How to Build an EHR System

You would like to build an EHR System or EMR software, now what? Start with this case study from the EHR developer Belitsoft International LLC. It's about how we developed a custom EHR System for an American investor (due to the NDA, we will call him Dr. Smith). This medical record system has now been successfully developed and implemented into his partner's clinic.

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We create/customize and implement HIPAA/GDPR-compliant EMR/EHR applications and other healthcare software solutions like insurance claims processing software and medical store inventory management systems for healthcare businesses from the USA, Canada, Israel, the UK, and other European countries.
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Executive Summary

Modern EHR or EMR 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”).

There are differences between EHR (Electronic Medical Record), EMR (Electronic Health Record), and PM (Practice Management) software.

EHR/EMR software has a clinical focus while PM software focuses on the administrative side of operating a practice (scheduling, billing, claims processing, etc). Savvy managers of medical practices implement integrated EHR/PM software that combines electronic health records and practice management capability.

Yes, in the nutshell, EHR or EMR is a digital version of a patient's paper medical chart. But there is the key difference. It matters because EHR applications include more features and integrations than EMR ones, and thus require more investment to develop.

The difference, according to the U.S. Department of Health and Human Services, is that the core function of an EMR is storage while an EHR is more about integration and access to the storage using interoperability standards (such as HL7 FHIR). In fact, we talk about so-called "API-enabled EHR database".

Beginning in 2019, 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. Of course, given that the EHR has been properly selected/implemented or developed/deployed, and maintained.

✅ What is the fastest way to build an EHR system for healthcare organization?

The fastest way for healthcare organizations: implementation of a ready-to-use EHR application (whether commercially licensed EHR or open source EHR) and its further step-by-step targeted on-demand customization (changing user interfaces, creating specialty-specific templates (for orthopedic EHR or other specialities), adding integrations with practice management system, picture archiving system, referral management system, labs, billing, patient portal, etc. or meeting the requirements of an external system).

Not every ready-to-use electronic health records program is ready for cost-effective customization. An experienced EHR consultant could be helpful when selecting ready-to-implementation-and-customization EHR system or company that sells electronic health record systems tailored to your business needs.

✅ What is the fastest way to build completely new EHR platform for medical startups?

The fastest way to start EHR business and get the seed-stage funding: the minimum viable product (MVP) of an EHR system, the EMR prototype, and the Proof-of-concept (PoC) of an EHR computer software.

✅ How to build your own EHR system?

EHR development from scratch is the way for healthcare organizations and medical startups who would like to build their own web-based EHR system. This option seems to be the only available way when you need to get full control over your EHR software features including user-friendly design, scale your system as your business grows or to enter a market with a new EHR system. With your own custom EHR you don’t need to pay license fees and don’t have "per provider" access restrictions, and you are protected from switching / changing EHR system (relevant for healthcare providers).

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.”
  • “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.”
  • “We are wishing to jump from paper-based medical notes to electronic. We 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 our practice grows.”
  • “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!"
  • “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”.

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.

Where to Start: Quick Tip

Formulate your idea in a request for information. In case you would like to create a new EHR system describe the scope of an EHR project. The initial request for proposal often looks like this:

  • "We are a rapidly growing EHR 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 an EMR system for our hospital. How much will it cost?"
  • "I would like to discuss the development of an EMR/EHR for my group practice of specialist physicians. Can we arrange a call to discuss a possible partnership?"
  • "We currently have a paper system and would like to upgrade to EMR software. What would be the cost of its development?"
  • "We are searching for 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 would it cost to deploy and maintain such a system?"

Cost of EHR development for Dr. Smith

Dr. Smith expressed interest in our EMR development services for the following reasons: proven experience in working with healthcare domain; competitive pricing; good reviews and references available online.

Dr. Smith wanted to know how much it would cost to create his custom EHR system and see examples of EMR systems we have developed in the past.

In many cases, each customer has their own very specific requirements, which cannot be met out of the box by any Electronic Health Record Platform. The main reason Dr. Smith gives for creating his own EHR systems is his needs are so specific that they are not met by any proprietary EHR or open source EHR.

34% (the Physicians Foundation, with the assistance of Merritt Hawkins, 2018) or even 40% (The Harris Poll on behalf of Stanford Medicine, 2018) of doctors claim dissatisfaction with their EHR's design/interoperability issues. Unfortunately, doctors are typically the most overlooked in an EHR implementation. To avoid this we always advise our customers to help us clearly identify needs and requirements of doctors to inform our EHR design and development team before the estimation process begins.

After the NDA was submitted, our EHR Business Analyst talked to Dr. Smith on a video call and asked detailed questions on features of his EHR system to estimate the development costs for each function.

After all the questions had been answered, the information was passed to our Senior EHR Developers. They prepared the “Use-Case Based Requirements Specification” with interactive Axure prototypes.

Based on mentioned documents our proposal included detailed descriptions of all the features and detailed estimation.

Just as Rome wasn’t built in a day, no enterprise-wide EHR is implemented overnight. When introducing the new EHR system, expectations must be clearly communicated to ensure the EHR system will be easy to use effectively and develop within budget. The biggest time waste during EHR implementation is developing features that are not currently required. To avoid this, it is crucial to have a hierarchy of goals.

We suggested to split the EHR project development into three main phases in accordance with his hierarchy of goals:

  1. Proof of Concept (POC). At this stage, we suggested to create the basic elements: the general structure of the EHR system, authentication, and patient management. Within this phase, Dr. Smith in a cost-effective and timely manner could evaluate our performance and saw the first results.
  2. Minimum Viable Product (MVP). At this stage, we suggested to create the scope of work and prototypes for the things that had not been specified in detail earlier but were required before implementation, for example, Admin Panel.
  3. 'Phase 3'. At this stage, we suggested to create the functionality that was not mandatory for the MVP.

The final estimation based on the hierarchy of goals was presented via a video call. Dr. Smith invited his own technical specialist to evaluate our EHR team’s skills in the real time.

The budget was approved and the contract was signed.

Agile Model Driven Development of Electronic Health Record

The Agile software development process was chosen because the Client wanted to build a large and complex software product while being 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 the Belitsoft office just once before the development process began to get acquainted with the Belitsoft management and development team.
  2. The EHR 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 the 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 BA 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.

EHR System Architecture

The project development team used the modern Service-oriented architecture (SOA) as the interoperability approach to architecture design. The application is split into several modules (services) and these modules communicate with each other via REST API. This type of architecture provides great possibilities of scaling, fault isolation and maintenance. 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 leading hospitals and healthcare systems.
3) Frontend: web admin panel based on React.js for form templates and User Management.

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 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.

This system has now been successfully developed and implemented into his partner's clinic.

Medical Scheduling module

We've developed a medical scheduling module for this EHR system. This module is easily integrated with billing and practice management modules.

Below see a use case of a receptionist checking a patient in.

Medical Scheduling System 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.
Medical Scheduling System 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.
Doctor Booking Appointment Dashboard in the EHR system 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.
Doctor Booking Appointment Dashboard in the EHR system 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.

Patient Charting Module in the EHR system 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.
Starting New Encounter Form in the EHR system 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.
Filled Encounter Form in the EHR system 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.
Patient Examination Form in the EHR system 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.
Patient Billing Form in the EHR system 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. 

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 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

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.

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 implementationHIPAA/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.

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 from the EMR software companies.

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.

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 Top open source EHR systems (or medical software with EHR features) by monthly keyword search volume (Google USA, Semrush).

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.

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Deputy Business Development Director at Belitsoft
I am a customer’s advocate and an expert in Healthcare IT.
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