How to Build an EHR System

You would like to build an EHR System or create an EMR software, now what? Start with this guide from the EHR developer Belitsoft International LLC (4+ years of experience in developing and customizing HIPAA/GDPR-compliant EMR/EHR systems and medical databases for health networks, hospitals and small clinics, private practices and physicians, outpatient facilities, pharmacies, implementation consultants, medical software businesses and EHR startups from the USA, Canada, the UK, Israel and some other European countries).

Executive Summary

There are only two ways of building your EHR system - a quick way and a long way.

The quick way: implementation of an ready-to-use EHR system (whether Open Source EHR or commercially licensed EHR) and its further step-by-step targeted on-demand customization (changing user interfaces, creating speciality-specific templates, adding integrations with practice management system, picture archiving system, referral management system, labs, billing, patient portal, etc. or to meet the requirements of an external system). Not every ready-to-use EHR system is ready for cost-effective customization. An experienced EHR consultant could be helpful when selecting ready-to-implementation-and-customization EHR system tailored to your business needs.

The long way: EHR development from scratch. This option suits you when you need to get full control over your EHR software features, don’t want to pay license fees, don’t want to have "per provider" access restrictions and don’t want to be one-vendor-locked that could prevent you from switching EHR. An experienced EHR developer could be helpful when you need to know the cost of developing a certified EHR system, its stages as well as the possibilities to cut costs.

In both cases, you need to start with a detailed description of the required features.

Where to Start: Quick Tip

Formulate your idea in a request for information. In case you would like to create a new EHR system your request for proposal might look like this:

  • We are a rapidly growing healthcare startup company looking to build our own EMR software to fit our needs. I would like to set up an initial call this week to inquire about your services. Thank you.
  • I wanted to develop a EMR system for our practice and how much will it cost?
  • I would like to discuss the development of a EMR/EHR for my group practice of specialist physicians. Can we arrange a call to discuss possible partnership?
  • We currently have a paper system and would like to upgrade to EMR. What would be the cost of its developing?
  • We are searching an EHR system that we can implement to the clinic. We have 80 physicians part of our group. We are looking for a personalized EMR system that will connect to our Billing system. What is the deployment and maintenance fee of it?

Your Reasons Behind the Custom EHR Development

If you understand the reason behind you wanting to create your own EHR system despite hundreds of existing alternatives on the market, it will save you a lot of time and money.

Firstly, it could be much cheaper to approach the EHR consultants who will study your requirements and choose the existing system available on the EHR market that is the best fit for you.

Secondly, 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 experienced EHR developers take into account how quickly do you have to implement the EHR system.

✓ If you need new EHR system ASAP, they would suggest splitting the development process into several stages:

  1. development the most important features, the so-called minimum viable EHR system that could be implemented quickly and bring 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 (EHR implementation, HIPAA/GDPR certification, ONC certification);
  2. development of other features.

✓ If the EHR development speed matters, but isn’t critical and the budget isn’t big, the EHR developers would study the requirements for the new EHR system for you and then look for ready-made systems (e.g. open-source EHR systems) that could be inexpensively customized.

✓ If the development speed is not a priority and there are no existing systems that fits your requirements, the EHR developers will offer to build a new EHR from scratch.

In this case it is better to choose the team which has experience in systems development and a has backend EHR framework that could dramatically increase development speed and associated costs. The most expensive part of creating a new EHR is backend and integrations, not user interfaces.

What Would Work Better For You?
Request a free call back from EHR developers
to get the clear answer.

What is the main reason that motivates you to build your own EHR/EMR system?

We addressed this question to our clients.

Here are the answers: 

“We are a rapidly growing healthcare startup company looking to build our own EMR software to sell licenses or subscription-based access to medical practice owners.

“I developed a "template" of sorts for myself and have recently allowed several other physicians in my clinic use it. The feedback has been tremendous and I've been encouraged to consider developing a new EHR based on what I have. I have been encouraged by many physicians to develop my idea into a prototype and "...shop it around, and sell it!" I have a new and novel approach (in concept). The idea actually came from frustration with all the EHR's I've worked with and the seemingly unbridgeable gap between "writing good, legible and useful" notes with " billable notes!" 

“As an EMR implementation consultant, I have experience in implementing others’ EMR applications. Now I’ve decided to create and implement my own EMR platform and I need an outsourcing development partner.”

“I am a physician at the early stages of my private practice career and now wishing to jump from paper-based medical notes to electronic. I need a solution that would also integrate practice management with records management, a bespoke system that could be upscaled/tweaked/developed in the future as my practice grows.”

“We have 80 physicians as part of our group. We are looking for a personalized EMR system that will connect to our Billing system”.

“We are a small private practice. We are using many different systems and need a customized solution. We have outgrown our system. We have looked at many ready-to-use EHR systems and they are dismal and overpriced, they will NOT do the job”.

Tell us you reason to build an EHR system and
get a clear, personalized answer on where to start and how much will it cost.
(We sign an NDA before you share sensitive information with us).

Building a custom EHR System For Medical Practice Owners

It is obvious that the main reason why medical practice owners create their own custom EHRs is the dissatisfaction with the boxed solutions.

Pre-built EHR systems have numerous disadvantages. The main thing is it forces your doctors to fit predefined limitations. You have to change your workflow to adjust to the new software.

Moreover, you will not be able to easily modify it over time to maintain a high productivity rate. The ready-made EHR software targets a wide range of consumers and it is not cost-effective for EHR product vendors to customize it for specific customers.

The boxed systems developers charge a lot in part because of the high hourly rates of programmers in the USA and the UK.

As a result, if a practice purchases a ready-made solution (because their competitors across the road have done so or because they weren’t able to find a better alternative in time) the doctors suffer from it (see the reviews written by the physicians who have purchased boxed systems and used them for some time).

After buying a ready-made system the painful decision about switching comes up, which leads to double or even triple purchases. This practice is so widespread, there are scientific papers written about it.

Here’s an excerpt from a report titled “Why physicians switch electronic health record vendors,” presented on the “Business and Health Administration Association Annual Conference 2017.”

“System functionality and cost were the two largest deciding factors in switching vendors. Shifting regulatory standards require additional functionality to fulfill quality reporting measures including the Meaningful Use and Physician Quality Reporting Systems standards and many physicians and health systems have decided to switch vendors in order to accommodate these requirements. Despite the associated costs with switching, many physicians and health systems have decided to switch vendors in order to receive the additional functionality, reporting, and platform benefits associated with a new vendor or records system.”

A custom-built EHR and the complementary support prevents the switching problem because you can just update the system you already have.

This is what the reliable researchers from KPMG say:

“Many of these “out-of-the-box” EHR implementations, which were often fast-tracked in an effort to meet meaningful use requirements, typically restricted providers from realizing a clear return on investments (ROI). Healthcare leaders understand that developing and implementing a post-EHR implementation strategy under the auspices of a change-management model has become a pressing need. When organizations work under a change-management model such as lean – a long-term approach that seeks to achieve small, incremental changes in processes in order to improve efficiency and quality – they can continually leverage technology to create more value. This approach also 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.”.

Change Management in Healthcare Organization is the controlled identification and implementation of the required changes within health IT systems in accordance with the changes within a business. It's only possible with custom EHR development since it's based on the so-called Agile approach At its core, Agile is a software development methodology that make it possible to quickly change the EHR software in accordance with business changes.

If you’ve decided to develop your own bespoke EHR system, it would be meaningful only if you choose a responsible EHR technology developer which has experience with custom EHR software development.

Belitsoft develops healthcare applications and has been working on the custom software market for over 15 years. Our rates are lower than that of the American or British companies.

Building a custom EHR System For Startup Owners

The EHR startup founders see the disadvantages of the boxed systems and the physicians’ complaints about them. This means the demand for new EHR SaaS applications that would have a more convenient UI, speech recognition, integrations, certifications, etc.

It is important to develop EHR startups in close cooperation with practicing doctors - target users of EHR systems - as well as a team of professional EHR technology developers to show the potential to the investors.

At the same time, it is important to take into account the EHR market trends picked up by reliable researchers, for example, these ones.

There are the following EHR market trends:

  • The US market has reached saturation in terms of EMR penetration into healthcare organizations, with growth falling to rates significantly below those seen during the last decade.  Growth is being driven by revenue per bed/PCP being increased as EMR vendors integrate more functionality (e.g. PHM, HIE, telehealth, RCM, clinical systems) into EMRs.
  • There is no single global EMR market. With a few exceptions, there are largely individual local markets that are typically driven by local issues and served by local vendors. Most geographic markets are quite different from the US, and far from saturated. EMR solutions replacing paper systems will still drive a substantial proportion of market growth.
  • In many developed countries, the number of EMR customers is declining and the value of contracts is increasing owing to regionalization and integrated care initiatives. Local legacy vendors may struggle to scale to meet requirements. At the same time, a proven track record in a given country can offer a significant advantage.

Would your EHR startup be better developed as a “module” or a “plug-in” to be sold to existing EHRs or as a self-contained EHR system?

Module/Plug-in option:

  1. It is cheaper and faster to develop. A minimal prototype is enough to start offering it as a module for other EHR system owners. Choosing this option, you save time because you do not need to develop many features that the other EHR has already built-in and can be borrowed later on. The so-called minimum viable version of a product (MVP) can be enough for you to start the negotiation with potential buyers.
  2. You can start getting ROI faster with less investment. However, you can earn less by selling it as a module in comparison with a self-contained program.
  3. The prototype will need to be further developed/adjusted to be integrated into other systems. More likely that should be at the expense of the party who buys the module. 

Self-contained EHR System:

  1. More time and investment needed before getting ROI.
  2. When the project is completed you can benefit from that in the following ways:
    Make it work as a SaaS and sell licenses.
    Sell the business to a new owner or another EHR. In addition to the development, you need to take sales/marketing efforts into account.

We can help you to start both with either a Module/Plug-in approach or a Self-contained System approach.

Message Us To Know
The Cost of Building You EHR startup

Estimation of the Cost of Custom EHR Development

Quick Rough Cost Estimation

After the quick rough cost estimation is finished, the client receives the “Vision and Scope Document” with basic descriptions of all the features and the rough cost for the full-featured EHR.

We do this estimate for free, it usually takes up to 20 business hours.

How we do it

First, our EHR Business Analyst will talk to you on video call (1-3 are usually enough) and ask you questions about all the features of your desired EHR system.

After all the questions have been answered, the information is then passed to a Senior EHR Developer.

The Senior EHR Developer analyzes the complexity of each feature based on his experience and writes down the approximate development time for each.

Example:

  • Feature #1. Cost = 10h;
  • Feature #2. Cost = 20h;
  • Feature #N. Cost = 30h.

Then the Senior EHR Developer starts looking for ways to deliver the feature faster and cheaper. If there is such a way, he decreases the time allocated for this feature.

He goes over each feature in this manner and you get the total rough cost as a result.

We should note that the absence of detailed requirements means:

  • the more features your EHR system includes, the risk is higher that the actual costs will exceed the initial estimate because the features are not detailed in a specification document.
  • you can't objectively compare prices for your EHR development project from different EHR technology developers.

Get a Free Quote From Experienced EHR Team

Detailed Cost Estimation 

After the detailed cost estimation is finished, the customer gets a “Vision and Scope Document” along with the “Use-Case Based Requirements Specification” (and interactive Axure prototype, if needed). It includes detailed descriptions of all the features and more precise and accurate cost for the full-featured EHR system because the features are more detailed.

Example of Use-Case Based Requirements Specification (the abridged version)

Use Case №1: A receptionist schedules a doctor's appointment for a client

Successful scenario:

SS 1. The client calls the practice to schedule an appointment with a particular physician.

SS 1.2. The receptionist checks whether the client is registered in the system through the search going to the “Patient/Client” menu and choosing “Patients” or “New/Search” submenus.

SS 1.3. The receptionist enters the client’s name in the search field or looks through the list of patients.

SS 1.4. The receptionist finds the client in the system.

SS 1.5. The receptionist goes to the client’s profile and adds an appointment.

SS 1.6. The receptionist fills the popped-up appointment form, entering the visit’s category, title, facility, billing facility, provider, date, time, duration of the visit. The receptionist can also set a status, reminder, room number or leave a comment if necessary.

SS 1.7. The receptionist checks the availability of a needed physician.

SS 1.8. If the chosen physician is available at the scheduled time, the receptionist saves an appointment.

SS 1.9. The system sends information about a scheduled appointment to the chosen physician and other users according to their roles and permissions. The information is duplicated to the client’s account in Patient Portal if the patient is registered in the system.

Alternative scenarios:

AS 1. The client calls the practice to schedule an appointment with any available physician.

AS 1.1. The receptionist goes to the “Calendar” menu and sets the demanded date.

AS 1.2. The receptionist chooses the physicians and checks their available visiting hours at the demanded dates and times. All physicians could be chosen at once.

AS 1.3. The receptionist clicks on the demanded timeline of the chosen physician to add an appointment.

AS 1.4. Clicking the timeline pops-up appointment form with the same fields as in SS 1.6.

AS 1.5. After filling all the needed fields of an appointment form the receptionist saves the appointment.

AS 1.6. Same as SS 1.9.

AS 2 The receptionist checks whether the client is registered in the system through the search and doesn’t find him because he is a new client.

AS 2.1. The receptionist checks if the client is registered in the system through the search going to “Patient/Client” menu and choosing “Patients” or “New/Search” submenus.

AS 2.2. The receptionist enters the client’s name in the search field (no matches found) or looks through the list of patients (no patient’s profile).

AS 2.3.a. The receptionist goes to the “Patient/Client” menu, clicks on “New/Search” submenu and the “Search or Add Patient” page with the same form is opened. The receptionist fills the needed sections with appropriate data and clicks on the “Create New Patient” button.

AS 2.3.b. The receptionist goes to the “Patient/Client” menu and clicks “Patients” submenu. On “Patient Finder” page receptionist clicks on “Add New Patient” button and is redirected to the “Search or Add Patient” page. The receptionist fills the needed sections of “Add patient” form with appropriate data and clicks on “Create New Patient” button.

AS 2.4. A confirmation window with previously entered data pops up and the receptionist presses “Confirm Creation of a New Patient” button to complete adding a new patient

AS 2.5. The receptionist is redirected to the Medical Record Dashboard of a new patient. Further actions to schedule an appointment are conducted according to SS 5 or AS 1.1

AS 3. The client wants to schedule an appointment with a particular physician at a certain time, but the physician isn’t available at this time.

AS 3.1. The receptionist goes to the “Calendar” menu, selects a particular physician and checks for the nearest available visiting dates and hours

AS 3.2. If the client agrees to reschedule his visit to the available date/time, receptionist schedules an appointment according to AS 1.3 scenario (if the client has already been registered in the system before). If it’s a new client, receptionist acts according to AS 2 scenario

AS 3.3. If the client wants to visit at a particular time, the receptionist offers him to schedule a visit to other physicians and checks their availability starting from the AS 1.1 scenario (if the client has already been registered in the system before). If it’s a new client, the receptionist acts according to AS 2 scenario.

Use Case №2: Physician enters the results of the encounter to the patient’s chart.

Successful scenario:

  1. The physician opens the patient’s “Medical Records Dashboard”, clicks on the “New encounter” button and is redirected to the “New Encounter Form” page.
  2. The physician fills the form with Visit Details, Reasons for Visit, adds Issues (Injuries/Medical/Allergy) to the Current Visit (if necessary) and saves the form.
  3. The physician is redirected to the “Encounter ” page with previously entered data.
  4. The physician conducts all the needed surveys to establish the diagnosis, available surveys are stored in the “Clinical” menu. For example, the physician goes to the “Clinical” menu, clicks on the “Vitals” submenu and is redirected to the “Vitals” page.
  5. The physician fills the needed fields of the “Vitals” form, saves it and is redirected back to the “Encounter” page with added “Vitals” data.
  6. The physician goes to the “Clinical” menu, clicks on the “Physical Exam” submenu and is redirected to the “Physical Exam” page.
  7. The physician selects the needed checkboxes of the “Physical Exam” form, leaves comments or chooses further treatment, if necessary, saves the form it and is redirected back to the “Encounter” page with added “Physical Exam” data.
  8. The physician has enough information to establish the patient’s diagnosis.
  9. The physician goes to the “Administrative” menu, clicks on the “Fee Sheet” submenu and is redirected to the “Fee Sheet” page.
  10. The physician selects price level and set of services for a new or established patient, that will automatically add an appropriate CPT-4 code for the service provided.
  11. In the section “Selected Fee Sheet Codes and Charges for Current Encounter,” the physician enters modifiers (if needed), price, units and note code (if needed).
  12. To justify the services, the physician should choose ICD-10 Diagnosis radio-button at “Search for Additional Codes” and enter the ICD-10 code number or the diagnosis in the search field. After that, the physician should click on the “Search Results” field and choose the appropriate diagnosis from the dropdown menu.
  13. The chosen diagnosis is automatically added to the “Selected Fee Sheet Codes and Charges for Current Encounter” section and is available in the “Justify” dropdown menu.
  14. The physician sets justification diagnosis, selects provider and supervisor (if needed) and saves the encounter form.
  15. The physician is redirected back to the “Encounter” page.
  16. The physician goes to the “Fee” menu, clicks on the “Billing” submenu and is redirected back to the “Billing Manager” page.
  17. The physician chooses filter criteria, finds the necessary encounter form, selects the encounter and chooses the form of the downloaded file.
  18. The physician can send the downloaded file to the clearinghouse/insurance company.

Use Case №3: Physician fills the prescription form for the patient

Successful scenario:

  1. The physician opens the patient’s “Medical Records Dashboard” and clicks on the “Edit” tab of the “Prescription” section.
  2. A window with the currently prescribed medications pops up and the physician clicks on the “Add” button.
  3. The physician fills the form with Starting Date, Provider, Drug name, it’s quantity, directions, and refills. The physician can also allow substitutions or disallow them.
  4. The physician decides to not add the current drug to the patient’s medication list and saves the form.
  5. The physician is redirected to the patient’s list of prescribed drugs and presses the “Done” button.
  6. The physician is redirected to the “Encounter ” page with the prescribed drug saved.

Pros of this approach (Detailed Cost Estimation)

  • significantly reduced risk that the actual costs will exceed the initial estimate. The EHR development company guarantees, that final budget will never exceed the Max price if new features won’t be added during software development process.
  • you can objectively compare prices for your EHR development project from different EHR technology developers with these documents.

This estimation is paid and takes 20 working hours or more depending on the complexity of the project.

Find out the the hourly rates of our EHR programmers! They are cheaper than in the USA and UK.

Detailed Cost Estimation of MVP version of EHR system

MVP version of EHR system is a EHR product created with minimal costs and time, but with only the main features.

We create appropriate documentation and estimate the MVP version of EHR system for free for clients who have the “Use-Case Based Requirements Specification”.

This estimation is useful if the client wants to understand how much money would he need to develop the most important features of the system.

The customer gets detailed estimation of the most important EHR features plus a personal face-to-face consultation. 

The final estimate is presented via a video call, the EHR Business Analyst and the EHR Developer Team Lead who participated in creating the estimate participate in the presentation. 

This allows the client to ask questions in real time (e.g. “Why does this feature take so much time?” or “Did you take this into account?”). The Team Lead or the Business Analyst would be able to answer immediately.

The video call would also let the customer get to know the EHR team that would work on his project. He can invite his own technical specialist to evaluate the EHR team’s skills. 

Let's Talk Business

Case#1 How We Developed a Custom EHR System For a Clinic Based on Our HIPAA/GDPR Compliant Interoperable EHR Framework

One of our clients is an investor from the USA (we have signed an NDA so we are not able to disclose the client's name and detailed information here) who wanted to create brand new EHR software because the available solutions didn’t fit the needs of his target audience. In collaboration with healthcare consultants from his partner - an Orthopedic clinic - he planned to develop a web-based SaaS EHR system.

The scope of work has included but wasn’t limited to the following features:

  1. A user-friendly interface.
  2. EHR Charting Module.
  3. Medical Billing Module.
  4. Integrated Patient Portal.
  5. Mobile-first EHR. It should be designed working closely with physicians to improve their record-keeping.
  6. Clinical Pathways Module;
  7. Module for Measuring and Benchmarking Clinical Performance. Benchmarking reports could show the difference between the treatment results of a particular patient and other similar clinical cases. Doctors can utilize these reports to compare their data with the information on the other patients with the same diagnosis and treatment plan (incl. medications) both in their clinic and other locations using this EHR;
  8. A HIPAA/GDPR-Compliant Architecture.

EMR Conversion Services (data migration) were also required.

Facing the lack of in-house EHR software developers, the client decided to outsource the EHR development and asked Belitsoft to develop the MVP version of such an EHR software.

The client chose Belitsoft for the following reasons: Proven experience in working with Healthcare domain; Competitive pricing; Good reviews and references.

How we organized the EHR software development process

Allocation of an EHR Business Analyst. This customizable EHR system was designed to be multi-featured with many interdependencies. In addition, the customer has planned to regularly add new functions once the software was on the market. So to make the system scalable and future-proof it was important to identify the potentially conflicting requirements and resolve them before the actual development begins.

This is why Belitsoft has assigned an experienced EHR Business Analyst (BA) who has previously worked on other healthcare systems to the project team. Their domain-specific knowledge was especially useful in translating the customer’s business needs into technical requirements.

Software Development Model Selection. Agile software development process was chosen because the Client wanted to build a large and complex software product staying highly involved in the project development and customization. In addition, the team needed to stay flexible to adjust to the constantly evolving business requirements. 

Effective communication is always 50-60% of a successful custom application development, that is why a proper communication plan was established:
1) The communication was mostly remote. The client has visited Belitsoft office just once before the development process began to get acquainted with Belitsoft management and development team.
2) The MVP software development process was divided into sprints - periods of time during which a portion of programming work had to be completed and made ready for client’s review. From the fifth sprint onward we were preparing e-mail reports for the client every 1-2 weeks to enable him to make any changes or refinements promptly.
3) The Business Analyst acted as a primary contact person for the client, having regular Skype meetings, systematizing all the requirements correctly and showing demos (sprint releases). The BA was also responsible for the conformity of the final product to the documented requirements.
4) Communication by email was used when our Client needed time to make important strategic decisions.

Software architecture selection. While developing this healthcare software, project development team was using the modern microservices architecture approach keeping in mind that it might be required to develop frontend apps for Web, Mobile, and Desktop. 

The HIPAA compliant server architecture was proposed by Belitsoft to the Client to make sure that the medical application meets the HIPAA's technical requirements.

The architecture of the system contains the following parts:
1) Backend: Database Layer (MySQL) and API layer (API for the web admin panel and API for the frontend apps);
2) Frontend: tablet-friendly mobile application. Tablets are very convenient tools that are widely used in the leading hospitals and healthcare systems.
3) Frontend: web admin panel based on Angular framework for form templates and users management. Angular, maintained by Google, was chosen because it’s very reliable compared to other JavaScript frameworks.

A HIPAA-Compliant Architecture A HIPAA/GDPR-Compliant Architecture

MVP-First Approach. “SaaS product development” term implies the development of specific features, an access control system to those features and a subscription billing system that charges users for access. At the first development stage in order to reduce the cost of the MVP version development of the SaaS EHR, we developed only the most important functions that our Client’s customers were ready to pay for, along with the access control system. At first, it allowed our Client to add his customers to the system manually. At the second stage of the development, it became possible to automate the billing process and integrate the SaaS with online payment systems like PayPal.

To prevent the loss of patients’ information, we have developed 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.

ehr example Clinical Pathways Module. Example of the Custom EHR interface
ehr example Module for Measuring and Benchmarking Clinical Performance. Example of the Custom EHR interface

Setting up the right testing process. The high quality of a custom healthcare software can be guaranteed only when a proper testing process is established. An experienced project manager Dmitry Garbar applied best practices to boost the productivity of the software development and testing team on the project.

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.

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. 

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.

Integrated Patient Portal

Integrated Patient Portal Integrated Patient Portal Design

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.

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

Medical Billing Module

Are you looking for a personalized EMR system that will connect to your Billing system? EHR needs to have a robust module to handle payments and reimbursements.

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.

The reasons Why You Might Consider the Customization/Implementation of Ready-to-Use Open Source EMR/EHR Applications

Medical practices turn to open source software for the following reasons:

  • Reduced development and configuration costs. Organizations should want to have an EHR 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.
  • Pre-built сustomization options. Open source systems are more flexible by design, and so are easier and cheaper to modify.
  • Pre-built Interoperability. Open source EHRs are built with interoperability in mind and are often easier to integrate with third-party systems than proprietary solutions.
  • Easy to test. Most open source software can be freely downloaded and installed. You can try the system at leisure and see if it fits your practice before committing to its implementation.
Top open source EHR systems (or medical software with EHR features ) Top open source EHR systems (or medical software with EHR features) by monthly keyword search volume (Google USA, Semrush). Source: https://belitsoft.com/

The open source medical software market includes products like Open Dental, OpenEMR, Docmein, HealthKit, ERPNext, OpenMRS, one touch emr, Odoo, 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.

We have chosen three best universal EHR system (OpenEHR, OpenEMR, and OpenMRS), and one speciality-specific EHR (OpenDental) for the following reasons:

  1. There is the demand for these systems.
  2. These systems are built using the most popular programming languages. 
  3. These systems are mostly HIPAA/GDPR compliant.
  4. Some of these systems have ONC certification.

Send us your request for information to learn more. We can customize the best open source EHRs for your practice’s workflows or medical specialty 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.

Case#2. How We Developed and Implemented Voice Recognition Plugin for an EHR system

Belitsoft was approached by the owner of a private medical practice from the USA. Doctors and nurses working in his company 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.

ehr example EHR Voice Recognition

The scope of the project was extensive and subject to change. So the client and us agreed on Agile development methodology along with the time and material cooperation model.

The client’s representatives visited Belitsoft’s office before the kickoff to get acquainted with the team and the company leadership. Over the course of the project several key staff members went to the client’s office to learn more about the end users and their work environment.

The development process was split into a number of 3-week sprints. Each sprint ended with a demo session where we showed the result of our work to the customer. These meetings were useful as a source of feedback for us and as a proof of money well-spent to the client.

The client has also put together a focus group from medical professionals working for him. These people proved invaluable in understanding the end users’ needs and testing of the features.

ehr example EHR Voice Recognition
ehr example EHR Voice Recognition

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.

What are the regulations to keep up with

API-enabled EHR API-enabled EHR. Source: cell.com/fulltext/S2405-4712(15)00004-6

Beginning in 2019, all eligible professionals and hospitals 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

What are the security measures EHR developers must take

HIPAA compliance

Compliance with the HIPAA requirements is a must for any EHR. Achieving it requires securing several parts, which include EHR software itself, servers, and network (firewall, router, https, certificates, etc).

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.

What does GDPR have to do with EHR

The General Data Protection Regulation (GDPR) is an extensive new law coordinating the collection and use of personal data in the EU, which came into effect on May 25, 2018.

GDPR is concerned with all kinds of personal info relating to an identifiable individual. This could include names, addresses, contact details or demographic info. The Regulation applies to any organization/person with a European presence, or which deals with the individuals’ data within the EU.

The Regulation concerns the private and public healthcare sectors. Healthcare providers must ensure they comply with the requirements and demonstrate that they are protecting their patients’ data adequately. Any healthcare organization has to verify patients’ identities and create a system to erase or rectify their information.

Do you need to be GDPR compliant? Read the following articles to stay on top!

Where to host your EHR/EMR software?

As a healthcare provider, whether you decided to buy new off-the-shelf (“out-of-the-box”) EHR/EMR or to build out your own EHR/EMR system, you probably understand that this type of software cannot be used without hardware to storage your medical data. Organizations need to ensure their data is stored securely and is accessible to protect patient data. Clinicians must have access to data where and when they need it for a successful data storage option. There are three healthcare data storage options: on-premise, cloud and hybrid data storage.

HITInfrastructure.com discussed the benefits and drawbacks of different storage options.

On-premise storage:

  • Healthcare organizations are more likely to lean toward on-premise storage than other industries because the control they have over an environment kept in-house. Hospitals tend to want to build their own datacenters. Uptime is super important in healthcare; you can’t afford to have these systems go down.
  • On-premise storage does not require a wireless internet connection to retrieve clinical data, making it considerable less risky. Due to the nature of healthcare data, organizations want to deploy the storage solution they feel is the most secure, which is often the solution they have the most control over.
  • Servers hosted on-premise are costly because of the resources they require to maintain. Healthcare organizations have to find the physical space within the organization to host the servers. Cooling costs are also a big expense required to ensure the servers do not malfunction. Besides, Rack servers don’t take up as much space or require the same cooling energy costs, which makes them ideal for smaller organizations that want to host their datacenter on premise but don’t have much space or resources.

Cloud storage:

  • Cloud data storage also saves organizations money by allowing them to purchase more storage space as needed, rather than investing in additional on-premise servers.
  • Cloud is becoming the preferred choice for healthcare back-office applications, backup and disaster recovery, revenue cycle management and patient engagement. Advantages of the cloud can also include cost savings, scalability, speed, freed up internal storage, a mobilized workforce, and improved user applications.
  • The most prominent concern organizations have when moving to the cloud is the lack of control over where the data lives. Organizations can choose between public and private hosting services. While private cloud options give entities more control, they still do not offer the same level of control as on-premise servers. Private clouds give IT administrators more control over the storage environment, but deploying a private cloud can be costly because of the expert staff required. While most cloud vendors are upfront about their HIPAA compliance, organizations are still concerned about ensuring patient data is completely protected in the cloud. 
  • Leveraging a public cloud can potentially save organizations a significant amount of money on storage by removing the need to maintain an on-premise environment.  
  • The public cloud is useful for developing new applications because of the flexibility it offers during the building and testing process, he added. Once the application is tested, it can be moved to the on-premises data center or a private cloud hosted on site if the organization does not wish to keep the public cloud.
  • Entities may also use multiple cloud vendors and service models to host different parts of their datacenters or multi-cloud storagemodels to perform different tasks. Multi-cloud data storage also uses different cloud service models or providers for data because different clouds are better suited for different tasks.

“If I'm going to use a public cloud like AWS or Azure software and get those on an expense basis, I must predict what that's going to be every month. That means my operational expenditures are going to go up, and that's not good. The challenges of correctly sizing what we have in our private cloud and then managing what parts to put in public cloud and how much public cloud space we’ll need is an architectural challenge. Anytime anyone needs an environment, resource, or an IT service, it's now automated and it can be deployed. Right now, we're a private cloud, so it's on-premises, but it's deployed using virtualization technology.”
 Brian Lancaster, Nebraska Medicine Vice President of IT

“We had several thousand servers, both physical and virtual. Some of them were running Windows 2000, Windows 2003. They were old and susceptible to threats and unable to be patched. We virtualized all those old physical servers and upgraded them. Now I can recommission those in a very easy way to have a warm standby. It helps with our backup and recovery and our disaster recovery, as well.”
 Tom Hull, CTO, Moffitt Cancer Center

Hybrid data storage:

  • With hybrid data storage model entities don’t need to choose between on-premise or cloud storage deployments. Instead, organizations may choose to store more bandwidth intensive data, such as images, on an on-premise server so they can be accessed quickly.
  • Hybrid solutions are important for data backup and recovery. Many cloud data storage solutions offer backup and recovery services which can also duplicate on-premise data into the cloud so in the event of a disaster where the on-premise server is compromised, the data is not lost.
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