is not available. Stay far away!” Time-consuming  Van from Carolina Internal Medicine and Pediatrics found out that a user had to spend a lot of time on many routine processes: “Tried to switch from Practice Fusion to it, but it has been a nightmare. Now we are stuck paying for a more expensive EMR for a year, during a year contract, that we will not use because it puts me behind in seeing patients by at least 30 minutes.” As for the drawbacks of the system: “Everything that was not note-writing. If they would have shown all the other things you do in day-to-day practice during the demo, I do not think I would have got this software. The guy doing the demo talked about other EMRs causing death by a thousand clicks. Well, this EMR may not cause death by a thousand clicks with the note-writing but everything else you need to do such as ordering labs, medications, billing, messaging, all take so much time that it eliminates any of the time-saving in the note-writing.” AdvancedMD EHR Disadvantages AdvancedMD is used by 37,000 practitioners in 13,000 practices and 700 medical billing companies. Overcharging Akram from Elmira Urgent Care had a terrible experience with this EHR: “I own a walk-in clinic. I signed up for their service at the end of July and they overcharged me for the entire month of July. I made it clear, however, when I signed up, they should start the charges in August. In the first week of August they charged my account again. I kept calling them about the overcharges, they never addressed the issue. They would always say “we will have a manager call you” and it never happened.  My staff tried to go through the training - they were very slow, hard to reach, have very bad customer service and no tech support. You call, leave a message, and with all luck, you will get a phone call days later. My staff found their software very complicated. The practice management portion was difficult to learn. They would assign you live lectures that are spread weeks apart.  My billing company started to learn their system to do my billing using their software, they found AdvancedMD billing portion to be very complicated and cumbersome. That is when I felt I've had enough with them.  The process took 5 months, I cut my loss short and canceled their agreement. This was after several attempts to have them be more customer service oriented and help me finish the training. This was to no avail. This is by far the worst experience I've ever had. Up until today they still owe me the charges for one month from the beginning when I signed up. I wrote them several correspondences, no reply or answer.” Kimberly from CMHC experienced that as well: “Difficult to use, no customer support, I would call or email with a question and would not hear back for a week. I was sold the product under false pretense and when I began to receive my monthly invoice it was much more than I expected. When I did speak to customer support they were, in short, not helpful. I was required to submit a notice 10 days prior to the end of the month to cancel the contract. I emailed my contact multiple times asking where I should send the email and never heard back. I attempted to log in at the beginning of this month and my account has been disabled with no notice, no response from anyone in customer service. For a small practice, stay far away from this product. Far far away.” Billing Problems Rhonda from BILLING ESSENTIALS found out that AdvancedMD was negatively affecting her productivity: “I work every weekend (Saturday & Sunday) posting charges for 5 Physicians. AdvancedMD Billing software is almost impossible to use on the weekends. It is slow, dragging, freezes up and kicks me out, so that I have to log back in. I have to give up trying to work every weekend (which REALLY throws me behind)! The Tech team is "working on" the problem, however, it has gone on for over 2 years now.  They are trying to say it is a problem with my computer, but if that were true, I would have those problems all of the time. It's just Saturday and Sunday, which says to me that AdvancedMD's system is running some sort of back-ups, and/or Maintenance that is causing the system to be virtually unusable on the weekends, but they will never admit that. Had we known in advance that this would be a problem, we never would have signed up to use AdvancedMD software.” Diane from VIP Medical Group faced similar problems: “AdvancedMD tech support is poor. We first signed up for the billing so we could bill facility fees and professional fees. It turned out we couldn't bill facility fees because the UB04 was not set up correctly and they couldn't fix it.  The reports are terrible. They have updated them but we would have to pay more money a month for the update. That should be included, as it is with most software. We cannot write prescriptions for controlled substances, unlike we were told we could when we implemented the EHR.  We cannot get it to print on the forms required by California law. I called the tech and engineering people for 8 months trying to get it fixed and they never figured it out or got back to me. Now we are stuck with it, having to write out the RX by hand and then scan in a copy of it or manually add it, each time the patient is seen.” High Downtime Nicole from Reyes & Associates felt relieved when their contract with AdvancedMD was over: “In the beginning, we were assigned a Representative who was very attentive, returned all calls and emails promptly. Once we were "Live", our Rep was "no longer with the company" and for months we could not get in contact with anyone to resolve all of our issues. So glad our contract is over.” This is why: “We originally chose this software because of all the features they offer. Although the features are physically there, 98% of the time they don't work. Our biggest issue has been appointment reminders. I can't even count how many "tickets" we filed for them to fix the issue. Needless to say, we just stopped trying to use the reminder system because we were wasting our time. As a result, 50% of patients per day were a "no show". For what this software costs each month is NOT worth it. They advertise how much it will increase revenue and it did the complete opposite. Onto of the PM features not working, the EHR and eRx have also been issues the entire time. We finally got tired of trying to get things switched and have since switched over to a much better program for 1/4 the cost.” Long and Complex Implementation  Jenna from CFWI thought that AdvancedMD overpromised and underdelivered: “First, it only works in Internet Explorer. Not only does this limit you, but it causes problems as well. For example, each workstation has to be configured with specific internet settings before the program will even let you log into it. This is rather cumbersome for our practice given that there are ten office locations throughout the state. It became problematic when IE released a new version, though. Settings had to be reconfigured. Since certain functionality is not built into IE, downloads were required, and even then, certain links would not launch. ADP customer service informed me that it was a software issue on my end, and gave no assistance beyond repeating the steps I had followed.  Second, implementations do not go quickly. At nearly every step, I had to wait three to four weeks for the next step. It wasn't because I didn't have the necessary data, but because that was when the next meeting time was available.  Also, the configuration and IT groups were not on the same page. Configuration was trying to give me a live date when IT had not even begun the conversion work. Finally, although willing to deal with the troubleshooting that was required to keep 25 clinicians and ten office staff configured correctly and to coordinate the implementation myself, I was not willing to sacrifice the efficiencies the sales team had promised.  In the sales pitch, the cost for EHR was beyond our price point, and we declined to sign. The ADP sales lead suggested "EHR lite," which meant purchasing just the PM platform and using the templates and electronic notes available on the PM side. Since we have no MD, we do not need high dollar add-on functionality like eRx, so it sounded like a great option.  I asked and the team verified that all the functionality I did need would be available in the PM platform, and it would just work a bit differently. Not so. As I got into the implementation phase, I was unable to create templates in the PM platform because my 2010 word processor was not an old enough version to work with the software.  I manually created custom templates that customer service agreed should have worked, but which would not function as forms for clinicians unless they completed every note or report in a single sitting. As a solution, customer service proposed our clinicians finish all documents in a single sitting. No edits allowed. This is actually impossible for some evaluations. So no templates for us, and, honestly, even if they had worked, sales forgot to mention that prior note data and significant data like Dx would not be available to populate future templates.  There was also no trackable workflow. Billers would not know if there were outstanding notes or when a note was completed unless they manually checked, which would have been possible because there was no way to limit access to the PM notes. You either have access to all notes (including office-related documents) or none.” Nextech EHR Disadvantages Nextech specializes primarily in Ophthalmology, Plastic Surgery, Dermatology, and Orthopedics. It is implemented in more than 4000 practices. Implementation Issues Joe from KL, Ophthalmology practice got an unpleasant surprise during the implementation phase: “Nextech was paid >$25K for implementation of the software. The implementation was not completed when it was learned that the software was not going to perform as promised during the sales process without substantial additional investment. Nextech was non-responsive to calls and letters, until finally a lawyer's letter was sent to the company. The issue remains unresolved and the company has kept all funds for implementation that was never completed.” Expensive Upkeep Anna from OPSC found out that keeping Nextech EHR working is very costly: “One glitch that is frustrating is name changes. Once a patient is in the system, you can't change their name or the system deletes their file data. Photos, op reports, everything. It's a frustrating process b/c to make any new documentation legally correct, you have to go in by hand and change it everywhere it's written, which on surgical consents can be almost 20 times. Then anything automated that goes out still has their wrong name. For divorced patients, this is a frustrating reminder.  Most importantly though is the yearly fee. Once you purchase this software, you then have to continue purchasing it every year or it doesn't work properly (no updates) and you have no support from Nextech if something goes wrong. I wasn't here when it was purchased, but our physician emphatically denies ever knowing this was going to be the case when he made the initial buy-in. We pay thousands a year for this system, but switching seems very daunting and they know that. You're basically trapped when you buy-in… Say you miss a year, you will have to pay for the year of service you DIDN'T get and then another year to get up to date. It's a huge ripoff.” Kile from MLMD Aesthetic Plastic Surgery considered this system expensive as well: “We have been using Nextech for more than ten years. In the early days, they would even come to our office. The cost is extremely expensive. I have a very significant problem with the fact that they do not offer online scheduling. They have been promising for ten to eleven years they would have it. It is always just a matter of months or just around the corner. The system is not compatible with any other software so our hands are tied. Very expensive but we might be able to justify the cost if they had fulfilled their promise of providing online scheduling for clients.” Poor Customer Service Fabrice from Entourage Medical Esthetic Solutions was disappointed with the level of support Nextech provided: “The SMS Reminder module doesn't work. The support team doesn't answer our emails. It's impossible to know who is in charge of a problem. Our requests are being forwarded from one service to another. No one takes responsibility. We have had open issues for over a year and there is no solution in sight. In the meantime, we lose a lot of doctors' time because of no-shows. We started with the basic settings and planned to buy several other modules. But we are considering other options now. My advice: hands off.” Ellie from Andrews Facial Plastic Surgery also had a few things to say about that: “Though we only use certain aspects of the software rarely, we either must pay the FULL support fee or agree to shut down that support of that component. If we shut down support of that component and then decide to use again in the future, we will need to REPURCHASE that component - even though we already paid the full purchase price for that component alone (EMR). If you make 10,000 EMR entries annually or 100, you pay the same fee for support. This is not attractive to lower volume practices.” Unoptimized Processes Jennifer from Washington Pacific Eye Associates felt disgruntled with Nextech: “Dealing with this company has been frustrating at best and misleading at worst. The examination template is not at all "intelligent" and requires you to enter the same information multiple times.  It is also inflexible. It takes 4 mouse clicks and deletes to remove one diagnosis and plan. It requires 5 mouse clicks to sign and lock a chart. The online portal has a terrible user interface and has actually made my check-in and registration time for patients quadruple. The portal will often kick a patient out of the system after they have created a user name and password. Then the patient tries again and the code will not work. They call the office for a new code.” Kareo EHR Disadvantages Kareo has over 500 employees who support a product used by 50,000+ healthcare providers. Unexpected Charges Jeremy from Taylor Made Integrative Therapy got billed even though he never made the actual subscription: “Red flag went up when they wanted my credit card information before I was able to use the free 3-month demo version. Well, I was busy setting up a new practice that I moved into December 1st and never used the software. I emailed them 8 days after the 3-month demo expired which was December 4th and that I wouldn't be able to afford the EHR just yet and to check back in February. No response from Steve Cohen, the sales guy.  But on January 10th I don't just get a bill but they automatically withdraw over $800 from my account for a service I never used. I called and left a voicemail, then I emailed Steve Cohen, no response back from either yesterday. I call again and the guy puts me on hold at least 4 times and his response is, "Well we tried to call you several times." I understand I went past the deadline so I was willing to pay for the 6 business days of use after the demo was over but that was over $500. And then I got hung up on. I guess I know why they get your credit card info. If you don't want the software they can find some way to charge you anyway!!!” Questionable Data Practices Dorothy from Bradford Medical Group was using this EHR out of necessity, but when she finally decided to switch, she was in for an unpleasant surprise: “My biller used Kareo. When her business closed I stayed with Kareo billing and started using the EHR because it was free if you used their billing services. I never liked the actual EHR but its integration with the billing software was important. I previously used the old version of MISYS which was noncompliant with the new rules under Obamacare. In comparison to MISYS and like anything free, this program is far, far inferior. It was like going from a Mercedes to a bicycle. Some examples: Scanned documents are all lumped together in one box unlike MISYS where documents are sorted under consults, studies, labs, hospital, etc and easily found. The font on prescriptions is 6-8 and can't be changed. It's so tiny I'm embarrassed whenever I have to give a patient a script.  I'm in Ohio. Kareo was cited by the Ohio Pharmacy Board for noncompliance. E-scribing was shut down all summer. Now at the end of the day, I have to print out and maintain a list of every script I write. I can't see prescriptions from other doctors. They don't use Silverscript. I could go on but the worse thing just happened. I was given a 28-day notice of a 40 % price increase in what they charge me for billing so I'm leaving. I discovered, as did another reviewer in this thread, that my data is a hostage. I'll have to pay monthly to JUST LOOK at the EHR data. Or I can print out every patient's chart before they shut me off. They are shaking me down and holding my data as a hostage. This is egregious but probably legal on their part and is probably in the contract I signed.” Dan from Daniel P. Nelson LPC PLLC had a similar experience: “If you decide to end your contract with Kareo, you will have to download your notes page by page after the initial 20 pages allowed in a pdf download. This makes it a daunting task to secure your data before you are locked out of their system. This amounts to extortion in my opinion as you are forced to pay because it is nearly impossible to retrieve your data.” Overcomplicated Billing Melody from Walnut Street Health & Wellness had to overcome billing-related issues in Kareo: “Poor training. poor customer service. errors that I do not get answers on. Does not pull in appointment code & ending date of service, using Care360 for EMR. Pulling up info - not enough info shows. No place to make recommendations (like when pulling up the list of "encounters", which insurance is it). Too many steps to find the patient balance, why is it not on the first patient screen.  Also, copay, have to add an extra step in to find copay for insurance unless the patient has a card. Difficult to figure out what needs to be fixed on denials. No place to put the reason the patient is coming in that will cross over. So an "office visit" for any reason, we make a note and then have our staff print that day's appointments - or flip between systems. I have over 30 years of experience, the sixth system I have been on, and I am NOT happy.” Inefficient Jeffrey from UC Davis Med Group found out that many features of Kareo were implemented suboptimally: “ Creating progress notes is frustrating. Must save notes before changing screens, otherwise, all information LOST. No auto-save. Saving data prior to a change in the screen, must save and CLOSE the document. Multiple steps to re-open again. Always inefficient.  DoctorBase is an "answering device for providers" to provide the caller's phone number. The glitch for NEW callers: NO NAME provided, no message recorded. 10-15 "unknown" callers by end of the day: 1/2 -3/4 were salesmen or bankers wanting to give loans.  When I changed companies, I was unable to transfer data in bulk. I had to transfer every patient individually. Other companies ALL had the ability for bulk transfer. I would have to transfer emails individually, all 15,000.  Limited & unsophisticated ability to create progress notes to limit keystrokes.  Requesting program upgrades: infrequent, rarely helpful, never quick or responsive even for minor change requests.  Initial support staff NEVER heard from again. I had to sort out problems through trial and error. I had 10 years prior experience in sophisticated programs before this disaster.  These are only a few of the problems I had before leaving. 6 months later, I received a call from Kareo asking how I would like to improve my experience & upgrade the system. They apparently did not know I was long gone.  Working with pharmacies is never smooth or easy.  Many more issues, unfortunately, that I have suppressed.” Compatibility Issues with iPad Dr. Harshad Patel, a solo practitioner, faced problems while working with Kareo on the iPad. These problems have taken a toll on the doctor-patient time: “Our practice is located in Arizona, and the time on our EHR is incorrect since the base of Kareo is located in California our system is on California time as opposed to Arizona. We have brought this issue to Kareo, nothing was done there was no resolution to this matter and the time is still incorrect.  One major issue that we are having is, we use a desktop for the use of Kareo and as well as an Apple IPad. We are having an issue accessing "labs and studies" on the iPad and every time we open up this tab our app not only kicks us out but does not allow us to access the labs from the iPad thus causing Dr. Patel to then have to leave patients room come to the front to look at the labs, majorly taking away from Doctor-Patient time. This matter has been brought to Kareo’s attention numerous times, and it is still not resolved. We have been having this issue now for a total of 3-4 months. We call and receive a very typical answer from them stating that "we have our engineers working on it and someone will give you a call" no one ever gives our office a callback. we are very dissatisfied at this point with Kareo and cons definitely outweigh the pros with this system.” Poor Integration and Implementation Francis from Caring Partner Medical Clinic regretted using this EHR: “I am currently using this EHR because my billing company recommended it since they use the Kareo practice management. It has been a nightmare for me having used a much better EHR - Athena. The onboarding process was a disaster and after 3 months, the lab integration has not been completed with LabCorp and there are no follow-ups. I have to initiate every contact with my coach who should be reaching out to me to make sure that my transition to Kareo is seamless. There is no integration with Imaging centers so you have to order the tests and then manually fax them to the imaging center, unlike Athena.  When it comes to labs, you cannot find some of them like a common FIT test to screen for colon cancer. How about e-prescribing? Forget about prescribing common diabetes supplies like test strips, lancet or OTC medications, they are not there. With Athena, once you start typing the name of the supply you need, it pulls everything up and you can transmit those to the pharmacy electronically. For those you now want to fax to the pharmacy manually, the pharmacy name, phone or fax # does not even show on the prescription so you have to go back to the patient's chart and go to somewhere in the demographics to find the fax # and then write it down or memorize before faxing.  When you place a referral, you cannot attach documents such as labs, radiology reports to the referral before e-faxing. What is the point e-faxing just a referral and then printing out other relevant records that should accompany the referral to manually fax....so dumb.  How about releasing a patient result to their portal, you are not able to comment on the results that you are releasing to the patient. You have to send a different message to the patient after you have already released the results. Now, I keep getting an error sending a message to patients through the portal using Google chrome browser and Firefox with different computers and they don't have any clue what is going on. I can't get any help with the technical support or my coach. They created a case and that's it. I guess I need to be calling them and taking time from caring for the patients to be doing that before I can resolve any issues.” Underwhelming Customer Support Anusuya from Windsor Internal Medicine thought that the customer support at Kareo leaves much to be desired: “I have been using Kareo for many years. The customer support is very frustrating. Hold time to speak to someone is more than 30 minutes. Today I tried to contact someone regarding EHR support. After waiting on hold for 35 minutes someone answered the phone. The line was not clear and I couldn't understand what she was talking about.  Further questioning lead me to understand that she was in Costa Rica and did not have any clue what I am talking about. She transferred me to someone and again another hold for 20 minutes. Finally, I had to hang up the line. I am using another EHR for my nursing home patients MDLOG/MDOPS. Customer service is excellent. Get to talk to someone within a few minutes and the reply and help I get from them is very impressive. I wanted to talk to someone in Kareo who can help me. The answer is we will create a ticket and someone will contact me later. Never get a callback. I don't have time to write reviews but I am forced to do with the lack of knowledge their support staff has.” Greenway Health EHR Disadvantages The products of Greenway Health are used by more than 10,000 organizations.  Implementation problems Ruth from The Children's Clinic of Klamath got way less than the salespeople promised: “The salesperson did not know the capabilities of the system and misrepresented what it could do. It took 14 months to get to the point of trying to implement some of the elements of the package we purchased. We still aren't there. Trying to solve the discrepancies between what was purchased and what we got has been time consuming and extremely difficult. Like repeated emails daily, like sending emails to the CEO, CFO etc. multiple times, calling, faxing etc. We have been in that black hole you hear about.  We purchased this system after our total dissatisfaction with the Intergy system. When Intergy sold to Greenway and we were shown the PrimeSuite program we were so happy to think there was a system with templates that were relatively easy to use so the doctors would stop complaining. I like the idea that Greenway is trying to straighten out the problems with the product, it is just a very, very slow process. They do listen to customers with ideas for improvement. First, RCM caused us to lose over a hundred thousand dollars in revenue, and I had to do the coding. We were sold a product that did everything our local billing company did and more. Using it was made a condition precedent to the purchase. It was a disaster that took a year to resolve. Every patient's account had to be reviewed and corrected.  The EMR portion of the program is a disaster. The front office staff were ready to walk out. Scheduling and rescheduling are very time consuming and multi-step processes. There is no way to print a month's schedule or even see a month which you couldn't see even if you did have that feature because the screen is so small it takes a magnifying glass to read it.” Poor Customer Support Mark from Physicians to Women, Inc is tired of his employees always being put on hold when calling Greenway: “Poor, poor, poor support! I often have staff members running around trying to be productive while they wait an hour on hold each time they call. They have to use their own cell phones, then put them on speakerphone and put it in their pocket so that I'm not just paying them to sit on the phone for an hour. My nurse often walks around with Greenway On-Hold waiting music emanating from her pocket. It'd be funny if it wasn't so infuriating.  I get a nervous tic every time someone says the words "Seamless upgrade" to me. A recent example of our latest "Seamless upgrade" was the search function for diagnoses was just crippled. Now, I have to memorize the exact wording of the descriptor for the ICD-9 code I need. I can't just search for a keyword, I have to know how the sentence begins exactly. So now I have to pull out my iPhone, perform a ICD9 keyword search on a free app, then enter the ICD9 into greenway. Greenway's response, after listening to Greenway music for an hour, was I could send in an email requesting that the ability to search for ICD9's. I have little faith such an email would ever be read by anyone who'd give a care.” Complicated Implementation Gerard from Foot and Ankle Associates of New Mexico found Greenway EHR too complicated both during the implementation and after it: “EMR side is long outdated with no apparent plan for modernizing. They are STILL working out problems as simple as getting it to have a functional spell check that is compatible with current operating systems. Specialty support other than ob-gyn is non-existent On the provider side, EMR is very complicated to get up and running and needs a dedicated templates person for PE admin and templates both. Superbill does not show total charges for the visit. No easy report to even show a physician how much they billed that day. Lab interfaces and integration are available but very expensive to have built. Patient portal, mobile access and others are an additional add-on expense as are many of the other features they show when advertising the product.” User-Unfriendly Romanth from APWI regrets committing to this EHR: “We have been using this product for over 8 years. While it does what we need, because we have had to find ways of setting it up to do so, it is certainly not user friendly.  It is an antiquated set-up; a windows based main server and a Linux-based image server. Hence, we cannot do hyperlinks (from the note to a specific image) and we have to look at all the images to find the relevant one. Furthermore- there is no way of knowing specifically, by looking at the documents section and seeing the description, as to exactly what the visit was about (procedure, suture removal, etc...). This is because the "reason for visit" is set up in an Intergy Module (a different module), which limits the description based on a CPT code. This is useless for me, as I cannot see at a glance the various visit reasons without having to look at each note.  I also cannot scan images directly into a progress note without causing significant slowing down of the system. This is because the note is only designed for text. There are many frustrations with this software, but once you are in it, it's expensive and you've already committed. The account manager changes like the seasons, and support does not get back in a timely fashion.” Hard to Use for Vaccinations Susanna from Coastal Pediatric Group thought that Greenway isn’t built to handle immunizations the way it should be: “Very difficult to use for pediatrics. Vaccine entry is very time consuming. Would take 1 hour per day for my nurse to enter the vaccines properly. The process to make templates is ok, but not great. Used this EMR in my previous practice and definitely did not consider it in my new practice.  The system cannot remember lot numbers and always asks for which manufacturer in a long list even though each vaccine is only made by one manufacturer. No barcode scanner for vaccines available. It is not easy to enter point of care tests such as urinalysis and strep tests. Portal system that links with it is not good either. A parent has to have a separate login for each child. My parents did not use the portal system at all.” NextGen EHR Disadvantages NextGen boasts a rather large number of connected practitioners - over a million.  Difficult to Use and to Switch From Afshin from Scottsdale Personal OBGYN had problems both when working with NextGen and when trying to replace it: “Do your research before purchasing this EMR, because once you sign up with them, it is very difficult to get rid of it. They make it very difficult to sever the ties with them, and costly to obtain your patients' records and will continue to charge you if you have authorized them to withdraw the monthly subscription from your credit card, which might be related to the lack of communication between their different departments, but nevertheless amounts to harassment and lots of time wasted disputing those withdrawals with your bank.  I also got charged twice in 1 month last year, and still waiting for a response from their accounting department to get a refund for the overcharge (despite multiple emails) If you use their efax service, make sure you get a list of efaxes you have received to verify the overage fees they charge you (so far they have not sent me the list of efaxes and continue to charge me for overage each month despite the fact I have canceled my services) I started my subscription with meditouch/Health fusion, later changed name to NextGen office. The software is a billing platform with an EMR tacked on to it. I had used various EMRs during residency and in a group practice and this is the absolute worst product, most rigid software with lots of clicks and not user-friendly. Just reviewing a lab result is a hassle, needing to go in and out of the chart note, with numerous clicks in between.  On several occasions, I noticed Meditouch glitching and chart associated with the labs belonged to another patient, therefore had to double check all the time, an issue that I had never encountered with any other EMR (EPIC, Cerner ambulatory, Praxis, even NextGen Enterprise etc.)  Once the salesperson had sold the subscription to me he would not return my phone calls, and customer service was practically non-existent. Eventually I was assigned a new contact person who was a lot more responsive but unable to solve any of the product related, customer service related or billing related issues. Eventually, I switched EMR, and canceled my subscription with NextGen and received a confirmation that my services were discontinued, but their billing department continued to charge my credit card on file. Make sure not to sign any authorization for the billing department to charge your credit card. In order to export my patients' data to my new EMR, NextGen wanted $ 5000. My new EMR (Praxis) transferred the data for a fraction of the price.” Inefficient Features Eric from Healthy Z Family Medicine also had a few words to say about that: “Wow, there is so much not to like...  Word searching for ICD10 codes, past medical history and problem lists returns hundreds of search items that have absolutely nothing to do with the words being searched. Also, if you enter the words out of the order in which they would appear, you will never find them.  Social History is much more than whether a person drinks alcohol or smokes. There is no way to put in valuable details of a patient's social history and automatically include it in your notes. A lot gets lost by having to adhere to some stupid engineer's formatting. Same with past medical/surgical/obstetric histories-you can't add any valuable details to anything (like which knee was replaced and what happened after their concussion, etc).  The charting is so useless that I have given up and gone back to paper charting. I start an encounter just to put my billing through. Health Maintenance: I can't enter that a patient refuses to do a colonoscopy or mammogram. All I can do is "disable" that patient from being counted for meaningful use. Poor formatting: while they tout being iPad friendly, each page has lots of unused space, so there is a lot of scrolling just to enter data or get to the save button (and if you don't press save, you lost it). More poor formatting: entering vitals->information is so spread out that it takes two screens to enter. AND peak flow is on the first screen while height and weight are on the second "additional information" screen. Which is more important? Also watch out for the backspace button, sometimes it works like you would expect, and other places you will get logged out and lose all of what you were doing.” Unfit for Communication Between Physicians Jonathan from Chest Medicine Associates used many different EHRs and NextGen doesn’t shine compared to them:  “I am a Pulmonologist in a busy private subspecialty practice. I have experience using several different electronic health records. Our practice has been using the NextGen product for more than 7 years--so I can speak as a battle tested user of this product.  There are certainly some advantages to using any decent electronic health record including access to outpatient records across campus, handling of phone calls, archiving of information, etc. However, the NexGen product has a long, long way to go to catch up. For communication with other physicians the product is atrocious. Computer generated notes are laden with typographical errors, grammatical errors, truncated sentences, and at times gross inaccuracies.  For instance, our current template for physical examination puts no output into the office note for the pulmonary exam (and this is for a busy pulmonary practice!). Here is a recent example of text from a COPD follow up note template: Reason(s) for Visit: 1. COPD - routine follow-up -The patient is seen in follow-up for COPD. The COPD - routine follow-up began since the last office visit. The COPD - routine follow-up has worsened. It occurs daily. The patient rates the severity of the symptoms as mildly severe. Symptoms are aggravated by moderate activity. Symptoms relieved by resting and sitting. ....  On top of this there are nonsensical changes of font size and style in mid sentence that make office documents look like ransom notes. I care about the quality of my written work, so I literally spend hours on each, most of our template improvements are wiped out.  In my view, NextGen was clearly built first as a billing instrument, not as a robust tool to promote all aspects of physician practice. The awards are certainly not for the quality of office notes or layout of screens for the end user. Labs do not get imported into notes. Micro reports are difficult to read and necessitate scrolling through multiple windows. Data trending graphs are clunky, improperly scaled and often misplotted.  As a practice group, we have tried to work with the NexGen programmers and have been very dissatisfied over 7 years with their lack of responsiveness and seeming inability to fix identified problems. Often when one problem is solved many more are created. As a result, our practice has invested a large amount of funding to support a local programmer to try to correct many of basic flaws in the software that should be part of the package out of the box. Unfortunately, with major system upgrades most of our template improvements have been wiped out.” Detrimental to Productivity Paul from Augusta Health, Inc saw a decrease in the number of patients his practice could serve: “The product support was horribly useless. The techs and their supervisors knew very little about the product.  The Nextgen system itself is the real problem though. It takes so many clicks to perform the very simplest retrieval of information or data entry. The windows to see information or enter are tiny, 1 cm in height and cannot be adjusted. After a full year, our office of 4 MDs and 3 NPs (all tech competent) were still only able to see 10 patients per 8 hour day, and still spend time after hours to document. Awful. In all honesty, I cannot find one redeeming quality to this EMR, compared to any of the others I've used extensively or on its own. The answer to the problems were always: "It's being addressed in the next version roll out". This is a half-baked EMR. It's use is a danger to patient care and a real liability. We abandoned it.  The system is intended to have the clinician enter all HPI, IMP and Plan by point and click check-boxes. If these are not used, then it does not collect meaningful use data. However, the clinical utility of the text it generates is so generic, so hard to generate, and so cryptic that it is of no use to retrieve the facts of the case. The only way to enter your thoughts, history or plan is to free text it (in addition to the mandatory point and clicks), doubling your work. It doesn't even have a way to carry over information from past notes HPI or plan, so that it can be easily adjusted.” Aprima EHR Disadvantages Aprima (acquired by eMDs) is a fairly popular EHR designed to fit over 70 medical specialties. It has won the prestigious “Best in KLAS” award twice. However, it is far from perfect. Revenue Cycle Management crashes constantly Debra from Eagle Pass Pediatric Health Clinic was disappointed in the way Aprima RCM works: “The EMR is difficult to maneuver for both providers and health support staff. The system crashes constantly and there has never been enough response from support to fix the situation. The verification process did not work most of the time. On the PM side, our staff did all of the work to prepare for claim filing. RCM virtually did nothing to earn the percentage charged. Unfriendly response from RCM managers regarding billing errors and invoicing errors. Never issued a credit for copays and self-pay accounts.” Adds Extra Work Cristen from Lakeshore Surgical found the system extremely cumbersome: “Nearly everything. Everything takes a million clicks, and then the text that comes out is horrible. It looks and feels like a point-and-click system. The history has no flow when reading it. I am currently finishing my training with Aprima. My partner has used it for several years, and I really had no other options in this practice for my EMR.  So far I find it cumbersome and fairly difficult to customize. I just found out that for the simplest task (to modify a medication for a patient), it actually cannot be done. If the sig is entered incorrectly, you actually have to delete it then re-enter it. I have never heard of something so ridiculous in all my life. It requires being perfect with data entry, which is just not humanly possible. Not recommended.” Jeremy from Heart of the Rockies Regional Medical Center also had issues with this: “From the simple inability to auto-save, to the inability to put in simple error checks and stops, to the scads of extra fields and tabs that are not hideable cluttering up a simple and readable documentation process, to the slowness and propensity to stall/crash, to the strange text editing bugs - this software has more than doubled our documentation time…” Slow Shahriar from HouseCall MD complained that Aprima was both hard to implement and hard to use: “It started out ok with lots of support to start. A very complicated system to learn and set up and I took off 1 week to learn it and 2 months to set it up. I am the expert in our office and have a love-hate relationship. It helps us be compliant but it is extremely slow. They keep promising a fix and other things but at the end of the day, it slows your productivity really badly.” Janet from Mount Dora Podiatry also had this problem: The offsite server is extremely slow most of the time, and I am unable to wait for it to finish my note between patients. Recently, the server has been down for hours preventing us from finishing our work. It's very frustrating. Of course, Aprima always says it is our fault. We have upgraded all computers and internet without much improvement.” Bad Customer Support Paula from Family Medicine Associates was unpleasantly surprised by the low quality of support. It was the main drawback she mentioned: “100% customer support! It might as well be none. They take no responsibility for it either. If we could afford to go to a different software we would. I have "cases" (problems) that are still open after a year. I have to call and leave messages or send emails to supervisors/managers to get any response and it is usually an email stating that someone will call me soon. I may get the call but not a solution. They do not care about the customer once you have bought it.” ChartLogic EHR Disadvantages ChartLogic has been on the market for more than 24 years and gained a substantial customer base. But it is not without its flaws: Buggy Updates Eli from Morgan Hill Orthopaedics & Sports Medicine mentioned that the updates created problems rather than solve them: “The previous review was of Chart Logic 7, which I hear is great. Chart Logic 8? Not so much. Constant updates, each buggier than the last. Every time I think I'm settling into a rhythm, I get an email announcing a new update; which means in reality, hold your breath. We're rolling the dice again to see what new bugs pop up.  The list of "fixes" with each version begs the question, is this really being product-tested? If so, who's doing the testing? The worst part of it is that Chart Logic 7 is no longer available. If only they had worked out all the kinks before moving to a new version, but that's probably part of the financial model. Bring in as many practices as possible, and once they're inextricably tied into the system, hold them ransom. Monthly fees to host the data on a server. Much better than trying to sell a standalone product that actually works and doesn't need constant updating.” Unfit for Large Practices John from Colorado Rehab thought that ChartLogic wasn’t the best option for a practice as large as his: “Chart Logic seems like a nice intuitive product but the actual implementation left much to be desired. It seems like it would work fine for a smaller PCP but it just couldn't handle the complexity of our Docs' travel schedule. Plus, the inability of the implementation team to export/import our data was a major blow. Tracking multiple Docs across multiple locations that change weekly is not possible, the implementation team had a very difficult time importing SQL database correctly - this was a real show stopper.” MIPS Compliance Issues Kassidy from Southwestern Ohio Urology faced numerous problems, including those concerning her incentive documentation: “Not a good experience at all. Support can't answer your questions half the time. You can never get a projected time for anything. We can't get anyone to go over our quarterly MIPS to make sure we are on track. We weren't able to use the patient portal for over a year. We were told that MBS and ChartLogic were supposed to merge last year and now they say they don't have a projected time frame. You can't fix charts once they are closed. Spell check doesn't recognize words even though they are spelled correctly it says they are spelled incorrectly.” WRS Health EHR Disadvantages WRS Health is a cloud-based EHR/PM system that has been on the market since 1999. It has its fans, but also those who are less than happy about it: Expensive Customization Sangita from Advance Medical wanted to customize this EHR for her practice, but the costs turned out to be high: “I would not purchase this again. I requested a drop-down scheduling system and was told this would cost me a considerable fee. I asked for the company to coordinate with my phlebotomist so I could get labs uploaded automatically. This was another fee. The company has not strived to continually improve itself. These are simple programming issues that have not been implemented although they could make my life easier. Customer service has been slow to respond to 90% of my needs. Spellcheck was added after several years of me asking for it. Spell check still does not work for capitalized words or titles. They need additional programmers to fix problems as they are noted by every doctor. Years is a long time to wait for improvements.” Unfit for Pediatrics and Psychiatry Heather from WeeCare For Kids thought that WRS Health lacks many features that are necessary for her field: “Not very user-friendly for pediatrics. There is no creation of family accounts - we have to register each child in the family unit individually along with making sure all financial information gets to the parent for each child. This is the most inefficient way and causes more workload for my staff. The "task" aka messaging system is cumbersome and not user-friendly either since it only alerts about the messages and not the patient-related tasks - I have to remember throughout the day to check my "tasks" aka messages. There seem to be many systems that do not work properly - the system auto creates prior auths for all my controlled meds even though never needed, I am still waiting (1 month now) for the auto-posting of EOBs to happen (still paying for it though of course), some staff have problems signing on and permissions seem to come and go at will of the system - constantly having to take time to fix this. The support is good and responds quickly but lots of answers are overall “this is the way it is” - I can "turn off" the function if I want. Overall not a great experience with this system and again regret getting it. Unfortunately, I am stuck with it since the company states that I would have to buy out the contract if I want to switch - a small, independent office that can't afford that so we continue to curse the system and see patients.” Jackie from the Center for Emotional Wellness was promised a lot but only got disappointed: “We are a psychiatric practice. Psychiatry is very different than any other specialty. We were promised the sun, moon, and stars. That never materialized. We have been with WRS Health for over 3 years. Lots of promises to make improvements for our specialty but no follow-through. It is fairly easy to use. We do have slowdowns during the day and sometimes it will automatically log you out in the middle of something which can be frustrating when you lose part of a note. E-prescribing works on and off. We get a lot of calls from local pharmacies and mail-order that they did not receive a prescription even though our logs show it went through. Customization by the customer is not available. If you have issues you must put in a "ticket". We have tickets, I finally closed out because there was no action on them after months, some even were open over a year. It may work well for family medicine or internal medicine but I would not recommend it for psychiatry.” ModMed EHR Disadvantages Modernizing Medicine, the company that develops ModMed, has been on the market since 2010. While not being as popular as Epic or Cerner, it has a decent customer base. But their EHR has its share of flaws: Overpromise and Underdelivery Deanna from Urology Nevada found that the ModMed sales team promised far more than the practice got: “Sales promises you the world but watch out! Poor implementation, never had a site visit nor did they gather my Interface requirements and when I asked about the requirements, I was told: "We have done this 1000 times we know what we are doing." I wasn't given a test environment with working interfaces to our PM system to test the interfaces in advance of go-live. When I asked for interface specs, I was told they don't have any and I still do not have them. I argued the point months in advance of Go Live and I was told that if they were to give me a test environment it would delay my go live until 3rd qtr 2018 instead of 1st qtr 2018. Go Live, they decide to upgrade our Production Environment that morning without notifying me, we had blow-ups (errors) across 3 locations (80+ users). Since January 15th, I have 90+ issues I've reported to them and 46 issues still open, and the majority of the 46 issues are things that Development has to fix or Interfaces that need to be fixed because they are lacking data such as Date of Death, Our Doctor's Name, No Referring Provider Interface (and they charged me to upload a .csv file so I could have something in the EMR) and more. It's been a nightmare and still is. I wouldn't select this EMR if I had to do it over again because the original quote is low, but then you get hit with “well if you want that feature you will have to pay X Amount per Month”. A NIGHTMARE COMPANY to deal with. I can go on and on, but this will have to do. I think you can get off it.” Data Transfer Issues Bob from Linda Woodson Dermatology faced a long delay in implementing ModMed due to problems with importing data from their previous system: “I would not recommend this system. The price is right, but they are unable to get us online and functional. Apparently, the programmers are not able to find a way to make the data conversion from another major company's database functional, even though they have hired a third party to make it work. Further, the communication between us and the various entities involved is impossible. We signed a contract with the company to provide EMR services to our practice on May 29, 2014. Unfortunately, it is now December and they have been unable to complete the data conversion from our old system, and we are not yet live. We received assurances throughout July, August, and September that we were almost there, but we are not able to use the system at this time.” Subpar Customer Service Kent from Midwest Skin Cancer Surgery Center was disappointed with the way ModMed support responded to his issues: “The company does not respond to real problems with the EHR. I have reported billing issues where incorrect modifiers are used for billing with no resolution in OVER A YEAR! The software does not run properly on the most recent version of Firefox which is a browser required to be used by the company. When using this combination repeated delays occur when entering data with endless spinning wheels popping up. I reported the problem after spending months and $$ with my contracted IT people trying to figure out the issue (including swapping out my computer). A month later the issue is still "open" and unresolved. Multiple problems including incorrect coding of modifiers, and incompatibility with more recent versions of Firefox which is the internet platform needed to run the program. Customer service is completely unresponsive when you can get a hold of them and drop issues without resolution. Requires having a full-time office person available to try and deal with the company.” Jeanette from Valley Dermatology Associates had similar problems: “It is easy to get through to the support department, but very difficult to find someone that understands the product enough to know what your issue is. The typical response is, "let me log in and see if I can repeat the problem." I know it is a problem. I'm not even asking if it is. I'm asking if it is a known issue and if so when in it will be fixed. If it is an unknown issue, I will gladly enter my own case. Enhancement requests are prioritized by the effect on all customers, not by the facility. We have yet to see an enhancement.” Prognocis EHR Disadvantages Prognocis has been on the market since 2002 and is currently serving around 15,000 medical professionals. Just like other EHR systems, it has its advantages, but also flaws: HIPAA Compliance Issues Pamela from The Practice of Health and Wellness had problems keeping up with HIPAA due to the system’s inflexibility: “With so many EMR/EHR systems to choose from, and conducting hours of research, I chose the worse of the worse. No ease of use. No logic in use. No VPN to maintain settings, instead, they expect a medical office not to update their computers in order to keep the original settings on internet explorer.  Cannot use chrome. Cannot keep up with HIPAA regulations due to the settings’ inability to be updated. I felt like I was 30 years behind in computer technology. After 2 months of complaining and deciding to switch to a competitor, I received an email from the higher-ups. 100 emails too late. They charged out tens of thousands of bogus charges and collected 10%. They charged me a lot per month for this disaster.  I switched to Athena! Best thing I ever did! Prognocis aka Bizmatics, nearly closed my doors waiting an entire month to resubmit claims. I've been with Athena for 6 weeks and have not had one claim denied and payments are coming in. They only charge you 8% of what they collect. Prognocis, on the other hand, charges per month for poor service with no significant money collected. If it weren't for my office manager, I would have received no payments at all.  Learn from my mistake. Any positive reports about this system are submitted by their staff who were once medical office staff. I'm sure this system worked well 15-20 years ago. Computers have come a long way and Bizmatics/Prognocis simply did not keep up. Did I mention the amount in IT fees I accumulated trying to get this system to work? My IT specialist finally had a heart to heart talk with me.” Technical Problems Diane from Diane R Krieger MD met with a lot of technical glitches in Prognocis: “Very unresponsive technical support. Every time there is a software upgrade, previously functioning unrelated elements stop working and it takes weeks to months to get them to function again.  Their server is slow and I am often documenting late into the night because the slow speed makes it impossible for me to finish my notes in real time.  My office internet is quite fast so the problem is not on my end. it's difficult to go from field to field - I spend my day in endless futile clicking waiting for fields to change. For example, If I am documenting the history and I want to see the weight change, I have to leave what I am doing to go to the face sheet or vitals page and it takes too long. The prescription module is not efficient.” Bad Support Annette from Harrisburg Foot & Ankle Center was dissatisfied with both the functionality of Prognocis and its customer support: “Support is the biggest issue. I have issues that are still not resolved from 6 months ago. I'm told the issue is fixed only to find it is not. It gets sent to "the back," who fixes one thing, and then three other things that were fine get messed up.  They said we could customize reports, but we can't. They don't work. They told us they are accurate, but then I have to prove they are not. It's a huge problem when dealing with accounting and financial needs. We should be able to do more on our own and not have to wait for them to design a report. We need more stock reports that are basic so we can customize them for ourselves.  You can not apply the copay, deductible, etc. until after you hear from the insurance company, so if you have multiple patient payments, it is a lot of work to see what DOS they are waiting for.” Brian from The Kahan Center for Pain Management faced similar problems: “Originally I thought this would be a good system but have found it cumbersome and not easy to use.  I purchased it to use in a cloud format and have problems with printing notes, referrals, and prescriptions - and wind up getting blank pages. Also when trying to copy information from prior notes, I will get an ActiveX problem even though Internet settings are allowing ActiveX. Have to log out and log back in again.  I have tried customer support and their response time has been delayed. Underwent a CMS audit for meaningful use, and they could not help us. They finally got back to us, after the deadline. It's currently not offered as an integrated system with practice management, which makes things difficult because sometimes charges come across correctly and other times it does not.  I have had a lot of duplicate billing. Also, it will incorporate codes from prior visits that were not used on the current visit, so my billers have to delete codes. As far as flow, there are problems with it. The point and click system is slow and time-consuming even though we use a cloud. I have not benefitted from the system and even though I have met meaningful use I am switching EHR.” Sevocity EHR Disadvantages Since getting its first customer in 2002, Sevocity has spread to over 40 states.  Inefficiency Rachel from Schreiber Allergy admits that while this EHR is cheap, its inefficiency outweighs low costs: “If I could get out, I would. The fact that one person only can be on the chart is ridiculous. It will slow down your pace and make your flow less efficient. If I had to do it over again, I would not purchase this system. Only one person can be in the chart at one time - so your staff cannot help you enter information if you are in the chart. Very inefficient!  No iPad or iPhone app  Every time an update is made the system becomes more burdensome  We give suggestions to improve the system - positive changes are never made.” Glenn from City Podiatry also mentioned a few things:  “a mild complication in billing when a procedure and distinct E/M occur on the same visit,  needs more efficient podiatric friendly charting, very difficult to find appropriate ICD 10 codes, often times need to go to the internet or other software that I use in another practice,  medication reconciliation is cumbersome and creates congested chart notes “. Connectivity Issues KK from Nutt-Walley Clinic experienced numerous connectivity issues with Sevocity: “The implementation program was great, but we have since learned that we cannot do many of the things we were able to do on our old system. And many of the work-arounds do not work for our clinic.  The program does work, but we have had a lot of calls to support for problems with connectivity, RCopia, etc due to the servers being down, HL7 issues with data not crossing over from our Practice Management program to Sevocity.  We also have issues with corrections not crossing over, but instead duplicating patients causing someone to constantly merge accounts. I also have a problem with everyone being able to get into functions that only Administrators should have, such as merging. We have had problems in the past with this sort of thing and it caused many headaches and months to correct it. Overall, it does do the basics and we are adjusting. We were used to more functions and possibilities.” MicroMD EHR Disadvantages The company behind the MicroMD electronic medical records software has been on the market for more than eight decades. While its EMR is not as well-known as some of its competitors, it still has a decent user base. Medical professionals point out the flaws in MicroMD: ICD Coding Issues Amy from Regional Medical Center had trouble finding the right ICD-10 codes: “Very frustrating product. Not able to find a patient's main information on the same page. I have to close current notes in order to review the previous charting. The area for typing notes is really narrow and letters are tiny - which is very easy to generate typo. Trouble to find accurate ICD 10 code. Many different buttons have the same function, but it is not easy to locate them when you need them.  Has been using this product for 2 years. Just find out some new "tricks" to access the patient's info quicker. Not user-friendly.” Sue from Inner City Health Center also had a few things to say about that: “To create a phone message from a lab result screen requires ELEVEN clicks!!! The transition from ICD-9 to ICD-10 has been terrible - codes are not accurate and specific wording from the ICD-10 coding book is often nowhere in the EMR. Unable to minimize the current screen to look at other information in the patient's chart.” User-Unfriendliness Nicole from Southern Illinois Regional Wellness Center had a whole slew of comments regarding the UI drawbacks in MicroMD: “This product is not user-friendly at all. The reporting systems are so antiquated and not easy to use. The reporting is not geared towards reporting outcomes for CMS (UDS reporting and meaningful use). To print reports Micro-MD requires you to use plus signs and equals signs, it is 2017. It should be a lot easier than that to print reports. Not UDS friendly, you cannot filter reports any way you want too.  Cannot build flat file transfers (interfaces with other companies). Reporting is antiquated.  Micro-MD does not have the ability to scrub invoices which create more work for our billing dept. We are an FQHC and have very specific billing and reporting requirements, Micro-MD has not been helpful with any of this.  The PM and EMR applications are not well integrated. When we asked them about UDS reporting and flat-file transfers they informed us that they could not do that it would take too many hours of work to create these interfaces. Their solution was a new add-on they creating might be able to help but it would cost extra and still would have the information we needed at our fingertips. And no one from the company even discussed what this new software add-on would do or presented it to us to see if it was something that could possibly work to resolve our issues with Micro-MD.” Clunky Reporting Carol from Pediatric Associates of Franklin didn’t like the reporting system in MicroMD: “Overall, the software serves our purpose but it has very limited reporting for benchmarking or population management reports without running several reports to obtain the data you need.  We have family charts and accounts and it is unable to print the entire family balance on the encounter form so it can be collected at the time of service. It will only provide a balance on the patient/child who is being seen. This presents a problem because another child in the family could have a balance but not be being seen on that particular day. Therefore, we have to check the entire balance in advance and write it on the encounter form in order to collect the family balance. A very manual system that is labor-intensive.” SRSPro EHR Disadvantages SRSPro is a specialized Orthopedic EHR that has been acquired by Nextech. While it has its proponents, there are people who are less than satisfied with it: Overpriced Customer Support Gary S. Reiter, M.D. thought that the low level of customer support brings the whole system down: “When Customer Service is really bad, it is difficult for Ease of Use and Overall to be much better.  I am a doctor in solo practice. SRSsoft EHR was advertised as a turnkey solution to implementing EHR and achieving meaningful use. Prior to implementing SRSsoft EHR, I was given poor advice on how to do the initial setup. This has caused a need for repeated further modifications of the system costing $225/hour. Every time there is an upgrade, there is an additional charge of $5000 for training. If you don't pay, your other software problems are ignored. For example, SRS trainers had me program user logins and IDs that were specific to individual employees. When the employees turned over, it is $225/hour to change it. I have asked them to do this change for 6 over months and they are just getting around to it.  Our new employees have to sign in under old employee names. Getting them to help me is a constant daily struggle. They nickel and dime you to death. They do not respond to calls for help. They close out "work orders" before they are even started, so you have to constantly resubmit them. They return your calls when you tell them you are not going to be in the office. Save yourself. Stay away from SRSsoft.” ICD-10 Coding Issues Shannon from New England Dermatology & Laser Center, while mostly fond of this EHR, had a few problems: “ICD-10 charge passage through seems to be an issue for our office. We will need to utilize a (large) paper superbill. SRS doesn't have the capabilities to utilize scribes like other software offers.  The biggest disappointment we have faced this year is the delay in turn around time for support whenever we have entered a trouble ticket. This is something we had not experienced in the past. This seemed to be a common theme/conversation of many offices while at the User Summit last fall.” Phoenix Ortho EHR Disadvantages Phoenix Ortho is an orthopedic EHR that prides itself on providing specialty-specific experience to its users. Bad for Handling Multiple Injuries Kenneth from LSO thought that this EHR has potential, although it still requires a lot of work: “ Although one could never expect any one piece of software to be a perfect fit for everyone, I believe that my experience would be typical, because I have a general orthopedic practice. The opinions held within this review were based on my use of the software for almost a year (I have since discontinued the use of the software and returned to paper charts. I have also resumed my shopping for an EHR).  My first main complaint is that although the software can handle a patient encounter with more than one body part when you do have more than one body part, the software becomes much harder to use and errors get easily introduced into the record (mostly right left). When entering the diagnosis, the side defaults to the body part selected on the "main" page. So if you want to enter a diagnosis for the right shoulder, left knee, right radiculopathy, etc., you either have to click back to the main page and select the body part or you have to make sure you change the side.  On a followup visit, I asked them why the computer doesn't already know that the shoulder diagnosis is on the right, they said that I have to fix that each time. In addition, my surgery scheduler tells me that if a patient has a bilateral problem (such as bilateral shoulder injuries) when surgery is recommended, there was no obvious indication in the reports or order as to which side upon which I desired to operate.  We had many complaints regarding the way the software handled patients with multiple problems at a single visit. For example, you couldn't post surgery on a knee and a shoulder at the same visit. You can't order physical therapy on more than one area without editing the prescription each time. There were many problems with right/left when a patient came in with bilateral problems. When we would call for support, they would tell us that most of their users saw patients with only one problem.  In my practice, I see a lot of major injuries. My patients rarely have one problem. It isn't uncommon for a patient to have a neck, back, knee and shoulder injury (as an example); this software was very difficult to use in that situation. Also, one odd problem with the software was that if the same exam applied to two body parts, sometimes the final report who show two different findings for the same exam. This is extremely embarrassing, especially when you have to explain this in a deposition.  For example: if a patient has a cervical injury and a wrist injury with medial nerve numbness. In the cervical exam section, the normal sensation will be documented; however, in the wrist exam, there will be numbness along a median nerve distribution. As far as documenting and reporting of the physical exam, there were several flaws with the software. With the cervical exam, it was difficult to document myelopathy. That had to be typed in the comment section each time. The physical exam section was minimally modifiable.  In addition, if I saw a patient with a neck injury, it was awkward to document abdominal or lower extremity reflexes. Those are documented in the lower extremity or lumbar exam screens. As a result, you would have to add the lumbar as a problem (even if it wasn't) in order to document those areas. When I suggested various modifications to the exam the developers created, support told me that I had to use the exam as they had it and add anything else in the comment section. Also, many of my patients' diagnoses are associated with a particular date of onset (or date of injury). I need that in the history (especially in work comp charts). To have a date of injury in the history, you have to "click" on their data entry tree. This is a problem if the injury was in another decade (such as 2009). When entering the date, you click on "Onset of Symptoms" then click on "Acute with Injury" then click on "On Date." Then you are defaulted to a calendar of this month and year. So you click on "Year," and it shows you a list of years in this decade (i.e.. 2010, 2011, 2012, 2013 etc.) so then you click on "Decade". Then you click on the 2000-2009 decade, then click "2009," then click the month, and then click the day.  I asked them why the computer can't remember that the patient fractured their forearm in 2009. Why do I have to remind the computer of that each visit? Things like date of onset and side should be associated with the diagnosis so they don't have to be entered each time. Another issue is that to use some of the functions of the software, you have to give the user local admin rights on the computer. This is lazy programming. Check with your IT guy; he won't like that at all! They should have set up the software so that it only required specific privileges, not Admin privileges.  Another major problem was that the reports had major formatting issues and they were not customizable by the end-user. So the office notes generated looked amateur. Chiropractor software was generating more professional reports than mine. I was so embarrassed, especially if my report was being used as evidence in a personal injury case.  Another problem was that each time I set up a surgery, I needed to send that "task" to a specific employee. So each time I'd have to select that person out of a 15 person pull-down list. Why can't the software remember that all surgery requests should go to employee A for scheduling? This may seem minor, but it is an example of how amateur this software feels. It is a generally accepted standard that when entering a username and password, the cursor starts in the username field. You type the username, hit the Tab key, then type the password and then press the Return key - not with Phoenix Ortho. After entering the username, the first Tab takes you to a useless checkbox, and the second TAB takes you to the password field. So you have to be cognizant of that when you are working in Phoenix Ortho because it is different than all other software.  Also, there was no internal consistency in the software. Certain activities had contextual pull-down menus, whereas others had pop-up dialog boxes. As a result, the software was very annoying to use on a large screen, because in many cases where a contextual menu would work great, they'd use a pop-up, and I found that my mouse was chasing down pop-up boxes all over my screen. It is true that you can scan in documents (such as imaging reports), but there was no way to search for them; there was no way to add keywords; you couldn't even sort them alphabetically or by date. So results were in random order, and it took forever to get information out of the software. No Fax Acceptance Katelyn from SDSM didn’t like the extra work some of the Phoenix Ortho issues created: “The ability to obtain faxes through this system is nonexistent and very hard to set up. We are unable to route properly and waste a lot of paper having to manually scan into the appropriate patient. They do updates during open hours and we've had a few system breakdowns that caused interruption and deletion of faxes, new patient appointments, and even data.”

What is HIPAA-compliant Database?  A database is an organized collection of structured information controlled by a database management system. To be HIPAA-compliant, the database must follow administrative, physical, and technical safeguards of the HIPAA Security Rule. Often it means limiting access to PHI, as well as safely processing, transmitting, receiving, and encrypting data, plus having a proactively breach mitigation strategy. Administrative, physical, and technical safeguards of the HIPAA Security Rule HIPAA Rules for Database Security If your database contains even a part of PHI, it is covered by the HIPAA Act of 1996 and can attract the attention of auditors. PHI is the information containing any identifiers that link an individual to their health status, the healthcare services they have received, or their payment for healthcare services. The HIPAA Security Rule (the part of HIPAA Act) specifically focuses on protecting electronic PHI. Technical safeguards (the part of HIPAA Security Rule) contain requirements for creating a HIPAA-compliant database. Centers for Medicare & Medicaid Services (CMS) covers HIPAA Technical Safeguards for database security in their guidance. The first question that can arise is whether you should use any specific database management system to address the requirements? The answer is absolutely no. The Security Rule is based on the concept of technology neutrality. Therefore, no specific requirements for types of technology are identified. Businesses can determine themselves which technologies are reasonable and appropriate to use. There are many technical security tools, products, and solutions that a company may select. However, the guidance warns that despite the fact that some solutions may be costly, it can’t be the cause of not implementing security measures. "Required" (R) specifications are mandatory measures. "Addressable" (A) specifications may not be implemented if neither the standard measure nor any reasonable alternatives are deemed appropriate (this decision must be well-documented and justified based on the risk assessment). Here are the mandatory and addressable requirements for a HIPAA-compliant database. Mandatory HIPAA Database Security Requirements HIPAA Compliant Database Access Control Database authentication. Verify that a person looking for access to ePHI is the one claimed. Database authorization. Restrict access to PHI according to different roles ensuring that no data or information is made available or disclosed to unauthorized persons. Encrypted PHI PHI must be encrypted both when it is being stored and during transit to ensure that a malicious party cannot access information directly. Unique User IDs You need to distinguish one individual user from another followed by the ability to trace activities performed by each individual within the ePHI database.  Database security logging and monitoring All usage queries and access to PHI must be logged and saved in a separate infrastructure to archive for at least six years.  Database backups Must be created, tested, and securely stored in a separate infrastructure, as well as properly encrypted.  Patching and updating database management software Regular software upgrades, as soon as they are available, to ensure that it’s running the latest tech. ePHI disposal capability Methods of deleting ePHI by trained specialists without the ability to recover it should be implemented. By following the above requirements you create a HIPAA-compliant database. However, it’s not enough. All HIPAA-compliant databases must be settled in a high-security infrastructure (for example, cloud hosting) that itself should be fully HIPAA-compliant. HIPAA-Compliant Database Hosting You need HIPAA-compliant hosting if you want either to store ePHI databases using services of hosting providers, or/and to provide access to such databases from the outside of your organization. Organizations can use cloud services to store or process ePHI, according to U.S. Department of Health & Human Services. HIPAA compliant or HIPAA compliance supported? Most of the time, cloud hosting providers are not HIPAA compliant by default but support HIPAA compliance, which means incorporating all the necessary safeguards to ensure HIPAA requirements can be satisfied. If healthcare business wants to start collaborating with a cloud hosting provider, they have to enter into a contract called a Business Associate Agreement (BAA) to enable a shared security responsibility model, which means that the hosting provider takes some HIPAA responsibility, but not all.  deloitte.com/content/dam/Deloitte/us/Documents/risk/us-hipaa-compliance-in-the-aws-cloud.pdf In other words, it is possible to utilize HIPAA compliance supported services and not be HIPAA compliant. Vendors provide tools to implement HIPAA requirements, but organizations must ensure that they have properly set up technical controls - it's their responsibility only. Cloud misconfigurations can cause an organization to be non-compliant with HIPAA. So, healthcare organizations must: be ensured that the ePHI is encrypted during transit, in use, and at rest; enable data backup and disaster recovery plan to create and maintain retrievable exact copies of ePHI, including secure authorization and authentication  even during times where emergency access to ePHI is needed; implement authentication and authorization mechanisms to protect ePHI from being altered or destroyed in an unauthorized manner as well as include procedures for creating, changing, and safeguarding passwords; implement procedures to monitor log-in attempts and report discrepancies; conduct assessments of potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI; include auditing capabilities for their database applications so that security specialists can analyze activity logs to discover what data was accessed, who had access, from what IP address, etc. In other words, one needs to track, log, and store data in special locations for extended periods of time. PaaS/DBaaS vs IaaS Database Hosting Solutions Healthcare organizations may use their own on-premise HIPAA-compliant database management solutions or utilize cloud hosting services (sometimes with managed database services) offered by external hosting providers.  Selecting between different hosting options is often selecting between PaaS/DBaaS and IaaS.  For example, Amazon Web Services (AWS) provides Amazon Relational Database Services (Amazon RDS) that not only gives you access to already cloud-deployed MySQL, MariaDB, PostgreSQL, Oracle, Microsoft SQL Server or Amazon Aurora relational database management software, but also removes almost all administration tasks (so-called PaaS/DBaaS solution). In turn, Amazon's Elastic Compute Cloud (Amazon EC2) services are for those who want to control as much as possible with their database management in the cloud (so-called IaaS solution).  on-Premise vs PaaS/DBaaS vs IaaS Database Hosting Solution PaaS/DBaaS vs IaaS Database Hosting Solution Azure also provides relational database services that are the equivalent of Amazon RDS: Azure SQL Database, Azure Database for MySQL, Azure Database for PostgreSQL, and Azure Database for MariaDB. Other database engines such as SQL Server, Oracle, and MySQL can be deployed using Azure VM Instances (Amazon EC2 equivalent in Azure). Our company is specializing in database development and creates databases for large and smaller amounts of data storage. Belitsoft’s experts will help you prepare a high-level cloud development and cloud migration plan and then perform smooth and professional migration of legacy infrastructure to Microsoft Azure, Amazon Web Services (AWS), and Google Cloud. We also employ experts in delivering easy to manage HIPAA-compliant solutions and technology services for medical businesses of all sizes. Contact us if you would like to get a HIPAA risk assessment and analysis.

Are you ready to take your healthcare app idea to the next level? Partner with our experienced healthcare software developers. Belitsoft provides dedicated developers for hire to work closely with you to ensure your app is a success. Contact us today to learn more about our offer and how we can help you achieve your goals. Benefits of Hiring Dedicated Healthcare App Developers from a Software Development Company Creating an in-house team for healthcare app development can come with certain drawbacks  These include the financial burden of paying full-time salaries and benefits, the need to hire specialized experts for specific projects, and the expenses associated with office space, equipment, and employee training. There may be a limited pool of local talent with the necessary skills and qualifications, and high staff turnover can make it difficult to maintain a stable team. The hiring process can be lengthy and there are additional costs such as office space and equipment maintenance. All these expenses may not make sense for a one-time project. When working with freelancers for healthcare app development, there are potential downsides to consider  The platform may not verify the skills of the freelancers and it can be challenging to ensure they have the necessary expertise. The responsibility of evaluating freelancers falls on you, which can be a challenge. The healthcare industry has strict regulations that must be adhered to, which can be difficult to ensure with a freelancer. Freelancers may not prioritize your project, leading to delays or abandonment. Communication and availability may also be a challenge. If a freelancer leaves the project, you may be left to handle the consequences on your own. Working with an app development agency for healthcare app development has several benefits  You are not limited by geography and can work with a team from anywhere and have the flexibility to hire contract workers on a pay-as-you-go basis.  An established healthcare app development company can either handle the entire project for you or provide the dedicated developers with the required skills for your app development. You can set a scope of work, with the option to assess progress. The healthcare app development agency also vets software developers for their skills and ensures the quality of their work. They hire developers who have experience working with similar projects to make the best decisions for you in terms of technology stack and development practices.  Cost of Healthcare App Development Services The cost of healthcare app development services can vary depending on a number of factors: the scope of the project, the expertise level of the developers required, and the number of hours needed to complete the work.  At Belitsoft mobile development company, we strive to customize our pricing to meet your budget requirements and only bill for hours worked on your project.   To get a quote for your specific healthcare app development needs, please contact us so we can discuss your project plan and conduct preliminary research. How to Hire Good Healthcare App Developers Not hire just coders, but also healthcare business domain consultants Before planning for healthcare app development, consider consulting a reputable app development company with healthcare-specific expertise. They can help identify bottlenecks and ensure your solution aligns with current industry trends.  Select companies that are familiar with laws, regulations, and standards that affect healthcare apps  HIPAA applies to all businesses creating medical apps for the US market, and compliance is required if the app enables patients to share personal data with healthcare providers.  GDPR applies to data exchange among EU Member States and must be followed for all software solutions that gather and process EU residents' data. Canadian businesses must also comply with the PIPEDA when designing apps that gather and process the personal data of Canadian citizens. If your project requires it, hire healthcare app developers who have a strong understanding of integration standards, semantic vocabularies, and integration frameworks Integration standards, also known as the "glue" of the healthcare technology industry, play a crucial role in ensuring interoperability. Developers who are familiar with standards such as Health Level 7 (HL7) version 2.x, HL7 Fast Healthcare Interoperability Resources (FHIR), ANSI X12n 5010, NCPDP SCRIPT, DICOM, and HL7 v3 Clinical Document Architecture (CDA) will be able to effectively design and implement solutions that can seamlessly integrate with a wide range of healthcare systems. Semantic vocabularies are also crucial for ensuring that clinical data is interpreted correctly. Developers with knowledge of commonly used vocabularies such as ICD9/10, LOINC, RxNorm, and SNOMED-CT will be able to create solutions that can effectively process and utilize clinical data. Integration frameworks, such as Healthcare Information Technology Standards Panel (HITSP) and Integrating the Healthcare Enterprise (IHE), provide a mechanism for both syntactic and semantic interoperability, encompassing a complete clinical workflow. Developers who have experience working with these frameworks will be able to create solutions that can effectively integrate with existing healthcare systems and workflows. If your app project requires it, consider developers who have a thorough understanding of the revenue cycle workflow This includes knowledge of concepts such as billing schedules (when bills are sent, when payments are expected, and how to handle any discrepancies that may arise), payment models (how various payment models work and how they can be integrated into the solutions they are building), and denial workflows (how to handle denied claims, including how to appeal denials, and how to accurately track denied claims). Look for expertise in data security and general integration standards Healthcare app developers should have skills in encryption tools, libraries, secure coding practices, and standards such as SOAP and REST framework. Choose app developers with cross-platform expertise Hire mobile developers who specialize in creating cross-platform apps. This will ensure that your app can run on major platforms such as Android, iOS, and Windows, expanding your potential user base. Additionally, using technologies like React Native will guarantee a high-quality product that performs well on all platforms. Opting for a cross-platform approach can also save you time and resources compared to hiring multiple development teams for each platform. Look for a full-service app development provider A full range of services includes design, programming, testing, deployment, and maintenance. Competent project managers also play a key role in the success of a healthcare app development team. They expertly plan and execute complex projects, and set clear expectations with stakeholders to navigate the complexities of developing mobile solutions for the healthcare industry. If your organization does not have experienced project managers or is unable to move highly skilled professionals from their current responsibilities, it may be necessary to look for a reliable technical partner with comprehensive project management capabilities during the evaluation process. Request a meeting with an app development team During this one-on-one time, delve into their areas of expertise, past experiences, and passions within the field. Ask for their resumes and to check out examples of their previous work. This will give you an in-depth look into their qualifications and skill set, and help you make an informed decision on who to partner with for your project. Secure a solid agreement by negotiating and signing a contract with your chosen health app development team Discuss and agree on important details such as hourly rates, payment timelines, and the form of payment (such as wire transfers or digital currency). This contract will outline the terms and conditions under which your project will be delivered. When structuring the agreement, ensure that the following points are covered: Maintaining confidentiality through a non-disclosure agreement (NDA) to protect sensitive information about your business and project. The Software Development Life Cycle model being used, including the developers assigned to your project, their specific niche (such as Android,  iOS or cross-platform), and the estimated time frame for each stage. A dedicated approach to troubleshooting and debugging to prevent rewriting code. After-sales support to handle updates and feedback as your app gains users. Availability of developers at important times to make necessary changes to your app. Clear payment terms, including a schedule for payments upon completion of phases. Property rights, ensuring that you are the exclusive owner of the software and holder of copyright and trademark rights. Usage of the project in the company's portfolio, with the option to limit the information shared in case studies.  It's time to kick off your healthcare app development project! Begin by planning out the initial stages of development, focusing on creating the core features of your app. These will serve as the foundation for your minimum viable product (MVP), which you can then test and improve upon. Why Dedicated Healthcare App Developers from Belitsoft Our services We offer a range of services to support you at any stage of your healthcare app development project. With Belitsoft, you can save time and resources by avoiding the need for extensive research or hiring candidates. Discovery Phase Our team of app developers excels in technical research and analysis. We provide a thorough understanding of the nuances of your app project, including visualization, technical intricacies, and practical roadmaps with deadlines. Let Belitsoft elevate your vision to the next level. App Prototyping Our experts can help you design a Minimum Viable Product (MVP) that provides valuable insights into customer needs and market demand. Get ahead of the competition with Belitsoft's prototyping services. App Development Our experienced app developers are equipped with diverse profiles and unique qualifications, allowing them to be true professionals in their field. We can help you create a product from scratch or join your project at any stage and pick up where you left off. App Deployment Our team of experts can take care of all aspects of deployment, including assembly, migration, and launching of the finished version. We strive to make the deployment process as seamless and stress-free as possible. Our approach Belitsoft offers a range of healthcare app development services to help businesses customize their technology solutions. Instead of spending time and resources on hiring and training a team, outsource developers from Belitsoft to build the software solutions you need to improve organizational processes and patient experiences. Our flexibility allows you to add as many diversified developers to your in-house team as needed, or even assemble a dedicated team of specialists. Customized Solutions Our professionals work with you to develop solutions that meet your unique needs. From medical appointment scheduling and prescription ordering to health record access and emergency assistance, we can help you transform the way you deliver patient care. Dedicated Outstaffed Team We offer a discovery process to find the right mix of talent for your project, with clear monthly fees and direct client management. Our teams can be assembled and ready to work in just two to three weeks, with confidentiality and NDAs signed for every project. Outstaffed R&D Our R&D process includes a discovery period to thoroughly research your project needs, with teams created from scratch and including UX/UI designers, software engineers, project managers, and Q/A specialists. Long-Term Involvement We are directly involved in your project from start to finish and offer continued support even after the project is completed. No Subcontractors At Belitsoft, we directly employ every member of our team, ensuring accountability and trust. Let's Meet

Professional Developers mostly use relational databases like PostgreSQL, MySQL, SQLite, and Microsoft SQL Server. https://survey.stackoverflow.co/2022/#most-popular-technologies-database-prof Databases in Healthcare: Zero Downtime and High Security The healthcare industry, like a hospital, it's a 24/7 operation, it's open all year long. Hospitals have thousands of connections to the database and database administrators cannot afford to put the database down. If the database isn't available when a surgeon or doctor is in the operating room and needs to make a decision and they don’t have all the information about the patient anymore, that can have really big consequences. There's a lot of private information in healthcare, and patients are involved. Looking at certain information, like an address or telephone number, should be locked for non-authorized users including… healthcare software developers. So developers must not have patient information in test and dev, they have to use not real but mixed data like names changed to something random, replacing characters, selecting a random record, and stuff like that. Examples of Relational Databases in Healthcare EHR Databases eClinicalWorks sells electronic medical record and practice management software to more than 70,000 healthcare providers in the United States. Their Java-based applications use SQL Server databases.  They moved the database server to an Infrastructure as a Service (IaaS) cloud (Azure Virtual Machines and Azure Disk Storage). In a typical SQL cluster, the company has two VMs deployed in zone redundancy and one for disaster recovery in a different region to enhance availability and reliability. In total, they use 2,200 Azure virtual machines.  “Every customer gets their own back-end database and is logically separated on the shared infrastructure. This is how we’re able to deploy customers running independently without any commingling of data,” explains Bharat Satyanarayan, Vice President of Technology and Quality Assurance at eClinicalWorks. Claims Databases Consumer Direct Care Network (CDCN) provides different services to tens of thousands of individuals, including claim processing services.   They moved the back-end of their Claim Processing System from an on-premises to a Database as a Service (DBaaS) cloud (followed by rebuilding and rearchitecting to make it cloud-ready).  Using Azure SQL Database, a fully managed relational database service, CDCN can handle 400,000 transactions in billing and payroll a week, and their portal serves 200,000 users.   Health Analytics Databases  Health analytics company Dr Foster helps hospitals and regional care systems understand the factors influencing the quality of care, using Microsoft SQL Server Big Data Clusters.   “We need to be able to access like several hundreds of terabytes of data and that's data for every hospital in England. We need to be able to access it quickly and shape it and make sense of it. SQL allows us to do that with speed and with accuracy and helps us keep it safe,”  says George Bayliffe, Head of Data at Dr Foster. Five different teams work with the data store.  Data engineering team manages data processes to pass usable data to the team of statistical analysts. Team of statistical analysts models the data with AI and machine learning to produce insights.  Application development team builds web apps to present the data to customers.  Consultant group provides custom services (including reporting) to customers.  Operations team is responsible for the security, integrity, and availability of the data across the organization.  “[For one of our clients] we had to deploy our solution to a datacenter in Germany. By replicating the entire environment with Azure Virtual Machines, we can keep this data completely isolated from our network [to maintain data within national borders to satisfy GDPR regulations],”  says George Bayliffe.  Database for Real-time Analytics in Healthcare POCT Science House is a diagnostics company that enables healthcare providers to receive lab reports. It operates 85 labs that produce several thousand patient reports every day for district and community hospitals. Inside the labs, more than 400 automated analyzers identify chemicals and other characteristics in biological samples.  The data from the tests are then compiled into reports to help clinicians quickly identify signs of disease and propose treatments. Plus, the government uses anonymized versions of the data to get a broad view of the nation’s well-being to help plan healthcare policies. The company uses Oracle MySQL HeatWave Database (managed database service) on Oracle Cloud Infrastructure to collect data from 400-plus automated analyzers. The integrated HeatWave in-memory query accelerator makes fats dashboard reporting without needing to move the data for analysis.  The medical device manufacturer Bionime provides diabetes patients with a self-monitoring blood glucose system.  Bionime selected Oracle MySQL HeatWave on AWS as a fully managed database service that combines transaction processing with an in-memory query accelerator for a high-performance analytics engine.  Oracle MySQL HeatWave consolidates both transaction processing and queries in one MySQL Database for real-time analytics. It eliminates the need for a separate analytics database and ETL (extract, transform, and load) processes.   Databases for Cloud-based Healthcare SaaS apps Nuance Communications software technology corporation provides primarily SaaS-based speech recognition and transcription healthcare application that is used by more than 500,000 clinicians in 10,000 healthcare organizations globally to capture more than 300 million patient stories each year. The company uses Azure SQL Database with the geo-replication features in two datacenters, so database changes are propagated in real-time from the master database to five read-only database instances across the datacenters to guarantee a recovery point objective (RPO) of five minutes or less. IT Infrastructure of healthcare SaaS Azure Traffic Manager routes traffic to the closest data center based on network response times to provide the optimal user experience without any downtime. Azure Load Balancer routes the request to an available microservice instance deployed as an Azure Virtual Machine and can quickly be horizontally scaled to provide unlimited capacity. And while Azure Virtual Machines provide the raw compute power, Azure Storage is used to provide an access to the file system. Azure Virtual Network in conjunction with Network Security Groups is used to ensure that only authorized personnel has access to patient data. Azure Security Center to manage and monitor individual virtual machines for malware and virus protection.  Clinical Quality Registries IT Infrastructure of Uppsala Clinical Research Center (UCR) UCR's National Quality Registries include treatment and outcome data based on all hospital patients and are used by thousands of doctors, nurses, medical secretaries, and representatives within county councils. A national quality registry contains person-based details relating to a problem, the taken actions, and the results within the health and care services. The registers provide feedback on the work of the healthcare providers and can generate intra-departmental comparisons of the treatments and results, as well as comparisons with other care providers. We are "automatically loading patients' data, both from the primary health and hospital care, into the MySQL database servers," says Kalle Spångberg, Group Director at UCR. The National Quality Registries is based on four MySQL servers. All in all, treatment data from about 1.5 million patients are registered in the Quality Registries. The users of the National Quality Registries record patients, treatments and outcomes. It collects transferred patients' data automatically or through the online Web form.   The data is received by an Apache Web server which, in turn, sends a request to a Tomcat Java Application Server where logic and communication with the MySQL databases are managed. About 20 quality registries are allocated on two MySQL servers, "DBMaster" and "DB-Prod". Every night, the MySQL production database as well as the MySQL redundant slave database sends a batch of data to the analysis server, which produces dynamic reports through the National Quality Registries' online application. 

Before Extration To host and manage healthcare data for analytical purposes, a separate healthcare analytics database is needed. The raw EHR database data should be converted, preferably adopting the OMOP Common Data Model, to enable systematic analysis with standard analytic tools. Raw EHR databases are usually optimized for fast data entry and retrieval of individual patient records, not for complex analysis. Creating a separate database specifically for analysis can improve query speed and reduce the load on your operational EHR system. Database system development includes database design, implementation, and database maintenance.  Healthcare analytics database design  Conceptual Data Model This is an abstract representation of the data and connections between distinct entities (such as patients, visits, medications) without being tied to a particular database system. Specification of a logical schema The logical schema defines each table needed in your database, like "Patient", "Medication", "Diagnosis". It includes Columns (or fields/attributes) that determine what information goes into each table, such as patient name and date of birth). The Datatypes of the columns, like text, numbers, or dates, are also specified, along with any Constraints like Primary Key - a unique identifier for each row in a table, such as patient ID. Healthcare analytics database implementation This involves creating the actual database based on the logical schema. Examples include optimizing data storage for better performance, implementing security measures to safeguard data, and establishing user interactions with specific data segments. Healthcare analytics database maintenance This entails ensuring the database continues to perform well and adapt to changing needs. Monitoring performance and addressing issues, making changes to the structure as needed, effective communication between healthcare database administrators, developers, and users to determine necessary changes. Our healthcare software development services handle complex challenges of healthcare data analytics, ranging from data extraction to the application of advanced statistical and machine learning techniques. Contact our experts for deeper data insights. Difference between EMR and EHR data Electronic medical records (EMRs) digitize the traditional paper charts found within a specific hospital, clinic, or doctor's office.  Electronic health records (EHRs) are much more comprehensive, as they include all the data found in EMRs as well as information from labs, specialists, nursing homes, and other providers. EHR systems share this data across authorized clinicians, caregivers, and even patients themselves, allowing for coordinated, patient-centered care regardless of location. Besides patient care, EHR data serves administrative and billing purposes.  Recently, EHRs have become a major source of real-world evidence, aiding in treatment evaluation, diagnosis improvement, drug safety, disease prediction, and personalized medicine. We collaborated with a US healthcare solutions provider to integrate EHR with advanced data analytics capabilities. Our integration streamlined data management, empowered healthcare providers, and optimized care delivery processes, resulting in improved patient outcomes and operational efficiency. Check out our case to learn more. The complexity of EHR data demands a multidisciplinary team to handle the challenges at every stage, from data extraction and cleaning to analysis. This team should comprise experts in database, computer science/informatics, statistics, data science, clinicians, epidemiologists, and those familiar with EHR systems and data entry procedures. The large volume of EHR data also causes significant investment in high-performance computing and storage. For more information on effectively leveraging EHR data and healthcare analytics, explore our comprehensive guide on EHR Implementation. Improve patient care and streamline operations with our EHR/EMR software development. From seamless data integration to intuitive user interfaces, our team of dedicated healthcare app developers can tailor to your needs. Get in touch for project planning and preliminary research. Traditional Relational Database Systems  EHR data often fits well into the table format (patients, diagnoses, medications, etc.). Relational models easily define how different entities link together (a patient has multiple visits, each visit has lab results, etc.). Constraints offered by relational databases help maintain data accuracy.  Oracle, Microsoft SQL Server, MySQL, and PostgreSQL are widely used relational databases in healthcare. Distributed Database Systems   As databases grow massively, traditional systems struggle with performance, especially for analysis and complex queries. Apache Hadoop: The Framework Hadoop lets you spread both storage and computation across a cluster of commodity (regular) computers. The Hadoop Distributed File System can reliably store massive amounts of data on multiple machines. It also offers a programming model for breaking down large-scale analysis tasks into smaller parallel chunks. Apache HBase: The Real-Time, Scalable Database Apache HBase, on the other hand, uses HDFS for storage and is a non-relational database. It is designed to handle semi-structured or unstructured data, borrowing principles from Google's Bigtable solution for managing massive datasets. It enables fast retrieval and updates on huge datasets. NoSQL (like HBase, MongoDB, Cassandra DB) vs. Traditional SQL Databases NoSQL databases excel at handling images, videos, and text documents that don't fit neatly into predefined tables. They store data as "documents" (similar to JSON), providing flexibility in the structure of information stored in a single record. However, NoSQL databases prioritize horizontal scalability (adding more machines to store more data) and may sacrifice some consistency guarantees compared to traditional SQL databases. Data Extraction in Healthcare Inclusion/exclusion criteria may consider patient demographics like age, gender, or race. It can also involve extracting data from various tables in EHR/EMR systems, such as medication, procedure, lab test, clinical event, vital sign, or microbiology tables. However, some of these data or variables may have high uncertainty, missing values, or errors. To aid, Natural Language Processing (NLP) techniques can be employed. NLP can analyze text data within EHR/EMR systems to identify relevant mentions that may not be directly linked to expected keywords or codes but are important for analytics purposes. Moreover, accurately identifying missing relationships based on indirect evidence requires substantial domain knowledge. Cohort Identification  Cohort identification selects patients to analyze based on diagnoses, procedures, or symptoms.  Careful definition of the cohort is essential to avoid mixing patients who are too different. Without a well-defined cohort, the analysis will not yield useful insights about any group. Identifying your research cohort in EHR data can be tricky due to input errors, biased billing codes, and missing data.   Phenotyping methods and data types Rule-Based Methods for Cohort Identification ICD codes are a starting point for identifying patients. When studying conditions like heart attacks (acute myocardial infarction), it may seem logical to search for ICD codes specifically linked to that diagnosis. However, relying solely on ICD codes, especially for complex diseases, is often not sufficient. It is important to note that ICD codes are primarily used for billing. Doctors may choose codes that are more likely to get reimbursed, rather than the code that precisely reflects a patient's complex condition. The condition's severity, complications, and management are important factors not easily represented by one code. Errors in data entry or delayed diagnoses can lead to patients having incorrect codes or missing codes. Machine Learning Methods for Cohort Identification Machine learning algorithms can be trained to spot patterns in complex EHR data that may go unnoticed by humans, potentially finding patients that traditional rules might overlook. Clinical notes contain detailed patient information that is not easily organized into codes. NLP techniques help computers understand human language within these notes. Key Tools and Methods MedEx. A specialized NLP system designed to extract medication names, dosages, frequencies, and other relevant information. CLAMP. A broader toolkit that supports various NLP tasks in the medical domain, like identifying diagnoses or medical procedures within the text. OHNLP. A resource hub providing researchers with access to a variety of NLP tools, thereby facilitating their implementation. Complex models like Recurrent Neural Networks (RNNs) can effectively identify patterns in large datasets with many variables and patient records. Bayesian methods can help determine disease groups, even in situations where perfect data for comparison is unavailable. The FSSMC method helps cut down the number of variables you need to consider and ranks them based on their predictive utility for disease identification. Methods like clustering can group patients based on similarity, even without predefined disease labels. Simpler approaches can also be used in healthcare analytics for data extraction and transformation. One method is to define data requirements and use ETL pipelines. These pipelines extract data from different sources, transform it, and load it into a target database or data warehouse. ETL pipelines are efficient for processing large volumes of data, ensuring data integrity and consistency for analysis and reporting. While not as advanced as NLP or machine learning, these methods still provide valuable insights and practical solutions for organizations to leverage their data effectively. Leverage your healthcare organization's data analytics with our tailored healthcare business intelligence solutions. Our expert team employs advanced strategies to derive actionable insights from your clinical records and diverse data sources. Contact us now for advanced analytics to improve operations. Data Cleaning in Healthcare The primary purpose of EHR databases lies in supporting the daily operations of healthcare, such as billing, legal documentation, and user-friendliness for clinical staff. However, this singular focus presents challenges for analytics.   The purpose of data cleaning is to ensure that the analysis conducted is meaningful and focused on answering analytics questions, rather than battling errors or inconsistencies. This process aims to achieve a more uniform distribution of lab values. Various tasks fall under data cleaning, such as eliminating redundancies, rectifying errors, harmonizing inconsistencies in coding systems, and standardizing measurement units. Consolidating patient data from various clinical visits that have conflicting records of race, gender, or birthdate. Harmonizing disease diagnosis, procedures, surgical interventions, and other data that may be recorded using varied coding systems like ICD-9, ICD-10, or ICD-10-CM. Correcting variations in the spelling of the same medication's generic names. Standardizing the units used for lab test results or clinical measurements that vary across different patient visits. Data cleaning is essential for the entire EHR database to support all types of projects and analyses, except for projects that focus on studying errors in data entry or management.  Data cleaning methods should be tailored to the specific errors and structure of each EHR database. The provided methods serve as a foundation, but must be customized for each project. The first data cleaning project is usually the most time-consuming, but team experience with the database and common errors can help speed up the process for later projects. EHR data cleaning tools Many existing tools address datasets from specific healthcare facilities or focus solely on one aspect of data cleaning (like standardizing units). Some tools might be better suited for project-specific fine-tuning rather than broad database cleaning. Data Wranglers Data wranglers are tools specifically designed to handle diverse data types and offer transformations like reformatting dates, handling missing values, and pattern detection. Examples: DataWrangler (Stanford) and Potter's Wheel (UC Berkeley). They work with many data formats, help users understand big datasets quickly, and have optimized code for handling large datasets. While adaptable, they might not address the specific complexities and inconsistencies found in EHR data. Specialized EHR data cleaning tools may be necessary for the best results.  Data Cleaning Tools for Specific EHR Datasets  EHR databases can differ in сoding systems (e.g., ICD-10 vs. ICD-10-CM), date formats (European vs. US style), address Formats (country-specific). Because of this, data cleaning tools often need to be tailored to specific EHR database systems. It is unlikely that a single tool will universally apply to all databases. Even if certain tools aren't directly transferable, researchers can still learn valuable cleaning methods and approaches by studying tools like the "rEHR" package. rEHR package acts as a wrapper for SQL queries, making it easier for researchers to work with the EHR database. Statistical data cleaning methods also exist. For example, the Height Cleaning Algorithm detects and removes unlikely height measurements (like negative changes) based on median values across life stages. This algorithm is relatively simple to implement and catches many errors. But there are risks removing rare, but valid, data points (e.g., post-surgery height changes). Healthcare Data Quality Assessment Here's a summary of data quality metrics for assessing EHR data. Checking if data values are within expected ranges and follow known distributions. For example, pulse oximetry values should be between 0 and 100%. Verifying the soundness of the database structure, such as securing each patient, has a unique primary key. Ensuring consistent formatting of time-varying data and logical changes over time. Examining for logical data transitions. For instance, there should be no blood pressure measurements for a patient after their recorded death. However, it is important to note that rare exceptions may exist. Evaluating relationships between attributes, such as confirming a male patient does not have a pregnancy diagnosis. Common EHR Data Errors and Fixing Methods Cleaning methods primarily target tables containing numerical results from encounters, labs, and clinical events (vital signs). Issues with diagnosis codes, medication names, and procedure codes also can be addressed. Demographics Table The demographics table is the cornerstone of data quality assessment. Fixing Multiple Race and Gender Data analysis relies on unique identifier codes for individuals, especially sensitive personal information like medical records, instead of using actual names or identifying information. This is done to protect patient privacy and anonymize the data. It functions as a random ID tied to individuals or samples in the dataset, maintaining their anonymity. "Patient Surrogate Key" (Patient SK) is the unique key for each patient in a medical dataset. Data analysts can track patient records, test results, treatments, etc. without exposing personal information. Multiple demographic entries in a patient's records may have conflicting race or gender information. This is how we fix race/gender inconsistencies: Gather all Patient IDs linked to a given Patient SK, collecting all demographic data associated with that individual. Discard entries with missing race or gender (NULL, etc.) as they are likely incomplete or unreliable. If a clear majority of the remaining entries agree on a race or gender, assign that as the most probable value for the patient. If there is no clear majority, default to the earliest recorded value as a likely starting point. Fixing Multiple Patient Keys for the Same Encounter ID   The error of linking multiple unique patient identifiers (Patient SKs) to the same Encounter ID undermines the EHR database's integrity. If this error is widespread, it reveals a fundamental problem with the database structure itself, requiring a thorough investigation and potential restructuring. If this error occurred rarely, the affected records may be removed. Fixing Multiple Calculated Birth Date   In the healthcare database under analysis, patient age information may be stored across multiple fields—years, months, weeks, days, and hours. There are three scenarios for recording a patient's age: All age fields are blank, indicating missing age information. Only the "age in years" field is filled, providing an approximate age. All age fields (years, months, weeks, days, hours) are filled, allowing for precise calculation of the patient's age. It is important to consider that each patient's records may cover multiple visits, and the age values may vary between these visits. To determine the accurate birth date, we follow a systematic procedure: If all recorded ages are blank, the birth date is missing and cannot be calculated. If all ages have only the years filled, we either use the birth year indicated by the majority of encounters or the first recorded age in years as an approximation of the birth year. If at least one encounter has all age fields filled (third scenario), we calculate the birth date from the first such encounter.   This procedure ensures that we derive the most accurate birth date value possible from the available data fields. Lab Table Large EHR databases are used by multiple healthcare facilities. Each facility may use different kits or equipment to evaluate the same lab measurement. This leads to varying normal reference ranges for measurements, like serum potassium level. Additionally, EHR system providers allow each facility to use customized data entry structures.  These two factors resulted in multiple formats being used to report the same lab measurement.  For example, in one dataset, serum potassium level was reported using 18 different formats! Another major issue plaguing EHR data is inconsistency during data entry.  In an example database, it was noticed that some electrolyte concentration levels were incorrectly reported as "Millimeter per liter" instead of the common "Millimoles per liter" format.  Another common mistake is mixing and confusing the lab IDs for count versus percentage lab results.  This is prevalent in measurements related to White Blood Cells (WBC). For example, the database can have different lab ID codes for Lymphocyte Percentage (measured as a percentage of the total WBC count) and the absolute Lymphocyte Count. However, due to operator misunderstanding or lack of awareness, the percentage of lymphocytes is sometimes erroneously reported under the lab ID for the lymphocyte count, with the unit of measurement also incorrectly listed as a percentage. Instead of deleting these mislabeled values, which would increase the amount of missing data and introduce bias, we can develop a mapping table approach. This involves creating a conversion map to consolidate the data and make the reporting format uniform across all entries. Specifically, we can map the mislabeled percentage values to their appropriate lab ID code for the lymphocyte percentage. By employing this mapping, we are able to resolve the data entry errors without losing valuable data points. Developing Conversion Map Flow chart of the lab unit unification algorithm Conversion map example The conversion map is a table that helps us convert lab data from different formats into a unified representation. We use mathematical formulas in the Conversion Equation column to transform the original values into the desired format. If the original and target formats have similar distributions, no conversion is necessary. But if they are different, we need to find the appropriate conversion equation from medical literature or consult with clinicians. To handle extreme or invalid values, we incorporate Lower and Upper Limits based on reported value ranges in medical journals. Values outside these limits are considered missing data.   General strategies for managing the output of the data cleaning process When working with large EHR datasets, it is necessary to keep the unique identifiers in your output unchanged. These identifiers are required for merging data tables during subsequent analyses. It is also advised to be cautious when deciding to remove values from the dataset. Unless you are certain that a value is an error, it is recommended not to drop it.   To maintain a comprehensive record of the data cleaning process and facilitate backtracking, we save the results and outputs at each step in different files. This practice helps you keep track of different file versions. When sharing cleaned data with different teams or data analysis users, it is helpful to flag any remaining issues in the data that could not be addressed during cleaning. Use flags like "Kept," "Missing," "Omitted," "Out of range," "Missing equation," and "Canceled" for lab data. Clinical Events The clinical event table, specifically the vital signs subgroup, has a similar structure to the lab table in EHR databases. So, you can apply the same steps and approaches from the data cleaning tool to the clinical event table. However, it is important to note that this table may also contain other inconsistencies. Variable Combining   In the clinical event table, a common issue is the use of unique descriptions for the same clinical event. This happens because multiple healthcare facilities use the database, each with their own labeling terminology. To tackle this challenge, statistical techniques and clinical expertise are used to identify events that can be combined into one variable. For instance, there are many distinct event code IDs for the Blood Gas test, some with similar descriptions like "Base Excess," "Base Excess Arterial," and "Base Excess Venous." Once expert clinicians confirm these labels can be combined, a decision can be made to consolidate them into a single variable.   Medication Table Medication tables present their own unique challenges and inconsistencies that require different strategies. The data in the Medication table consists mainly of codes and labels, not numerical values. When working with this table, using generic medication names is more efficient than relying solely on medication codes (like National Drug codes). However, even within the generic names, there can be inconsistencies in spelling variations, capitalization, and the use of multiple words separated by hyphens, slashes, or other characters.  Procedure Table Procedure codes identify surgical, medical, or diagnostic interventions performed on patients. These codes are designed to be compatible with diagnosis codes (such as ICD-9 or ICD-10) to ensure proper reimbursement from insurance companies, like Blue Cross Blue Shield or Medicare, which may deny payment if the procedure codes do not align with the documented diagnosis. Three types of procedure codes are commonly used.  ICD-9 procedure codes Consist of two numeric digits followed by a decimal point, and one or two additional digits. They differ from ICD-9 diagnosis codes, which start with three alphanumeric characters. ICD-9 procedure codes are categorized according to the anatomical region or body system involved. CPT (Current Procedural Terminology) codes Also known as Level 1 HCPCS (Healthcare Common Procedure Coding System) coding system, CPT codes are a set of medical codes used to report medical, surgical, and diagnostic procedures and services. Physicians, health insurance companies, and accreditation organizations use them. CPT codes are used in conjunction with ICD-9-CM or ICD-10-CM numerical diagnostic coding during electronic medical billing. These codes are composed of five numeric digits. HCPCS Level II codes Level II of the HCPCS is a standardized coding system used primarily to identify products, supplies, and services, such as ambulance services and durable medical equipment when used outside a physician's office. Level II codes consist of a single alphabetical letter followed by four numeric digits. The data cleaning for the procedure table often may not be necessary. The data analysis framework, which involves multiple steps iteratively Healthcare Data Pre-Processing   Variable Encoding   When working with EHR datasets, the data may contain records of medications, diagnoses, and procedures for individual patients.  These variables can be encoded in two ways:  1) Binary encoding, where a patient is assigned a value of 1 if they have a record for a specific medication, diagnosis, or procedure, and 0 otherwise.  2) Continuous encoding, where the frequency of occurrence of these events is counted.   Tidy Data Principles  Variable encoding is a fundamental data pre-processing method that transforms raw data into a "tidy" format, which is easier to analyze statistically. Tidy data follows three key principles: each variable has its own column, each observation is in one row, and each cell holds a single value.  Variables are often stored at different tables within the database. To create a tidy dataset suitable for analysis, these variables need to be merged from their respective tables into one unified dataset based on their defined relationships. The encounter table within an EHR database typically already meets the tidy data criteria. However, many other tables, such as the medication table, often have a "long" data format where each observation spans multiple rows. In these cases, the long data needs to be transformed. A diagram illustrates how the principles of tidy data are applied. Initially, the medication table is in a long format, with multiple treatment variables spread across rows for each encounter ID To create a tidy dataset, we follow a few steps: Each variable is put into one column. The multiple treatment variables in the medication table are transformed into separate columns (Treatment 1, Treatment 2, Treatment 3, Treatment 4) in the tidy data. This ensures that each variable has its own dedicated column. Each observation is in one row. The encounter table already has one row per encounter observation. After merging with the transformed medication data, the tidy dataset maintains this structure, with one row representing all variables for a single patient encounter. Each cell has a single value. In the tidy data, each cell contains either a 1 (treatment given) or 0 (treatment not given). This adheres to the principle of having a single atomic value per cell. The merging process combines the encounter table (with patient ID, encounter ID, age, sex, and race variables) and reshaped medication data to create a final tidy dataset. The merging process combines the encounter table and reshaped medication data to create a final tidy dataset. Each row corresponds to one encounter and includes relevant variables like treatments, demographics, and encounter details. Feature Extraction: Derived Variables  Сertain variables, such as lab test results, clinical events, and vital signs, are measured repeatedly at irregular time intervals for a patient Instead of using the raw repeated measurements, feature extraction and engineering techniques are applied to summarize them into derived feature variables.  One common approach is to calculate simple summary statistics like mean, median, minimum, maximum, range, quantiles, standard deviation, or variance for each variable and each patient. Let's say a patient's blood glucose levels are recorded as follows: 90, 125, and 100. Features such as mean glucose (105), maximum glucose (125), and glucose range (35) could be implemented. Derived feature variables can also come from combining multiple original variables, such as calculating body mass index from height and weight.  Additionally, features related to the timing of measurements can be extracted, such as the first measurement, the last measurement, or measurement after a particular treatment event. The goal is to extract as many relevant features as possible to minimize information loss. Dimension Reduction  Variable Grouping or Clustering Many EHR variables, such as disease diagnoses, medications, lab tests, clinical events, vital signs, and procedures, have high dimensions. To reduce data complexity, we can group or cluster these variables into higher-level categories. This also helps to ensure a sufficient sample size for further analysis by combining smaller categories into larger ones. For example, the ICD-9-CM system comprises over ten thousand diagnosis codes. However, we can use the higher-level ICD-9-CM codes with only three digits, representing less than 1000 disease groups.  Healthcare Data Analysis and Prediction Statistical Models  EHR datasets are big, messy, sparse, ultrahigh dimensional, and have high rates of missing data. These characteristics pose significant challenges for statistical analysis and prediction modeling. Due to the ultrahigh dimensionality and potentially large sample sizes of EHR data, complicated and computationally intensive statistical approaches are often impractical. However, if the dataset is properly cleaned and processed, certain models, like general linear models, survival models, and linear mixed-effects models, can still be appropriate and workable to implement. Generalized linear models (GLMs) are commonly used and effective for analyzing EHR data due to their efficiency and availability of software tools. For time-to-event analysis, survival regression models are better suited than GLMs, but they need to account for issues like missing data and censoring in EHR data. Mixed-effects models are useful for handling longitudinal EHR data with repeated measures and irregular timing. Dealing with the high dimensionality is a major challenge, requiring techniques like variable screening (SIS), penalized regression (LASSO, Ridge), and confounder adjustment methods. Large sample sizes in EHR data pose computational challenges, requiring approaches like divide-and-conquer, sub-sampling, and distributed computing. Neural Network and Deep Learning Methods Deep learning (DL) is a class of machine learning techniques that uses artificial neural networks with multiple hierarchical layers to learn complex relationships between inputs and outputs. The number of layers can range from a few to many, forming a deeply connected neural network, hence the term "deep" learning. DL models have input, hidden, and output layers connected through weights and activation functions. DL techniques are increasingly applied to various aspects of EHR data analysis due to their ability to handle high dimensionality and extract complex patterns. Deep learning approaches can be categorized as supervised learning for recognizing numbers/texts from images, predicting patient diagnoses, and treatment outcomes, and unsupervised learning for finding patterns without predefined labels or target outcomes. Supervised learning is the most developed category for EHR data analysis. DL has some advantages over classical machine learning for EHR data: Can handle both structured (codes, tests) and unstructured (notes, images) data Can automatically learn complex features from raw data without manual feature engineering Can handle sparse, irregularly timed data better Can model long-term temporal dependencies in medical events Can be more robust to missing/noisy data through techniques like dropout However, DL models require careful hyperparameter tuning to avoid overfitting. Types of Deep Learning Networks Multilayer Perceptron (MLP) The foundational DL model, with multiple layers of neurons. Good for basic prediction tasks in EHR data. Convolutional Neural Network (CNN) Excels at analyzing data with spatial or local relationships (like images or text). Used for disease risk prediction, diagnosis, and understanding medical notes. Recurrent Neural Network (RNN) Designed for sequential data (like EHRs over time). Can account for long-term dependencies between health events. Used for disease onset prediction and readmission modeling. Generative Adversarial Network (GAN) A unique approach where two networks compete. Used for generating realistic synthetic EHR data and disease prediction. Choosing the Right Architecture CNNs are great for images and text. GANs offer more flexibility (data generation, prediction) but can be harder to train. RNNs are good for long-term dependencies but can be computationally slower. Deep Learning Software Tools and Implementation  TensorFlow, PyTorch, Keras, and others offer powerful tools to build and train DL models. They are often free and constantly updated by a large community. Online tutorials and documentation make learning DL more accessible. TensorFlow Mature framework, easy to use, especially with the Keras open-source library that provides a Python interface for artificial neural networks). It has a large community and is production-ready, with good visualization tools. However, it may have less of a "Python-like" feel in its basic form and there may be potential compatibility issues between versions. PyTorch Feels like standard Python coding, easy to install and debug, offers more granular control of the model. However, without Keras, it requires more coding effort and the performance can vary depending on how you customize it. We have a team of BI analysts who tailor solutions to fit your organization's unique requirements. They create sharp dashboards and reports, leveraging advanced statistical and machine learning techniques to uncover valuable insights from complex healthcare data. Contact our experts to integrate BI for a comprehensive view of patient care, operations, and finances.

Belitsoft is a technology partner that has in-depth experience in the healthcare industry and understands the unique challenges of developing EHR systems, a trusted advisor that can help you achieve your strategic goals, and an EHR development company that is able to provide excellent customer support for the long-term. Hire EHR developers to customize HIPAA-compliant EHR for your healthtech business. Get A Proposal For EHR Customization Reasons Behind the Custom EHR Development The growing demand for security, scaling, and sharing data is causing trouble for those who use legacy EHR Systems. If patient information is spread across incompatible systems, it's difficult to get a complete picture and use real-time updates. Because users have to manually enter data, transferring information between systems leads to errors. Sharing patient data raises concerns about protecting patient privacy and complying with legal requirements. Such EHRs may have weak security, increasing the risk of data breaches or unauthorized access. Many legacy EHR systems have unintuitive interfaces, making them annoying to use. Organizations that have custom EHR system want modify and expand them on a variety of reasons. They may want get positive net financial return, decrease expenses by participating in state programs (Promoting Interoperability Program, MIPS and the Quality Payment Program) or satisfy the legal requirements ( HIPAA certification, ONC certification) and so on. “[...] A long-term approach that seeks to achieve small, incremental changes in processes [...] enables organizations to fine-tune their EHRs in response to changing healthcare regulations, new technologies, evolving patient needs and a growing aging population. Without change management, however, the EHR operates in a silo and doesn’t align with the way clinicians practice medicine or with new industry demands, which creates dissatisfaction and underutilized technology.”. KPMG How we estimate custom EHR development The cost of EHR development depends on the number of features you need right away - the more of them and the more unique they are (SCOPE), the sooner you need to implement them (TIME) - the more expensive the development is likely to become (COST) (the so-called Quality triangle). The most expensive part of creating a new EHR is backend and integrations, not user interfaces. Healthtech companies express interest in our custom EHR development services for the following reasons: proven experience in working with healthcare domain; competitive pricing; good reviews and references available online. They want to know how much it would cost to customize their EHR systems and see examples of EHR systems we have developed in the past. In many cases, each customer has their own very specific requirements. We asks our customers to help us clearly identify their needs and requirements to inform our EHR design and development team before the estimation process begins. After the NDA is submitted, our EHR Business Analyst talks to customers on a video call and asks detailed questions on features of their EHR system to estimate the development costs for each function. After all the questions have been answered, the information is passed to our Senior EHR Developers. They prepared the “Use-Case Based Requirements Specification” with interactive Figma prototypes. Based on mentioned documents our proposal includes detailed descriptions of all the features and detailed estimation. We suggest to split the EHR project development into three main phases in accordance with the hierarchy of goals: Proof of Concept (POC). At this stage, we suggest to customize the basic elements of the EHR system. Within this phase, our clients in a cost-effective and timely manner can evaluate our performance and see the first results. Minimum Viable Product (MVP). At this stage, we suggest to create the scope of work and prototypes for the things that have not been specified in detail earlier but are required. 'Phase 3'. At this stage, we suggest to create other functionality that was not mandatory for the MVP. The final estimation based on the hierarchy of goals is presented via a video call. Customers invite their own technical specialist to evaluate our EHR team’s skills in the real time. Often, after that, the budget is approved and the contract is signed. How we manage custom EHR development The Agile software development process is often chosen because our clients want to build a large and complex software product while being highly involved in the project development and customization. At its core, Agile is a software development methodology that make it possible to quickly change the EHR software in accordance with business changes. Effective communication is always 50-60% of a successful custom application development, that is why we establish a proper communication plan. The communication is mostly remote. The client can visit the Belitsoft office before the development process begin, if necessary. The EHR software development process is often divided into sprints - periods of time during which a portion of programming work has to be completed and be ready for the client’s review. We prepare e-mail reports for clients every 1-2 weeks to enable them to make any changes or refinements promptly. The Business Analysts (BA) acts as a primary contact person for a client, having regular Teams/Skype meetings, systematizing all the requirements correctly and showing demos (sprint releases). The BA is also responsible for the conformity of the final product to the documented requirements. Communication by email is used when our clients need time to make important strategic decisions. EHR System Testing Plan The high quality of a custom healthcare software can be guaranteed only when a proper testing process is established. Our experienced EHR project manager Dmitry Garbar applied best practices to boost the productivity of the EHR software development and testing team on the EHR project. The system then can be successfully implemented into clinics. Example of EHR interface development EHR System Architecture API-enabled EHR Modern EHR system is a medical database software with user-friendly interface and forms for gathering, accessing, managing and transferring clinical records (also called “health records”, “medical records”, or “patient records”). According to the U.S. Department of Health and Human Services, the core function of an EHR is integration and access to the storage using interoperability standards (such as HL7 FHIR). In fact, we talk about so-called "API-enabled EHR database". All eligible professionals and hospitals in the USA are obligated to use CEHRT - 2015 edition certified electronic health record technology - to meet the requirements of the Promoting Interoperability Program (Meaningful Use). The ability of an interoperable EHR platform to seamlessly integrate with other medical systems and devices along with business intelligence reports generation and clinical decision support can enable medical business excellence. The project development team uses the interoperability approach to architecture design. The application is often splitted into several modules (services) and these modules communicate with each other and third-party modules via REST API. This type of architecture provides great possibilities of scaling, fault isolation and maintenance. The HIPAA compliant server architecture is proposed by Belitsoft to clients to make sure that the medical application meets the HIPAA's technical requirements. The architecture of the system often contains the following parts: 1) Backend: Database Layer (for example, MySQL) and API layer (API for the web admin panel and API for the frontend apps); 2) Frontend: tablet-friendly mobile and web application. Tablets are very convenient tools that are widely used in leading hospitals and healthcare systems. 3) Frontend: web admin panel based on React.js or other frameworks of choice for form templates and User Management. To prevent the loss of patients’ information, we develop a synchronization module. If a doctor’s tablet goes offline while they’re entering clinical data, this module will save the notes and upload them to the cloud when the Internet connection is restored. However, the arhcitecture of the EHR solution may be significantly more complex that this one like here when cloud technologies are involved. Core EHR Modules We Often Deal With Medical Scheduling Module A medical scheduling module for EHR system is often integrated with billing and practice management modules. Below see a use case of a receptionist checking a patient in. Today is February 5. A patient named Shawn Robertson asked to schedule a visit from 5 to 12 of February at any time and with any physician. Theresa Russell, a receptionist, sees that there are several options available during that period. She offers Shawn Robertson to visit Dr. Simon McKinney on February 7 at 8.30 AM. After getting the patient's consent, the receptionist clicks the chosen time slot. A pop-up window appears and offers Theresa to confirm the chosen time slot, the relevant patient data is automatically pulled from the system's database. After clicking the "Schedule an Appointment" button the patient is signed up. After getting authorized Dr. Simon McKinney moves to the “Encounter” tab and sees the patients that have a visit scheduled during the chosen timeframe (e.g. today, this week, this month). Today, on the 7th of February, there are 9 patients scheduled. The doctor sees the names of the first two and can look up the brief information on all the patients by clicking the “7 more encounters” link. After clicking the “7 more encounters” link Dr. Simon McKinney can see the brief information (including the chief complaint, if mentioned) about each patient to be seen today. EHR Charting Module Medical charting is the systematic documentation of interactions with patients concerning a patient's care, condition, and treatment. It is also a legal document: medical providers are required to keep detailed charting documentation, which could affect claims reimbursement in the case of an audit. With custom charting module the provider can spend less time typing, and focus on the patients and their health. Dr. Simon McKinney clicks the patient’s name and moves to the “Patient Chart” section - a medical dashboard that pulls generalized historical data about the patient from other sections of the system: demographics, vitals, allergies, latest documents (e.g. lab results, a user can add new documents straight from the dashboard without opening additional windows), prescriptions, immunizations, medications. The “vitals” section shows the vital signs’ history and deviations from the norm if any. The information can be filtered by specific timeframes. At the beginning of the encounter, after pressing the “create new encounter” button, a pop-up window appears that automatically pulls patient information necessary to begin the encounter. Dr. Simon McKinney can enter the chief complaint if it wasn’t entered earlier. They can also add the patient’s general information, if necessary. After pressing the “Start new encounter” button Dr. Simon McKinney goes to the empty form of the current encounter (this slide shows the finished visit with the conducted examinations). To begin the diagnostic process, the doctor presses the “Examinations” button. To begin the billing process, the doctor (or the receptionist) presses the “Administration” button. After pressing the “Examinations” button a pop-up window containing the available examinations appears. A user can select the necessary examination by pressing the appropriate tab at the top of the page. At this stage, the doctor fills in the vitals and can either save and close the examinations panel or save and continue with the examinations. The doctor presses the “Administration” button causing a pop-up window to appear. This window shows the available options to begin the billing procedure. The “Fee sheet” section allows the doctor to choose the price level and patient type. Then the doctor chooses the codes of the conducted procedures according to CPT4, as well as the ICD-10 diagnosis (the doctor can enter a keyword or part of the code into the search window to quickly choose the necessary code from the list). The chosen codes are displayed below, possibly with the prices and modifiers. The diagnosis should be supported by a procedure in the “Justify” field. After the billing form creation is complete the doctor presses the “Save and close” button and finishes the encounter. Medical History. This element logs the patient’s conditions throughout their life. It can include the growth chart, medication and immunization history, allergies, family and social data, habits (e.g. smoking and alcohol use), surgeries, obstetric information and more. Having it on hand allows doctors to gain insights as to the causes of the patient’s current condition. Medical Encounters. When someone visits a physician, this is where the doctor puts the gathered information on the patient’s current condition. Encounter data includes the chief complaint, history of present illness, physical examination results, vital signs, assessment, and treatment plan.  Orders and Prescriptions. This feature creates and stores the medication orders and prescriptions. These can be printed or sent electronically to the pharmacy straight from the point of care. Capabilities: submit e-prescriptions from your patient’s chart, automatic drug-drug and drug-allergy interaction checks, send prescriptions electronically to your patient’s local pharmacy, complete prescription refill requests electronically, view prescription costs at various pharmacies and medication alternatives, medical decision support, e-prescribing of controlled substances. Progress Notes. Regular, chronological updates on the patient’s condition. These are used mostly for hospitalized patients and can be entered by all clinical professionals participating in the care: doctors, nurses, pharmacists, dentists, etc. Test Results. Blood tests, biopsies, X-rays and other similar examinations are stored and managed by this module. Images (e.g. MRIs) can be either stored as-is using formats like DICOM or handled elsewhere, in which case the chart will likely contain the reports as text.  Information exchange. To increase their efficiency, the charts should exchange data with other modules in your EHR/EMR. Demographic information and vital signs (heart rate, blood pressure, temperature, etc.) should automatically be taken from other modules and entered in the forms so that the clinicians don’t have to do it several times. And integration with the billing module can help with assigning codes and decrease the number of errors. PHI Copying. According to HIPAA, patients can ask for and receive a copy of their personal health information (with certain caveats). This means that the charts should be either printable or convertible to a popular electronic format, e.g. PDF.  Guidelines. Including information like normative lab values, weight parameters, dosage guidelines, screening recommendations, etc. gives the physicians a benchmark to quickly measure patient stats against. A reference point like this helps doctors provide better care.  These values can also be accessible to the patients via the portal, thus improving their knowledge about their own health. Customizable/Specialty-specific Charting Templates. A dentist and a psychiatrist can include different things in the patient charts. So it would be preferable if the system adapted to accommodate their needs. This could be either done by making the charts highly customizable or including specialty-specific templates in the charting module. Speech-to-text. Dictating notes instead of typing them allows doctors to spend more time with the patient instead of the computer. The physician’s spoken words can either be transferred straight to the EHR/EMR and reviewed by the same physician later, or they can be sent to a medical scribe for a preliminary check first. EHR Telemedicine Module E-visits and medical consultations. The main idea of telehealth is to connect patients and physicians around the world quickly and securely through live video. This enables two-way, face-to-face interactions on a computer or mobile device with high-quality video and audio.  Secured communication can be held by a wired or wireless Internet connection.  The solution also allow screen sharing and multiway video so 3rd parties (such as caregivers or translators) can participate in a virtual consultation. All the additional attendees are added by the doctor. Consultation Notes. The feature allows doctors to create notes during the sessions with patients in order not to lose goals, medications prescribed, invoices, follow up appointments, or care plans they may have discussed. Patient-initiated. Patients can book follow-up appointments to their clinic visits or online consultations and consult with you via video sessions. This will definitely save the providers’ time compared with written communication.  Moreover, the patients can clearly see the type of appointment while checking their schedule so that they can plan their visits or video calls. EHR Voice Recognition Doctors and nurses were spending too much time on EHR-related tasks. This meant they either had less time for patients or more overtime work. Implementing speech recognition could be a solution to the problem - by talking to the machine the medical professionals could enter information quicker and even do it while examining the patient. The speech recognition system integrated with our client’s EHR was built as an on-premise solution due to security concerns. Its most notable features included: Voice input of text and numbers; Voice commands for navigation inside the system; Automatic expansion of medical acronyms and abbreviations; An option of adding more dictionaries for medical specializations; An option to adapt to the voice of a specific medical professional. The first release included three core dictionaries: general medicine, pathology, CT/MRT. Each contained the data the system needs to recognize and process the words relevant to the appropriate niche. The “general medicine” dictionary was useful for all fields within medicine, while “pathology” and “CT/MRT” had relatively few words and were cost-effective to implement. The system also included the option to expand the dictionary list, as mentioned above. As one of the customer’s requirements we have also created an open API for the system to make it easy to integrate with other medical solutions. We have also been tasked with finding the most suitable headset for doctors and nurses. It had to be convenient enough to be worn 8 hours a day and provide high signal quality. The resulted system has successfully solved the customer’s problems. Time spent on clerical tasks has decreased by 23%. The results were even better with older doctors, who were experts in medicine, but not experts in computers. Moreover, the focus group has reported higher satisfaction with their work environment. Patient Portal Features Medical patient portal is an extension of EHR. Data from it is published by a healthcare organization to the application with 24/7 online access. Accessing personal health information. Having entered a unique username and password, patients can browse (and print if necessary) health information including recent doctor visits; case reports; medication lists; immunizations; allergies; lab & test results. Updating contact and demographic information. Get patients to complete their registration and update their information online. Health professionals, for their part, have to check the accuracy and quality of registering data before it is accepted into their EHR. Scheduling appointments online. Patients can get the appointment booked via the portal without going through the hospital telephone system and auto attendants. They receive an alert as the doctor confirms or reschedules the appointment. They later modified the feature, making patients able to request a viable appointment. Thus, they can browse the hours for each location, every doctor who works there and their timetable, as well as check-up types they accept. Patient portals can help practitioners with cutting down on phone calls and decreasing non-appearance. Messaging with a healthcare team. When a patient portal is integrated with an EHR system, secure encrypted messaging is the simplest and most efficient way to exchange information and test results both for patients and medical professionals. Receiving notifications. If a patient books an appointment with a health professional, the system can reply with an e-mail, a text message (SMS) or a push notification to a mobile device. Plus, users can be reminded to take prescription medication or check a glucose level if the patient has diabetes. Integration with third-party apps and systems. More and more people use monitoring devices. Whether it be a fitness tracker, a medication reminder or a glucose monitor, these systems store patient vitals and can be useful for diagnosis and treatment. To reduce the amount of data entry required, patients can upload information directly from medical devices, fitness trackers or smartphones. Payments. Patient portals enhance customer experience in many ways, especially when providing the ability to make payments. This option makes it easier for patients to understand and handle their financial responsibility. So, what payment features should be supported? Insurance information: Login to the portal and view/update insurance data. Billing query: Submit billing-related questions via the patient portal. e-Payment: Make online payments via multiple modes. History storage: View records of medical payment amounts and dates in one place. Saved payment method: Securely hold a credit card or bank information for repeat payments. Downloading and completing registration forms. Whether patients complete registration forms online or when they are in the office, it usually takes 10 to 15 minutes to do all the paperwork. For those who complete pre-visit forms online, the system has to notify them of how long it takes to register. Accessing educational materials and communities. Just as patients want to see their health history, they also want to figure out these records. However, diagnoses and treatment plans are usually difficult for users to understand. With a portal, they are able to access supplemental information online. For users with lower health literacy, some health IT providers integrate natural language processing to translate certain clinical terms, thus making patient portal records more accessible. The most effective way to improve customer health literacy lies in offering patient education where applicable. More and more health IT vendors have signed licensing agreements with educational platforms, allowing them to integrate patient education materials into their systems. Patients often seek out people with similar health states for advice and support. Thus, for example, our client asked us to create a website for a community of people challenged with different diseases. Having logged in, they can access blog posts, chat with other community members and express their emotions with special icons. Medical Billing Module EHR needs to have a robust module to handle payments and reimbursements. Capabilities: generate invoices for the consultation and procedures, tracking payment status, automated billing codes transcription, composing and submitting claims to the insurance agencies, track the status of the claims (received, accepted for processing, denied or rejected), alerting on rejected claims with clarification, E/M Calculator, insurance card scanning, copayment calculator, automated eligibility verification. Claim Submission. This feature allows the practice to create superbills and electronically submit claims to a clearinghouse or directly to the insurance company. It must also be able to generate bills and patient statements for the patients who need to pay for the visit.  The claims are usually submitted in groups to save staff time. However, if even one of the claims is found to be non-compliant with HIPAA, the whole batch will be sent back for corrections, which cost time and, therefore, money. That is why EHR providers integrate “claim scrubbing” - automatic checking for errors before the claim is submitted.  It is estimated that 90% of claim denials are preventable by using better procedures, making a well-designed submission module a valuable tool for improving a practice’s bottom line. Copayment/Coinsurance/Deductible Processing. Your EHR should notify the reception staff if a patient needs to pay for the visit out of their pocket. This would help your practice increase the collection rate. Given the abysmal overall payment rates among patients (e.g. the average payment rate for people with high-deductible plans receiving outpatient care is only 18.2%), any improvement in this area is bound to be meaningful. Billing Reports. You can’t manage what you can’t measure, which is why EHR needs flexible billing reports. They will demonstrate the rates of reimbursement and patient collections, recent and historical trends, and more.  Many off-the-shelf EHRs have the option to create custom reports or tailor the existing ones to better fit the needs of the practice. In turnkey systems, the nature and flexibility of the reports are discussed in advance and then created according to the customer’s requirements. Claim Rejection Analysis. This module processes the rejected claims and highlights the errors that need to be corrected. The reasons could include incomplete or incorrect information, non-covered services, missing codes, etc. When the mistakes are fixed, the claims can be resubmitted.  Automated Coding. ICD-10 has almost 70.000 diagnosis codes. Together with a multitude of CPT codes, this creates a problem for the billing staff, as coding mistakes can lead to claim rejections or denials. An automated system will help the clinicians with assigning the correct values to the diagnosis and treatment, and will also transfer these values to the claim form, reducing human involvement and risk of error. A specialty-specific EHR, e.g. for Orthopedics or Behavioral Health, might have a module that suggests the codes most relevant for that specialty. This makes the work of clinicians and coders easier and once again decreases errors.  Automated Eligibility Verification. The EHR can be integrated with the insurance companies’ databases. As a result, the administrative staff can see the patient’s insurance details (if the patient is covered), and the clinic can avoid rejections.  Moreover, this data can also be transferred directly to the claim form to save time and decrease risk. Payment Tracking. This module helps manage financial resources by following each bill through every stage of its processing, from submission to payment. With this information, the administrative staff can estimate the reimbursement timeline Integrated Clearinghouse. A clearinghouse is a system that processes the documents sent from medical practice to the insurance company and vice versa (claims, 835 forms, etc.). Its purpose is to convert the data to the format that the receiving company’s software would accept.  It is often a third-party solution. However, there are EHRs that have a built-in clearinghouse, thus eliminating the need for intermediaries and saving the practice money on using external services. Messaging. An inbuilt messaging system will allow quick and secure communication between clinicians and administrative staff, which would be useful in claims preparation and rejection analysis. The same feature could be reused in a patient portal or for coordinated patient care if your EHR is connected to those of your partners - labs, specialized medical centers, etc. Referral Management. In certain cases, if the incoming patient doesn’t have a referral the insurance might not pay for their treatment. Having an integrated referral management system will help your billing team and reception employees be aware of the situation. Moreover, it will automatically inform the referring practice about the visit, closing the loop and freeing your employees from the need to follow-up via phone or fax. Accounts Receivable Management. If a claim has been denied it doesn’t mean that your practice will never see that money. More than three-quarters of them are eventually paid. But your employees need to work to make it happen. That’s where an A/R management system will come in handy. It tracks the outstanding payments, helps correct the forms and resubmits the claims. Lab Integration Module Capabilities: submit patient lab orders directly from chart; receive patient test results; share results with patients via the patient portal; automated reporting and analysis of the results (notification if normal parameters are overcome); submit electronic data on reportable lab results to public health agencies; checking lab results for possible impact of prescribed medication. Appointment Management for Patients and Staff Capabilities: scheduling an appointment via Patient Portal, website or manually by practice's personnel; automated check-in for physicians availability and preventing double bookings; appointment reminders via phone call, SMS, email and other means; patient recall system; appointment calendar with color coding; forming of wait lists of patients; automated notifications for cancelled appointments; calendars synchronization (iCal, Google or Outlook); composing schedules for clinicians (setting available dates & times, time-breaks, and locations); appointment management for receptionists (comparing physicians’ strains, view physicians’ appointments per day, week or month, schedule a recall visit); flowboard (filter by date, visit category, visit status, facility, physician). Send us your request for information to learn more. We can customize EHRs and improve UI/UX Design; develop additional functionality; help you deploy it to the cloud; set up backups; transfer data from your old EHR; provide you with dedicated technical support; consult you during your EHR implementation.

We build APIs for EHR systems, patient portals, and mobile applications. Need help with API development or testing? Let’s talk Patient Access API The patient access API was originally required to establish an API that allows members to access the following health information via a third-party application of their choice: claims and encounters provider remittances and enrollee cost-sharing information clinical data, including lab results, if maintained by the health plan formularies and preferred drug lists, and covered drugs in any tiered formulary structure or utilization management procedures (for Medicare Part C plans). This Final Rule expands the required API data to include: information about prior authorizations (excluding drugs) it must be available via the API no later than one business day after data is received by the payer Patient historical data from January 1st, 2016, onwards must be made available Now health plans must begin reporting annual metrics to CMS about patient access API usage in its current state. These metrics should be in the form of aggregated, de-identified data, summarizing patient use of the API. Provider Access API  The Final Rule requires health plans to adopt a Provider Access API, which allows In-network providers to request patient information from the payer.  Patient data (claims and encounters, excluding provider remittances and enrollee cost-sharing information, USCDI data classes and elements, and prior authorization information, excluding drugs) must be available to the provider via the API.  The sharing of patient information requires health plans to maintain a provider attribution process, to associate patients with in-network or enrolled providers with whom they have a treatment relationship.  Additional requirements are as follows:  Payers must allow patients to opt-out of having their data made available to providers.  Payers are required to provide plain language to patients about the benefits of API data exchange and their ability to opt-out. Payers are required to provide plain language to providers about the attribution process and how to request patient data.  Payer-to-Payer data exchange  Health plans are required to implement and maintain an API to support the exchange of clinical data between health plans at the patient’s request.  The result is an improved continuity of care when a patient changes health plans and continued access to their health records.  Health plans must establish and maintain processes for identifying previous and concurrent health plans and allow patients to opt into the data exchange.  The final rule requires health plans to comply with the following:  Claims and encounters, excluding provider remittances and enrollee-cost sharing information, USCDI data classes and elements, and information about prior authorizations, excluding drugs, must be made available via the API within one business day after receiving a request from a health plan. Only historical data with a date of service within five years of the request for data is required.  For members with multiple health plans, data must be exchanged within one week of the start of coverage and at least quarterly thereafter.  Current members must be allowed to opt-in by January 1st, 2027; and new members within one week of coverage.  Information received by other health plans must be integrated into the Patient and Provider Access APIs.  Health plans must provide plain language information to patients that explains the benefits of the API and their ability to opt-in.  Prior Authorization process improvement and reporting  Alongside the API implementation described above, health plans will need to make changes to prior authorization processes beginning in January 2026.  First, payers must send prior authorization decisions within 72 hours for expedited (urgent) requests and 7 calendar days for standard (nonurgent) requests. Approvals must state the date approved or circumstances under which the authorization ends and denials must cite a specific reason for being denied.  For items or services that are not subject to prior authorization rules, integrated health plans must send notice of its determination within 14 calendar days.  Second, health plans are required to report annual metrics about prior authorizations to CMS, beginning on March 31st, 2026, for the prior calendar year. These metrics include 4 standard prior authorization metrics, 2 expedited prior authorization metrics and turnaround time metrics for both standard and expedited requests. Further, an annual report must be made public, listing all services that require prior authorization.  Third, Merit-based Incentive Payment System (MIPS ) eligible clinicians, hospitals, or critical access hospitals (CAHs) are required to report a new attestation measure, the Electronic Prior Authorization measure, beginning in the CY 2027 performance period to be paid in the MIPS payment year, two years later (e.g., first payment in CY 2029). How to Comply With the CMS Final Rule Implement or Modernize your Health Data Management Platform The CMS Interoperability and Prior Authorization Final Rule does not explicitly mandate a "Health Data Management Platform" by name, but it clearly requires payers to achieve the core functions such platforms provide to comply with the rule’s data consolidation and interoperability requirements. Payers must aggregate and maintain five years of patient data (claims/encounters, clinical/laboratory data (via FHIR standards like US Core), prior authorization decisions (excluding drugs), and documentation supporting prior authorizations). This necessitates consolidating data from fragmented sources (EHRs, labs, pharmacies) into a single, FHIR-compliant repository—a core function of Health Data Management Platforms (HDMPs). As payers must implement a Patient Access API that includes prior authorization data (approvals, denials, reasons), a Prior Authorization API that enables providers to submit/receive decisions directly from EHRs, and a Payer-to-Payer API to share historical data with other payers (with patient consent), HDMPs are also a helpful option here because they simplify API development by normalizing data into FHIR formats and automating exchanges. As payers must report annual metrics on Patient Access API usage (unique users, demographics) and publicly disclose prior authorization approval/denial rates and appeal outcomes, HDMPs also support automated metric tracking and audit-ready reporting. While CMS doesn’t prescribe specific tools, HDMPs address three gaps traditional systems cannot. How Belitsoft Can Help Belitsoft specializes in building custom, interoperable solutions, including health data management platforms tailored to healthcare data governance and compliance. Let’s talk We can collaborate with clients to support their implementation needs and long-term strategy, including the following:  Analyze current data infrastructure. Understand current system capabilities, technology and business requirements. Implement the transformation. Provide end-to-end technical support for the implementation and managed services.  Healthcare IT. Implementing HL7 & FHIR and prior final rules.  We rely on the following resources and standards: United States Core Data for Interoperability (USCDI) HL7® Fast Healthcare Interoperability Resources (FHIR®) Release 4.0.1 HL7 FHIR US Core Implementation Guide (IG) Standard for Trial Use (STU) 3.1.1 HL7 SMART Application Launch Framework Implementation Guide Release 1.0.0 FHIR Bulk Data Access (Flat FHIR) (v1.0.0: STU 1) OpenID Connect Core 1.0 Interoperability compliance with the policies outlined in the Final Rule requires investment. However, health plans also have an opportunity to use the technology needed for compliance to align with value-based care goals. The industry is increasingly adopting value-based care payment models, and this growth is expected to continue in the coming years.

Patient Portal Requirements Patient portals help doctors meet government rules called the "EHR meaningful use incentive program". Key requirements for doctors under current Stage 2 requirements: More than 50% of patients have online access to view, download, or share their health data. Health info must be available to patients within 4 business days after the doctor receives it. More than 5% of patients must actually use the portal Why custom patient portal development? Private clinic networks, specialty and urgent healthcare companies, precision medicine organizations, nonprofit healthcare systems, university hospitals, as well as healthtech companies providing innovative healthcare platforms and telemedicine marketplaces sometimes want to build their own web-based patient portals to stand out from competitors. They may need to improve and revamp their existing applications and platforms, add new engaging features and non-clinical services, or reduce the number of portals their clients have to use. These organizations are looking for patient portal developers to complete their healthcare projects and help them with development overall. If you don’t know where to start with implementing the idea of an integrated medical patient portal, how to design and create a patient portal, what the best patient portal features are, or what the development costs, timelines, and deployment/maintenance fees are, ask Belitsoft's team. What is a Patient Portal? Integrated patient portals extend the functionality of EMR/EHR systems, Hospital Management Systems, and other healthcare IT systems. Patients can search their medical records and history online (including doctor visits, medications, immunizations, allergies, and diagnostic lab results), schedule appointments, download initial visit forms, request prescription refills, pay bills, message physicians or care teams, send and receive messages from their care providers, consult with them, and view educational materials. Integrated Patient Portal Design Send us your request for information to get a quote for patient portal development. Contact us to know how our EHR/EMR experts could help you with Integrated Patient Portal Development According to the legislation, an EHR system should provide access to the protected health information (PHI) about patients (personal health records) via Patient Portal. The CMS Finalized Rule mandates that payers and health systems should provide patients access to data through a Patient Access API and access to a list of in-network providers through a Provider Directory API. Patient Portal Features Medical patient portal is an extension of EHR. Data from it is published by a healthcare organization to the application with 24/7 online access. The patient provided with a secure login & password can view their lab results, diagnosis, radiology images or other clinical information. So portal is a convenient way for viewing, presenting and sharing information from EHR. Besides, authorized patients can interact with healthcare providers by submitting messages, scheduling appointments, or requesting prescription renewals through the portal. Among other system’s features there is the ability to get reminders and notifications for lab results, upcoming visits and diagnostic investigations. “Many patients want to go online and manage their visits, bills and medical records retrieval personally: They no longer want to use their lunch hour to make phone calls, and it's exciting that we can make this happen for them. ” - Dr. Daniel Shurman, co-founder at Pennsylvania Dermatology Partners 1. Accessing personal health information According to the officials, a key priority of such a patient portal is to provide patients with convenient round-the-clock access to personal health information (PHI) via the Internet. Having entered a unique username and password, patients can browse (and print if necessary) health information including recent doctor visits; case reports; medication lists; immunizations; allergies; lab & test results. Patients want to see more than after-visit summaries and lab results. That’s why more and more health systems seek to support OpenNotes international movement for allowing patients to receive all of their clinical notes. 2. Updating contact and demographic information. Get patients to complete their registration and update their information online. Health professionals, for their part, have to check the accuracy and quality of registering data before it is accepted into their EHR. 3. Scheduling appointments online Patients can get the appointment booked via the portal without going through the hospital telephone system and auto attendants. They receive an alert as the doctor confirms or reschedules the appointment. Janna Mullaney, COO at Katzen Eye Group & Aesthetic by Katzen in Baltimore, shares their experience. When they first implemented an online appointment system, their patients were able to send a request, then doctors either booked the requested appointment time or offered an alternate option if they were unavailable. They later modified the feature, making patients able to request a viable appointment. Thus, they can browse the hours for each location, every doctor who works there and their timetable, as well as check-up types they accept. Source: dribbble.com/shots/5978081-Healthcare-App-Booking-Appointments Patient portals can help practitioners with cutting down on phone calls and decreasing non-appearance. SSM Health CIO Philip Loftus recorded a drop in no-show rates due to online scheduling. According to Loftus, patients who book online are more likely to come. 4. Messaging with a healthcare team When a patient portal is integrated with an EHR system, secure encrypted messaging is the simplest and most efficient way to exchange information and test results both for patients and medical professionals. “One available component of the portal that practices might not always appreciate is the secure messaging feature, which enables a practice to communicate with patients in a HIPAA-compliant manner [...] Activating this module of your patient portal can reduce the time that your patients are placed on hold and helps your practice to overcome the frequent challenges of reaching a patient.” - Dr. Joy Woodke 5. Receiving notifications If a patient books an appointment with a health professional, the system can reply with an e-mail, a text message (SMS) or a push notification to a mobile device. Plus, users can be reminded to take prescription medication or check a glucose level if the patient has diabetes. 6. Integration with third-party apps and systems More and more people use monitoring devices. Whether it be a fitness tracker, a medication reminder or a glucose monitor, these systems store patient vitals and can be useful for diagnosis and treatment. To reduce the amount of data entry required, patients can upload information directly from medical devices, fitness trackers or smartphones. Our development teams are able to integrate any third-party solution as a microservice. We can easily connect a custom patient portal solution with an open API of Apple’s apps, for example. Thus, patients would be able to share their details and download their records onto their iPhones via the Health app. 7. Payments Patient portals enhance customer experience in many ways, especially when providing the ability to make payments. This option makes it easier for patients to understand and handle their financial responsibility. So, what payment features should be supported? Insurance information: Login to the portal and view/update insurance data. Billing query: Submit billing-related questions via the patient portal. e-Payment: Make online payments via multiple modes. History storage: View records of medical payment amounts and dates in one place. Saved payment method: Securely hold a credit card or bank information for repeat payments. Source:dribbble.com/shots/4868474-Healthcare-Payments 8. Downloading and completing registration forms Whether patients complete registration forms online or when they are in the office, it usually takes 10 to 15 minutes to do all the paperwork. For those who complete pre-visit forms online, the system has to notify them of how long it takes to register. 9. Accessing educational materials and communities Just as patients want to see their health history, they also want to figure out these records. However, diagnoses and treatment plans are usually difficult for users to understand. With a portal, they are able to access supplemental information online. For users with lower health literacy, health IT providers integrate natural language processing to translate certain clinical terms, thus making patient portal records more accessible. The most effective way to improve customer health literacy lies in offering patient education where applicable. More and more health IT vendors have signed licensing agreements with educational platforms, allowing them to integrate patient education materials into their systems. “We integrated this content with our EHR system so when a patient receives their clinical summary, they also receive educational information based on their diagnosis. We can also add information such as supplemental brochures, customize information, or include links that redirect patients to the AAO website or our contact lens distributor for more information,” - Dr. Mullaney Patients often seek out people with similar health states for advice and support. Thus, for example, our client asked us to create a website for a community of people challenged with different diseases. Having logged in, they can access blog posts, chat with other community members and express their emotions with special icons. Source:belitsoft.com/php-development-services/health-social-communities-and-networks-development The Cost of Patient Portal Development How much does it cost to develop a custom patient portal? There are three types of cost estimation based on three types of requirements’ completeness: Scope of Work, User Stories, Software Requirement Specification Scope of Work is a document that lists all the needed features of a product in general terms. The result of the cost estimation after creating this type of documentation is a minimum starting price. User Stories is a document that describes all the needed features of a product in more detail than Scope of Work (It captures "who" will use software’s feature, "what" exactly will be used and "why"). You will get Min/Max prices. Software Requirement Specification is a document that describes all the needed features of a product in as much detail as possible. You will get the exact price. Our experience proves that the most optimal start of patient portal development is based on the User Stories document followed by gathering of requirements up to the Software Requirement Specification document during the development. Where to start Formulate your idea in a request for information and send it to us to know what are the terms of delivery of patient portal software and the deployment/maintenance fee for it. Contact us to calculate the cost of your patient portal development/implementation.

Hospitals The average hospital generates terabytes of data every day - from EHRs, labs, pharmacy systems, billing systems, scheduling apps, and devices. Without BI, the data stays separate, slow to use, and not helpful when quick decisions are needed. BI consultants bring it together. They build dashboards for clinical staff, predictive models for risk managers, and workflow analytics for COOs. And increasingly, they’re sitting closer to the C-suite - not just reporting numbers, but highlighting what matters. Hospital systems, from top-tier academic centers to regional providers, are building dedicated BI departments.  Rely on our dedicated Power BI developers, experienced in building custom BI solutions tailored to clinical, financial, and operational needs. We help hospitals track the right KPIs, spot risks early, and make confident, data-driven decisions. BI Use Case #1: Better Care Hospitals can’t improve outcomes if they don’t know what’s going wrong, where, and with whom. BI teams monitor outcome KPIs: Readmission rates Post-op infection trends Discharge delays Clinical adherence gaps When BI is embedded in clinical teams, providers get alerts - not after the fact, but in time to act. One real-world case: hospitals using BI to flag sepsis early based on vitals and lab values — reducing ICU admissions and mortality rates. BI doesn’t replace clinicians but amplifies their vision. BI Use Case #2: Operational Efficiency BI consultants deliver performance insights on: Bed occupancy forecasting Nurse shift utilization Equipment downtime Patient flow bottlenecks Cleveland Clinic’s deployment of BI tools across operations is a gold standard: digitized workflows, integrated scheduling, and real-time resource tracking. The result? Fewer delays, less waste, better care. BI Use Case #3: Financial Visibility Healthcare finance is about seeing where revenue leaks, cost creeps, and margins disappear. BI dashboards surface: Revenue by service line Payer mix trends Length of stay vs. cost curves Denial rates and root causes The smartest CFOs use BI to answer questions faster: “Which DRG categories are underwater?” “Where are we losing revenue cycle velocity?” “How does staffing level affect case cost?” BI consultants don’t just help you measure the cost of care - they help you redesign it. BI Use Case #4: Compliance Healthcare is among the most regulated industries in the U.S. CMS, HIPAA, HEDIS, Joint Commission - the acronyms just keep coming. BI makes compliance predictable: Automated reporting to regulators Real-time privacy monitoring (unusual EHR access, etc.) Flags for missing documentation before audits occur Instead of scrambling when auditors arrive, hospitals with strong BI systems are already prepared, and logged. And when privacy breaches or billing errors are caught early? That’s BI saving reputation, not just revenue. Every large hospital system in the U.S. is now actively building analytics teams. The demand isn’t for domain-specific BI consultants who can work across: Epic/Cerner data models Claims systems Operational data from ERP and HR platformsHIPAA-aligned reporting frameworks In competitive health markets - especially value-based care regions - BI has shifted from innovation to necessity. Health Insurance Companies (Payers) Health insurers are becoming population health platforms, fraud monitors, and consumer engagement engines. The companies winning in 2025 are the ones with the sharpest visibility into cost, risk, and value. BI Use Case #1: Controlling Spend Healthcare costs are still rising. Wasteful utilization, unoptimized provider networks, and uncontrolled chronic conditions erode profitability daily. BI consultants are how insurers fight back  with math. BI teams analyze: Claims by cost driver, region, provider, or condition Patterns of overutilization (unnecessary imaging or ER visits, etc.) Projected future costs based on comorbidities, age, lifestyle, and geography When payers automate utilization management with BI, they flag the wrong services earlier. BI gives insurers the data to negotiate smarter contracts, with hard numbers behind every rate and benchmark. In a value-based care world, data is leverage. BI Use Case #2: Population Health The old model: react to illness, reimburse care. The new model: predict illness, prevent cost. BI is the bridge. Predictive analytics built by BI consultants can: Flag patients likely to be hospitalized within 12 months Identify populations trending toward costly conditions like diabetes or COPD Pinpoint care gaps by geography, provider, or demographic CMS star ratings, HEDIS scores, and ACA quality metrics are tied directly to financial performance and reimbursement. If your health plan can intervene early via a wellness campaign, a care manager phone call, or a targeted benefit - you lower spending and boost quality ratings. That’s margin expansion and market differentiation, powered by BI. BI Use Case #3: Fraud and Abuse In insurance, the fraud may be a pattern that looks plausible until you zoom out. That’s BI’s job. Advanced BI systems monitor: High-volume billers across time Duplicate or inflated claims Time-based logic (overlapping surgeries or implausible procedure schedules, etc.) Member usage anomalies Machine learning layered on top of BI platforms can score provider and member risk in real time - before the payout. Prevention beats recovery. This kind of proactive BI is both ROI-positive and a compliance win. BI Use Case #4: Personalization at Scale If your member experience still feels like a call center and a paper EOB, you’re going to lose to the next generation of digital-native plans. BI enables: Member segmentation based on health profile, engagement level, and benefit usage Targeted outreach for condition management, preventive screenings, and plan upgrades Product development tuned to real market needs (virtual care bundles for high-utilizers, etc.) Cigna’s “Health Advisor” wellness program is a perfect example. By mining member data, they identified who would benefit most from a health coach, prioritized outreach, and tracked the ROI in both satisfaction and downstream cost. This is retention science. BI Use Case #5: Compliance Star ratings, provider coverage, claims processing speed, and complaint handling - all of these reporting requirements need reliable, timely data. BI platforms automate: HEDIS and CMS measure tracking Denial rate reporting Claims aging and resolution summaries Audit logs and escalation flags BI lets you monitor your service quality in real time - from call center abandonment rates to claims processing times. That means you’re always audit-ready. Pharmaceutical and Life Sciences Companies Drug discovery, market strategy, regulatory compliance - every function now runs better with BI. Drug R&D: Turning Years into Quarters The cost of bringing a new drug to market still sits north of $1B. A lot of drugs still fail during development. BI helps by finding issues early and helping teams fix them faster. BI consultants in R&D work across: Clinical trial design - optimizing protocols using historical outcome data Real-time monitoring - spotting drop-off in recruitment or adverse events Trial performance analytics - comparing site efficacy, patient adherence, safety flags When Novartis invested in data lake infrastructure for its R&D arm, the intent was  faster iteration. BI makes it possible to adapt trial strategy while the trial is still in motion - saving time, dollars, and reputational risk. The result? Drugs move through phases with fewer surprises, and fewer delays. Manufacturing and Supply Chain When Pfizer partnered with AWS to deploy ML-powered BI tools on the factory floor, they were solving a problem: batch variability and quality control. BI systems help pharma manufacturers: Detect anomalies on the line - before defective batches are produced Optimize yield and machine uptime Forecast demand across global markets - and match production accordingly Monitor environmental data for compliance In an industry where a delay can derail national drug supply - or a single contaminated batch can trigger regulatory audits - BI is the difference between proactive control and expensive overreaction. At Merck, analytics-driven supply chain oversight improved on-time delivery rates and lowered operational overhead. BI helped operations and protected revenue. Commercial Strategy: Selling Smarter, Not Just More Pharma commercial teams are flooded with data — provider behavior, prescription trends, demographic shifts, campaign attribution.  BI consultants in commercial roles help answer: Which physicians are influencing prescribing trends in target geographies? What’s the ROI of our current drug marketing mix — by channel? Where is sales force activity misaligned with actual demand? Better BI enables precision sales: Tailored messaging by provider segment Optimized territory assignments Dynamic targeting based on real-time prescription activity BI isn't just showing where your sales are happening but where they should be. Compliance and Pharmacovigilance: BI Keeps You Out of the News In life sciences, regulatory risk is existential. FDA holds, label changes, or missed reporting deadlines can mean millions lost and years set back. BI platforms protect the enterprise by: Automating trial protocol compliance checks Surfacing adverse event trends post-launch Preparing standardized regulatory filings faster and with more accuracy Flagging quality issues before inspections Pharmacovigilance teams rely on BI to monitor global reports in real-time.  And from a governance standpoint, BI provides traceability and audit readiness - so when regulators ask “what did you know and when,” your team has the answer. Whether you're in drug discovery, clinical operations, manufacturing, or commercial, BI consultants are now embedded as strategic resources: Clinical data analysts supporting R&D velocity Supply chain BI architects driving predictive operations Market intelligence teams guiding brand launches and lifecycle management Compliance BI engineers ensuring regulatory readiness 24/7 Johnson & Johnson’s MedTech division hiring a Principal BI Consultant isn’t a one-off. BI is moving up the organization chart - into strategic planning, innovation councils, and executive dashboards. HealthTech Startups and Digital Health Companies HealthTech startups - ranging from digital health app makers and telemedicine providers to healthcare AI and analytics platforms - are another major source of demand for BI consultants.   BI Is the Feedback Loop Between Product and Patient Outcomes Most healthtech startups position themselves as outcomes-focused. You’re improving chronic care. Streamlining provider workflows. Reducing ER visits. But unless you can measure that impact, you’re just another well-designed app in a crowded App Store. BI gives you the feedback loop you need: Are patients using the tool as intended? Are outcomes improving across cohorts? Which features correlate with better results? A diabetes management platform, for example, is judged by changes in A1C, hospitalization rates, and care plan adherence. BI consultants build the dashboards that track those KPIs across thousands of users - and let your team iterate based on real impact. That’s what investors and enterprise customers expect in 2025: a line from product to health improvement, backed by live data. Startups live or die by resource efficiency. BI helps you: Identify your lowest CAC channels - and double down Monitor churn risk signals- and course-correct proactively Optimize clinician staffing - based on usage patterns and service bottlenecks Without these insights, you’re wasting ad dollars, burning cash on underused features, and missing key UX flaws. With BI in place? You’re making precision decisions: which A/B variant to ship, which referral program drives LTV, which user cohort needs a re-engagement campaign next week. Investors Don't Fund Claims BI is how you tell your story in numbers - not just in vision decks. Every enterprise client and every investor in healthcare asks: Does it work? Show me the data. Whether it’s: A 22% drop in readmissions A 14-day reduction in average diagnosis cycle A 3x increase in therapy adherence You can’t make those claims without BI capturing, validating, and packaging the evidence. And when those metrics show up in dashboards you can demo live? You’re selling proof at scale. Startups that don’t build this layer early either find themselves retrofitting analytics under pressure - which is always more expensive and less convincing. Even pre-Series A startups are hiring BI consultants as fractional experts to get dashboards running, define KPIs, and structure the first data pipelines. BI-Driven Startups Are the Product Some of the most successful startups in healthtech are analytics-first. Think: Komodo Health — turning national-level healthcare data into predictive signals Innovaccer — creating infrastructure for value-based care through real-time insights Clarify Health — offering BI tooling directly to providers and payers These companies don’t just use BI. They sell it. They hire BI consultants as product engineers. As client success partners. As platform architects. If your company plays in AI, clinical decision support, or population health intelligence — your entire roadmap is tied to the quality and flexibility of your BI foundation. Every funded healthtech startup is hiring BI roles right now - not just engineers, butthinkers who know healthcare workflows, regulatory nuance, and go-to-market data strategy. Why? Because they need to track usage and engagement in week one. Because they need to launch with compliance and reporting infrastructure already running. Because they need evidence of value before the next raise, not after. Founders that prioritize BI staffing now? They move faster. How Belitsoft Can Help Belitsoft helps healthcare organizations turn raw data into strategic decisions - by combining deep BI expertise with custom software development. Whether you're a hospital modernizing operations, a payer optimizing cost and risk, a pharma company running trials, or a healthtech startup proving impact - Belitsoft builds the tools that make your data work. What Belitsoft Can Offer Across Healthcare Sectors Hospitals and Health Systems Belitsoft can deliver: Custom BI dashboards for clinical staff, COOs, and risk managers, using EHR, pharmacy, lab, and device data. Real-time alert systems for events like sepsis risk, readmission, discharge delays. Predictive analytics for staffing optimization, patient flow, and equipment uptime. Integration services for Epic, Cerner, and other hospital systems into centralized BI platforms. Financial BI modules: denial tracking, DRG profitability, length of stay vs cost curves. As a custom development firm, Belitsoft can also build tailored modules on top of existing hospital IT infrastructure (augmenting BI in existing Cerner/Epic stacks with custom visualization or alerting tools, etc.). Health Insurance Companies (Payers) Belitsoft can offer: BI dashboards for claims analysis, population health trends, overutilization, and risk scoring. ML-assisted fraud detection tools (detecting anomalies, overlapping claims, inflated codes). HEDIS, CMS, and ACA reporting automation. Custom data pipelines that consolidate member engagement, claims, and provider behavior into one analytics layer. Member segmentation engines for targeted outreach, retention campaigns, and benefit design. Belitsoft’s strength is in stitching together data from disparate sources - legacy systems, call centers, digital tools - into one coherent BI engine. Pharmaceutical and Life Sciences Companies Belitsoft can provide: Trial analytics platforms: real-time monitoring, protocol optimization, patient adherence tracking. BI dashboards for manufacturing: predictive quality control, batch anomaly detection, equipment performance, supply chain forecasting. Commercial analytics systems: provider-level prescribing behavior, marketing attribution, sales team alignment. Compliance monitoring tools: tracking adverse events, trial deviations, and filing readiness. Data lake architecture & integration to support high-scale, multi-source analytics across R&D, supply chain, and commercial divisions. If a pharma company needs a Looker-like system with specific regulatory rules or integration with AWS/Microsoft stacks, Belitsoft can custom-build it. HealthTech Startups & Digital Health Belitsoft can support with: Early-stage BI architecture: setting up dashboards, defining KPIs, building pipelines for product/clinical/outcome tracking. Engagement and retention analytics for SaaS platforms (telemedicine, chronic care apps, etc.). Custom modules for A/B testing impact, clinician utilization, UX bottlenecks, re-engagement triggers. Real-time outcomes monitoring (A1C drops, diagnosis cycle time, readmission rates, etc.). Embedded analytics in client-facing tools (providers, payers) - product-grade BI. For data-first startups (like Innovaccer or Komodo), Belitsoft can serve as an outsourced product analytics team - building BI tools not just for internal use, but as part of the actual product offering.

Sectors Driving Modernization in 2025 Healthcare Providers (Hospitals & Health Systems) Modernization backlog in the U.S. hospitals has been growing for more than a decade under the weight of legacy EHRs, disconnected workflows, and documentation systems that force clinicians to copy-paste. Most hospitals replace core infrastructure before building anything new. That means EHR migrations, ERP consolidations, and cloud-hosted backend upgrades to scale across facilities. The Veterans Health Administration is the most public example - now deploying Oracle Health across 13 new sites with the goal of creating a unified record that spans different departments. Similar moves play out quietly inside regional systems that have been running unsupported software since the Obama era. Clinician-facing modernization, however, is where momentum is most welcome. At Ohio State’s Wexner Medical Center, 100 physicians piloted Microsoft’s DAX Copilot and gained back 64 hours from documentation duties. That’s literal time restored to patient care, without hiring anyone new. And it’s exactly the kind of small-scope, high-impact win that other systems are now copying. Children’s National Hospital is going broader, experimenting with generative AI to reshape how providers interact with clinical data by reducing search. Modernization used to mean cost. Now it means capacity. Digital tools are being deployed where FTEs are short, where burnout spike, and where attrition has already created blind spots in workflows. And that’s why boards are green lighting infrastructure projects that would have been stuck in committee five years ago.  The barrier, in most cases, is coherence. Hospitals know they need to modernize, but don’t always know where to start or how to sequence. Teams want automation, but they’re still duct-taping reports together from five systems that don’t talk. That’s where most providers are stuck in 2025: trapped between urgency and fragmentation. The systems that are breaking through are mapping out modernization in terms of what actually improves the patient and staff experience: real-time BI dashboards instead of retrospective reports, mobile-first scheduling tools that sync with HR systems, ambient listening that captures the record without forcing clinicians to become transcriptionists. Belitsoft’s healthcare software experts modernize legacy systems, simplify processes, and implement clinician-facing tools that reduce friction in care delivery. We help providers align modernization with clinical priorities, supporting everything from building custom EHR systems to healthcare BI and ambient documentation. Health Insurance Payers (Health Plans) In 2025, health plans replace brittle adjudication systems with cloud-native core platforms built around modular, API-first design.  They pursue more narrow networks, value-based care contracts, and hybrid offerings like telehealth-plus-pharmacy bundles. Legacy systems were never designed to track those parameters, let alone price them dynamically or support real-time provider feedback loops. That’s why firms like HealthEdge and their integration partners are getting traction — for enabling automation, and for embedding claims payment integrity and fraud detection directly into the workflow. In 2025, that’s the move: shift from audit-and-chase to real-time correction. Not post-event fraud analytics - preemptive denial logic, powered by AI. Member experience modernization is the other front. Health plans can’t afford to lose members over clunky app experiences, slow pre-auth workflows, or incomplete provider directories.  Payers are investing in: API-integrated portals that allow self-service claims and virtual ID cards Telehealth services, especially for behavioral health, built into benefit design Real-time benefits lookups, connected directly to provider systems Omnichannel engagement platforms that consolidate outreach, alerts, and support They’re expectations. And insurers that delay will watch their NPS scores erode — along with their employer group contracts. Regulatory pressure is also reshaping the agenda. Payer executives now list security and compliance as top risks in any tech upgrade. Only a third of them feel confident they’re ready for incoming regulatory changes That means modernization isn’t just a technology lift. New systems are being evaluated based on: Audit-readiness Data governance visibility API traceability Identity and access control fidelity Integration with CMS-mandated interoperability endpoints Pharmaceutical & Life Sciences Companies In 2025 most large life sciences companies have finally accepted what startups realized years ago: you can’t do AI-powered anything on top of fragmented clinical systems. Top-20 pharma companies are actively overhauling their clinical development infrastructure - migrating off the siloed, custom-coded platforms that once made sense in a regional, paper-heavy world, but now slow everything from trial design to regulatory submissions. According to McKinsey, nearly half of big pharma has invested heavily in modernizing their clinical development stack. That number is still growing. The pain points driving this shift are familiar: trial startup timelines that drag on for quarters, data systems that can’t integrate real-world evidence, and analytics teams forced to export CSVs just to compare outcomes across geographies. That’s a strategic bottleneck. Modernized platforms are solving it. Companies that have replaced legacy CTMS and EDC tools with integrated cloud systems are reporting 15–20% faster site selection and up to 30% shorter trial durations - just from clean workflow automation and real-time visibility across sites.  Modernizing clinical trial systems opens the door to better ways of running studies. Adjusting them as they go, letting people join from anywhere, predicting how trials will play out, or using AI to design the trial plan. All of that sounds like the future, but none of it works on legacy platforms. The AI can’t model if your data is spread across four systems, six countries, and seventeen formats.   That’s why companies like Novartis, Pfizer, and AstraZeneca are rebuilding their infrastructure to make that possible. Faster trials mean faster approvals. Faster approvals mean more exclusive runway. Every month saved can mean tens of millions in added revenue.  McKinsey notes that 30% of top pharma players have only modernized one or two applications - usually as isolated pilots. These companies are discovering that point solutions don’t scale unless the underlying platform does. It’s not enough to deploy an AI model or launch a digital trial portal. Without a harmonized application layer beneath it, the benefits stall. You can automate one process, but you can’t orchestrate the whole trial. Outside of R&D, the same dynamic is playing out in manufacturing and commercial. Under the Pharma 4.0 banner, companies are digitizing batch execution, tracking cold-chain logistics in real time, and using analytics to reduce waste - not just to report it. On the commercial side, modern CRMs help sales teams target the right providers with better segmentation, and integrated data platforms are feeding real-time feedback loops into brand teams. But again, none of that matters if the underlying systems can’t talk to each other. Health Tech Companies and Vendors The biggest EHR vendors are no longer just selling systems of record. They’re rebuilding themselves as data platforms with embedded intelligence. Oracle Health (formerly Cerner) is shipping a cloud-native EHR built on its own OCI platform, with analytics and AI tools hardwired into the experience. This is a complete rethinking of how health data flows across settings - including clinical, claims, SDoH, and pharmacy - and how clinicians interact with it. Oracle’s voice-enabled assistant is the new UI. Epic is taking a similar turn. By early 2025, its GPT-powered message drafting tool was already generating over 1 million drafts per month for more than 150 health systems. Two-thirds of its customers have used at least one generative feature. They’re high-volume use cases that clinicians now expect in their daily workflows. What used to be “will this work?” is now “why doesn’t our system do that?” Vendor modernization is now directly reshaping clinician behavior, admin efficiency, and patient experience - whether you’re ready or not. On the startup side, digital health funding has rebounded - with $3B raised in Q1 2025 alone. Startups are leapfrogging legacy tools with focused apps: Virtual mental health that delivers within hours Remote monitoring platforms that plug directly into EHRs AI tools that triage diagnostic images before radiologists ever see them Key Technologies and Approaches in 2025 Modernization Cloud Migration On-premises infrastructure can’t keep up with the bandwidth, compute, or integration demands of modern healthcare. Providers are now asking “how many of our systems can we afford not to migrate?” Cloud lets healthcare organizations unify siloed data - clinical, claims, imaging, wearables - into a single stack. It enables shared analytics. It allows for disaster recovery, real-time scaling, and AI deployment. It’s also the only path forward for regulatory agility. As interoperability rules change, cloud platforms can update fast.  Microservices and Containerization Legacy platforms are so big that if one module needs a patch, the whole stack often has to be touched. Nobody can afford this in 2025 - especially when the systems are built around scheduling, billing, or inpatient documentation. That's why organizations break apart monoliths. Microservices and containers (via Docker, Kubernetes, and similar platforms) let IT teams refactor old systems one piece at a time - or build new services without waiting for an enterprise release cycle. It’s how CHG Healthcare built a platform to deploy dozens of internal apps in containers - standardizing workflows and cutting deployment times dramatically. It’s how hospitals are now plugging in standalone scheduling tools or analytics layers next to their EHR. EHR Modernization EHRs are still the spine of provider operations. For a decade, usability and interoperability were the two top complaints from clinicians and CIOs alike. In 2025, EHR vendors deliver fixes. Epic now supports conversational interfaces, automated charting, and GPT-powered patient message replies. Oracle’s cloud EHR is designed with built-in AI assistants and analytics  from the start. Meditech’s Expanse is delivering mobile-native UX and modern cloud hosting. These are new baselines. And they’re being adopted because: Clinicians need workflows that reduce clicks Health systems need interoperability without middleware hacks Regulators are demanding FHIR APIs and real-time data sharing When the VA replaces VistA with Oracle across its entire footprint, it’s a national signal: modern EHRs are not just record systems now. Low-Code The staffing shortage in healthcare tech is real. And waiting months for a development team to deliver a small app is no longer acceptable. That’s why low-code platforms (Salesforce, PowerApps, ServiceNow) are gaining ground in hospital IT. Low-code enables clinical and operational teams to launch small, high-impact tools on their own. Examples in the field: A bedside tablet app that pulls data via FHIR API, built in weeks - not quarters Custom staff scheduling flows tied to the HR system, updated on the fly Patient outreach tools that route data back into the CRM without custom middleware Artificial Intelligence and Machine Learning Integration From clinical documentation to insurance claims to pharmaceutical R&D, AI has moved from pilot status to production use - and it’s quietly reshaping cost structures and workflows. Clinical AI The most visible adoption is inside hospitals and physician groups, where AI-powered scribes now operate as real-time note-takers. These ambient tools transcribe conversations and structure them into the clinical record as a usable encounter note. Early deployments are showing tangible gains: fewer hours spent documenting, faster throughput, and  happier physicians. Patient-facing apps now routinely include AI chatbots for triage, appointment scheduling, and FAQ handling, offloading low-complexity interactions that would otherwise clog up call centers or front desks.   Operational AI: Driving Down Admin Overhead in Payers and Providers Insurers have leaned hard into AI for process-heavy work: claims adjudication, fraud detection, and summarization of policies and clinical guidelines. Automating portions of the revenue cycle has reduced manual review, improved coding accuracy, and accelerated payment timelines. Deloitte’s 2025 survey confirms that AI is now a strategic priority for over half of payer executives, and not just for cost reduction. Underwriting, prior authentication decisioning, and customer service bots are now all AI-enabled domains -  because manual handling simply doesn’t scale. Provider systems are adopting similar logic. AI-driven tools now assist billing teams with denial management and code validation - helping recover missed revenue and reduce rejected claims, often without increasing staffing.  Pharma AI In pharma, algorithms screen compounds, predict trial success based on patient stratification, and optimize site selection based on population health patterns. One major biopharma firm uses machine learning to model which trial protocols are most likely to succeed - and which recruitment strategies have the highest yield. McKinsey estimates $50 billion in annual value is on the table if AI is fully leveraged across R&D. And the only thing blocking that is the systems. That’s why the smartest companies are modernizing trial management platforms, integrating real-world data, and building AI into their analytics infrastructure. Governance Is Now Mandatory Because AI is Embedded Once AI starts generating visit summaries, triaging patients, or flagging claims for denial - the risk of error becomes systemic. Most provider organizations deploying clinical AI tools now have AI governance committees reviewing: Model accuracy and performance Bias and equity auditsRegulatory alignment with FDA’s evolving AI guidance Interoperability Interoperability is the hidden engine powering everything that matters in healthcare modernization. If your systems can’t share data through APIs,  then every other investment you make will eventually stall. AI, analytics, virtual care, population health management -none of it works without integration.   The 21st Century Cures Act mandated that EHRs expose patient data through standardized FHIR APIs as a legal requirement. That mandate hit everyone who integrates with patient data: providers, payers, labs, and app developers. Cloud integration platforms, HL7/FHIR toolkits, and master patient indexes are now readily available and built-in to most modern systems.  Modern EHRs are now deployed with real APIs. Health plans open claims data to other payers. Patients expect apps to access their records with one click. And regulators expect interoperability to be a default. Modern health apps - whether built in-house or purchased - are expected to offer FHIR APIs, user-level OAuth security, and plug-and-play integration with at least half a dozen external systems. If they can’t? They’re not even considered in procurement. Challenges and Barriers to Modernization in 2025 Cybersecurity 2023 and 2024 were record-setting years for healthcare data breaches, and ransomware is still a daily risk. The challenge is modernizing with zero-trust architectures, embedded encryption, real-time monitoring. Security-first modernization is slower.  Legacy Systems  Modernizing one system often means breaking five others. So teams modernize in slices. They update scheduling without touching the billing core. They roll out new patient apps while the back-end is still on-prem. And that piecemeal approach - while pragmatic - creates technical debt. The challenge is the dependencies. It’s the billing logic no one can rewrite. The custom reporting your compliance team depends on. The integrations held together with scripts from 2011. In 2025, the health systems making real progress are doing three things differently: Mapping dependencies before they pull the cord Using modular wrappers and APIs to isolate change Sequencing modernization around business impact - not tech idealism Regulatory Requirements Every platform you touch has to stay compliant with HIPAA, ONC, CMS, and increasingly, FDA guidance - especially if you’re embedding AI. Replace your EHR? Make sure it’s still ONC-certified. Launch a new patient engagement app? Don’t forget consent management and audit trail requirements. Build a clinical decision tool with GPT? You may be walking into a software-as-a-medical-device (SaMD) zone. Many payers are holding off on major IT overhauls. The risk of investing in the wrong architecture - or too early - is real. But waiting also costs. The CEOs who are moving forward are doing so by baking compliance into the project timeline. They involve legal and clinical governance from day one. And they’re designing for flexibility  because the policy won’t stop shifting. And above all: they’re resisting the urge to rip and replace without a migration path that keeps operations intact. Cultural Resistance You can buy platforms but not adoption. Every new system - no matter how well designed - shows up as another thing to learn. Innovation fatigue goes away when teams believe the new tools actually give them time back, reduce clicks, and make their lives easier. In 2025, the organizations breaking through cultural resistance are doing two things well: Involving clinicians early - in co-design Delivering early wins - like AI scribes that give doctors back 15 minutes per visit, not promises of better care someday They also hire tech-savvy “physician champions,” embed superusers in departments, and give staff the support and agency to adopt at their pace. Because if modernization is delivered as a top-down mandate? It will stall. No matter how good the system is. Interoperability and Data Silos: Progress with Pain Ironically, modernization projects often make interoperability harder before they make it better. That’s because new systems speak modern languages — but your data is still in the old ones. Migrating patient records. Reconciling code sets. Building crosswalks between legacy EHRs and new cloud platforms. It all takes time. Even when the target system is FHIR-native, the data coming in isn’t. And until all entities in your network modernize in sync, you’re living in a hybrid world - with clinical, claims, and patient-generated data split across modern APIs and legacy exports. This isn’t a short-term challenge. It’s the operating condition of modernization in 2025.  The solution is to design for coexistence. Build middleware. Accept data friction. And keep moving. ROI Pressure Modernization costs money. Licenses, subscriptions, cloud costs, consultants — the sticker price is high. And even if you believe in the strategy, your CFO wants proof. That’s why the smartest CEOs are phasing modernization into value-based tranches: Replace the billing system after the front-end is streamlined Layer AI into existing documentation tools before replacing the EHR Roll out low-code apps to hit immediate ops gaps while core platforms evolve And they’re tying every dollar to metrics that matter: reduced call center volumes, faster claim approvals, shortened length of stay. Because in 2025, you need to modernize the things that move the business. How Belitsoft Can Help Belitsoft helps healthcare organizations modernize legacy systems with modular upgrades, smart integrations, and cloud-native tools that match the pace of clinical and business needs. Whether it’s rebuilding trial platforms, fixing disconnected EHRs, or making patient apps usable again, Belitsoft turns modernization from a bottleneck into a competitive advantage. For Providers (Hospitals & Health Systems) Belitsoft can support modernization efforts through: Custom EHR migration support: migrating from legacy systems or outdated on-premises EHRs to modern, cloud-native platforms. Frontend modernization: building mobile-native apps, ambient voice tools, or clinician-facing interfaces that reduce clicks and documentation overload. Integration layers: connecting fragmented billing, lab, and scheduling systems via FHIR APIs and custom middleware. Low-code tools: creating lightweight apps for patient check-in, nurse scheduling, or discharge planning without waiting for full-stack releases. Microservices architecture: decoupling legacy hospital software to enable modular upgrades - scheduling, reporting, documentation, etc. Belitsoft can act as both a modernization contractor and strategic tech partner for health systems stuck between urgency and fragmentation. For Health Plans (Payers) Belitsoft can deliver: Custom modernization of adjudication and payment systems, designed with modular APIs and cloud-native infrastructure. Member experience modernization: building digital self-service portals, real-time benefits lookup, and omnichannel messaging tools. Interoperability solutions: developing APIs for CMS mandates, FHIR integration, identity management, and secure audit-ready logs. AI-powered automation: embedding fraud detection, denial logic, or claim prioritization into claims processing. Compliance-focused upgrades: modern systems built for traceability, audit-readiness, and evolving ONC/CMS requirements. Belitsoft’s strength lies in building solutions that integrate legacy claims engines with new digital layers - enabling real-time interaction, transparency, and regulatory resilience. For Pharma and Life Sciences Belitsoft can offer: CTMS and EDC modernization: replacing siloed legacy systems with cloud-native platforms for trial design, patient recruitment, and data capture.Analytics and BI dashboards: real-time visibility into site performance, recruitment status, and trial outcomes. Integration of real-world evidence (RWE) into trial and commercial data pipelines. Manufacturing and supply chain visibility tools: real-time batch tracking, cold-chain monitoring, yield optimization. CRM modernization for sales teams: segmentation, real-time performance tracking, and better targeting tools. Belitsoft can serve as a modernization partner for pharma companies looking to move beyond pilots and point solutions toward scalable digital infrastructure. For HealthTech Vendors & Startups Belitsoft can support healthtech vendors with: Cloud-native platform development: building core SaaS tools for remote monitoring, virtual care, and diagnostics. Modern EHR integrations: FHIR API development, SDoH data handling, and embedded analytics. Product-grade AI/ML integration: powering triage tools, image screening, or care recommendations with custom models and audit-ready pipelines. Governance tooling: dashboards for model performance, bias monitoring, and regulatory alignment. Interoperability-first design: plug-and-play modules that are procurement-ready (FHIR, OAuth2, audit logs). Belitsoft can function as a full-cycle tech partner for healthtech companies - from prototype to compliance-ready production systems.

Hospitals Hospitals want now developers who know mobility, security, compliance, integration with legacy EHR. Often tasks include integration with a statewide health information exchange, meeting CMS data transparency mandates, digitizing intake to remove paperwork and much more.   From Colorado Springs to Stockton, hospitals are growing IT teams to replace 15-year-old software held together by end-of-life vendor contracts and manual data entry. Mid-sized systems are hiring full-stack developers to modernize intranet portals, build patient-facing apps, and refactor reporting tools to meet regulatory deadlines. The talent war is no longer just in San Francisco. Developers with experience in high-regulation industries - finance, insurance, government - are now being recruited aggressively into healthcare. The code needs to work, hold up under audits, downtime protocols, accessibility standards, and a user base that includes everyone from moms to seniors managing chronic disease. Digital Patient Experience Patient care now depends on code too. In 2025, U.S. hospitals are hiring React developers, API architects, and mobile engineers to build apps because they can’t function without them.  Application developers are now integral parts of health system IT teams. Kaiser Permanente 6,000-person tech division is building everything from chronic care management tools to backend integrations for EHR systems. Their employer branding and hiring pitch is - the code supports lives in new architectural reality.  Hospital IT is hiring healthcare developers who can make a consumer-grade experience while staying inside HIPAA’s rules.  Patient portals, mobile scheduling, bill pay, and messaging systems have become the primary way hospitals compete for repeat visits - especially as patients begin to treat health systems like service providers. A broken portal is now the equivalent of a front desk that doesn’t pick up the phone. A single missed appointment due to a bad mobile UI has a direct cost. At scale, it’s a patient churn problem. A glitch in the patient portal is a care barrier. Appointment scheduling must work via a multi-platform interface and integrate with provider calendars. Lab results should be synchronized through APIs. Messaging interfaces must provide real-time updates and push alerts. Bill pay portals must not require five-step logins. Care Management & Interoperability A failed integration may lead to a care gap. Developers with experience in FHIR, HL7, and EHR APIs are getting pulled into care management platforms, patient engagement tools, and analytics systems that depend on tight integrations. It’s not just about moving data between systems but also about translating fragmented inputs - from a clinic’s outdated records to a patient’s wearable device data - into something more useful, delivered where and when it’s needed. Development teams are being asked to extend EHR platforms with custom apps, build bridges between inpatient and outpatient systems, or create clinician-facing dashboards that synchronise live with care coordination tools. AI-Powered Clinical Tools Hospitals have been talking about AI at HIMSS for years. At HIMSS 2025, AI-powered chatbots took center stage. Software engineers with AI integration experience are now being brought in to help embed ML models into clinical workflows: flagging abnormal imaging, surfacing risk scores in the EHR, automating intake summaries using NLP. At the HIMSS conference, vendors showcased AI for diagnostics, triage, scheduling, and radiology. But behind every glossy demo is a developer writing the middleware, optimizing queries, or tuning data flows to prevent false positives from overwhelming the clinical team. The hires in demand now: ML-savvy developers who know how to productionize models, engineers who can handle unstructured data in healthcare-safe formats, and developers with NLP experience who can build structured outputs from free-text clinical notes.  Health insurers Digital Member Platforms The only way to keep members, cut costs, and stay competitive is to turn legacy infrastructure into software platforms that actually work. That’s why health insurers in 2025 are staffing up like tech companies.  Members want real-time benefits, telehealth access, billing tools, and claims status - all from a single app, all with an intuitive UI. This is how payers avoid losing members to the insurer that built it first. Health plans are hiring developers who can build responsive, secure, consumer-grade apps - across mobile and web. React, Angular, Swift, Kotlin - all in scope. If you’ve built consumer apps before and have worked in healthcare too, you’re qualified and rare. And behind every new front-end is a backend team working with APIs, translating insurance logic, and connecting together systems that were never meant to talk. Data Analytics & AI Insurers sit on oceans of data: claims, outcomes, network performance, risk scores, costs, fraud patterns. Developers are now being brought in to turn that data into live tools: dashboards for care managers, predictive models for high-cost patients, automated alerts for billing anomalies. They are tasked to build fraud detectors that catch patterns before payouts, predictive systems that identify who’s at risk for a $100K admission, population health dashboards for value-based care contracts and internal platforms to highlight which providers drive the most denials. One of the biggest hiring priorities: engineers who can work across cloud data warehouses, EHR integrations, and machine learning workflow - while meeting HIPAA restrictions every step of the way. At Optum, UnitedHealth’s tech arm, teams are already building AI-based products using LLMs to guide stuff. Think: GPT-4-driven tools for reviewing care histories, summarizing notes, or flagging escalation triggers before they become denials or readmissions.  Integration & Automation of Operations Payers are still hiring developers to build the integrations that move data between insurers and providers - often over HL7, FHIR, EDI, or …worse. Prior authentication, eligibility checks, and claims adjudication don’t magically automate themselves. The stack is part modern cloud microservices, part XML graveyard. If you can build clean REST APIs while reverse-engineering brittle vendor logic, you’re in demand. Performance matters. These systems process millions of transactions. Bad code drives up costs, triggers rejections, and floods support lines. That’s why insurers are hiring backend engineers who understand scalability, observability, and fault tolerance. Enterprise fast - with no crashes. Security Insurers handle more healthcare data than some hospitals. Developers at payers are expected to understand security by default: access controls, audit trails, encryption at rest and in transit, consent tracking, breach reporting windows.  The profile insurers are hunting in 2025: engineers who’ve built high-scale web or mobile platforms (millions of users, billions of records), developers with experience in healthcare data, claims or EDI experience who also know modern API architecture, cloud-native architects (AWS, Azure), machine learning engineers who can apply models to claims, utilization, or risk. The line between developer and product owner is blurred. They want contributors who do not just follow tickets. Pharmaceutical Companies In 2025, alongside chemists and biologists, pharmaceutical companies are hiring software engineers. R&D runs on code Increasingly, drug discovery is about models that predict molecular interactions, machine learning systems that screen compound libraries, and simulations that replace years of trial-and-error. Developers are building the infrastructure that lets AI find candidates, flag dead ends, and accelerate timelines. At Merck, Roche, Pfizer developers sit inside discovery teams, writing data pipelines for omics datasets, building search tools for clinical literature, and integrating predictive models into decision flows.   That’s why job listings call for Python, R, cloud compute experience (AWS, GCP), and comfort with frameworks for NLP and ML. The goal is measurable: cut years off development, cut costs per compound, and get to market faster. The pill comes with an app When a pharma company launches a new therapy, it often launches an app with it to help with adherence, patient education, symptom tracking, or sometimes to deliver treatment itself. Developers are being hired to build mobile apps that remind patients to take medication and track side effects, digital programs that deliver cognitive behavioral therapy alongside prescriptions, remote monitoring interfaces that feed real-time patient data to care teams and tools for physicians to match treatments to patient profiles. These tools are often FDA-reviewed, and must integrate with devices, wearables, or clinical trial platforms. Infrastructure is changing LIMS platforms, pharmacovigilance dashboards, clinical trial data portals — they all need upgrades. Pharma companies are modernizing the behind-the-scenes infrastructure: automating processes that used to be manual, standardizing systems across global sites, and connecting data silos that cost them time during trials. Developers here are the ones keeping supply chains visible, keeping regulatory submissions accurate, complete, and easy to review, and ensuring researchers can trust the data behind every candidate. There’s also investment in real-world evidence tools - ingesting data from EMRs, insurance claims, and patient registries to support research and commercial decisions. These pipelines require developers with strong ETL skills, data normalization experience, and the ability to handle unstructured raw data at scale. In 2025, pharma is recruiting developers who can build and maintain AI platforms for R&D, translate scientific questions into analytics tools, develop compliant, user-friendly patient apps, integrate bioinformatics pipelines and support regulated environments with reliable software. Healthtech Startups These companies were born digital. Their app is the product and their engineering team is the company. Startups in virtual care, chronic disease management, and hospital-at-home are replacing legacy systems. A virtual therapy company doesn’t need five layers of governance as large enterprises, hospitals, or government-adjacent healthcare organisations to roll out a new CBT module - it needs React developers who can ship it before the next round of funding.  A chronic care platform needs developers to link connected devices, support live vitals streaming, and push patient alerts to clinicians. Companies like Medically Home, Talkspace, or emerging DTx ventures are building logistics platforms, mobile apps, symptom checkers, and real-time coordination tools - all on modern stacks, all in production. AI is everywhere but most still struggle to make it work Every second startup has a GenAI pitch in 2025. Most of them need engineers who can translate that into something useful. Whether it’s using LLMs for patient intake summaries, NLP to extract meaning from unstructured clinical notes, or ML models that help clinicians prioritize outreach, the demand is: Python, PyTorch, TensorFlow, LangChain, vector DBs, and real-time data pipelines. Even non-AI healthtech startups want engineers who can plug in ML for triage, personalization, predictive alerts - and make sure the outputs are trustworthy and traceable. That means software engineers who understand ML ops. Scaling is where most hiring happens The moment a startup lands a hospital contract, the development team doubles. Integration is harder than invention. One client means Epic authentication, FHIR endpoints, new dashboards, and role-based permissions. Ten clients means infrastructure work, alerting systems, downtime protocols, and performance tuning. Some startups go further - building full operating systems for care delivery: telehealth plus eRx plus billing plus labs plus messaging.  And they all need engineers. Security When a digital health startup says “we’re HIPAA-compliant”, every API call, every audit trail, every token expiration — it all has to hold up in front of hospital procurement, enterprise IT, and patient advocacy groups. That’s why even early-stage startups are hiring devs who understand access control and identity management, encryption protocols and secure cloud storage, regulatory logging and breach-handling workflows, and FDA software frameworks and clinical validation logic. And most importantly, startups want developers who can figure things out quickly - without waiting for a specification doc. They want engineers who’ve pushed something useful into production. Startups don’t want corporate energy. Instead, they're looking for builders who are allergic to endless planning, but who know how to document, refactor, and protect patient data with the same seriousness as a hospital CIO. They want engineers who show up for a standup with commits, not questions. How Belitsoft Can Help Belitsoft is the development partner for healthcare companies. We provide vetted healthcare app engineers to build, scale, and maintain secure, regulatory-ready applications from hospitals to healthtech startups. Modernization Without Risk For Hospitals & Health Systems Belitsoft provides full-stack teams that understand patient safety, clinician workflows, and regulatory constraints  and build production-grade systems around them. Extend legacy EHRs with custom apps and FHIR-based integrations Build secure mobile apps (scheduling, messaging, billing) with intuitive UX Embed AI/ML tools in clinical workflows (triage, imaging, NLP for intake) Staff React, Swift, and backend developers experienced in HIPAA environments Full-Stack Development For Health Insurers Whether you need a single app or an entire modernization plan, Belitsoft can augment your team with developers fluent in payers' data, security, and performance needs. Build consumer-grade apps for member self-service, claims status, and benefits Implement ML tools for fraud detection, risk scoring, and billing alerts Integrate with provider systems via HL7, FHIR, or EDI Staff backend/cloud engineers who can scale secure systems with audit trails R&D Support For Pharma & Life Sciences Belitsoft helps pharma teams go from prototype to production with developers who understand the science, the model, and the compliance. Build data pipelines for omics, EHR, and real-world data (RWD/RWE) Develop trial portals, pharmacovigilance dashboards, LIMS upgrades Launch digital therapeutics apps with device and FDA-compliant integrations Staff engineers with Python, ML, and HIPAA/FDA experience Scale and Compliance Support For Healthtech Startups Belitsoft brings startup-ready developers who build fast, document properly, and keep patient data safe - no handholding required. Provide full-stack teams for MVP development, AI features, and UX Add backend engineers to refactor MVPs into scalable platforms Build HIPAA-compliant systems that pass procurement checks Cover DevOps, mobile, and AI/ML integrations without waiting on hiring cycles