EHR Development: Powerful Tips for Modern Healthcare Solutions
EMR and EHR software development is being utilized more and more extensively by the healthcare sector. As of May 2020, the software has proven to be an especially hot topic during the COVID-19 pandemic.
The definition of EHR is a real-life, patient-centric record with immediate and secure access for permitted users. Grand View Research states that the global EHR software market was worth $20.4 billion in 2018 and is expected to reach $33.294 billion by 2023.
The first systems resembling EHR software were created in the 90s by Lockheed Martin Corporation, which is currently a part of Allscripts Healthcare Solutions. The company produces EHR technology for healthcare providers and practices.
These days, EHR technology has become an advanced system that collects, interprets, and manages data for quick treatments, medical prescriptions, and more. The application of EHR development has a lot of potential and this article will tell you about this process in detail. The following aspects will be unveiled:
- essential functionality to build during EHR software development
- important aspects of EHR design
- vital consideration of EHR development in terms of regulations and security
- top EHR software, as examples to learn from
Let’s get straight to the insight!
Facts & Benefits of EHR Software Development
Let’s first clarify the definitions of EHR and EMR. The term EHR is sometimes used interchangeably with EMR, but there is actually a difference.
The EMR and EHR definitions are as follows:
Electronic medical record (EMR) - a term referring to the digital patient information of a particular medical institution. The data includes treatment history, visits, diagnoses, and other information related to the patient card.
Electronic health record (EHR) - a term that refers to digital information about a patient that is more extensive and can be used and shared among medical providers. The health data includes patient treatments, health conditions, symptoms, prescriptions, as well as some clinic management functions like billing and scheduling.
Therefore, EHR software development provides more extensive possibilities for hospitals and medical institutions.
The electronic health record may contain the following information:
- patient demographics
- insurance information
- medical history and orders
- health assessment notes, graphics, health vitals
- medical tests, lab results, radiology images, etc.
- prescriptions and treatment plans
- statistical data of medical practices
- billing and other information for patient management
So, how does EHR work?
EHR software systems work in a simple way. The healthcare professional enters information about a new patient into the system, which then creates a specific digital record. This record represents a patient card, where current health state can be updated and expanded in real-time.
Computerization of medical data and EHR development provide lots of benefits for both medical providers and patients.
Patients can benefit from EHR software in a few ways, namely:
- track and store personal healthcare data easily
- obtain enhanced and on-time medical care
- receive a faster and better diagnosis and further treatment
- have fewer errors in personal healthcare records
- deal with health concerns in a cost and time-efficient manner
- receive personalized reminders and appointments
- access interactive patient portal
Practices and healthcare providers receive the following advantages from EHR development:
- increase in practice and clinic efficiency and productivity
- simplification of work for medical personnel
- improved quality of medical services (e.g. advanced e-prescription capabilities)
- unified and up-to-date digital medical data
- interoperability across different healthcare specialists and departments
- smooth and consistent interaction across other hospitals, laboratories, drug stores, insurance providers, and so on
- possibility of remote patient monitoring and consultations
- reduced bureaucracy
- elimination of errors
- better patient management
- possibility to collect and evaluate patient data for studies, improved service, and more
- ability to handle administrative tasks and billing
EHR software development maintains a lot of advantages and this list can be extended. All in all, digital medical records are known to be reliable, easily accessible, and unified across medical professionals, practices, and patients.
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Essential Functionality in EHR Development
Now that we have checked out the uncountable advantages of EHR development, let’s have a look at the functionality and tech aspects.
Based on the specifics of the healthcare provider, the functionality of the EHR system can be customized to suit their direct needs. This can be utilized in the following medical projects:
- Medical schedulers
- Apps for wearables
- Software for charting and reporting
- E-prescription tools
- Telemedicine options
- Patient portals
- mHealth applications
As for the functionality involved in effective EHR development, here is a detailed list of EHR features that can be included in this software.
- Seamless system integration
Since EHR development implies that handling of lots of medical data across different medical establishments, it is vital to consolidate a range of systems and services that exchange this data in real time and on request.
The integration time during the EHR development process depends on the number of integrations and their complexity, like:
- HIS (Hospital Information Systems)
- Billing and reimbursement services
- Documentation systems
- Integration with laboratories, pharmacies, diagnostic centers or similar
Other third-party APIs
Electronic documentation management
Information should be structured well and easily accessible for practitioners, patients, and other parties. EHR development with a charting possibility is practical for presenting information. It would be useful to have custom EHR templates for information that suit a particular hospital’s needs.
The importance of this EHR feature lies in quicker patient treatment and the tracking of necessary medication. The practitioner can make quicker decisions for medication, while the patient receives a prescribed medicine from the pharmacy. As an advanced functionality of EHR development, it is possible to check the medication for interaction between drugs, allergy alerts, potential side effects, etc.
The process of e-prescribing is verified by a practitioner and sent to the pharmacy vendor. In its turn, the medication order is arranged and can be delivered to the patient. At the same time, the patient’s record is updated based on the medicine being prescribed.
All these processes are conducted digitally. The diagram above is a high-level view of the processes and roles involved in electronic drug prescriptions.
- Digital test and lab results
Health test results are obtained electronically from external vendors. So, during EHR development, the system should connect the practice with laboratories and diagnostic centers, notify patient and doctor about received results, as well as enter the corresponding information into the EHR system.
- Medical dashboards
Medical dashboards allow for the illustration of treatment results, processes, and medications for a particular patient. The dashboard also generates some statistical information and related charts.
- Time management and scheduling
Medical staff, and primarily the doctors, need to have the ability to optimize their time to increase productivity. As well, doctors and nurses should set appointments to organize their workload effectively.
- Management of access control
It is necessary to define and control access to the system on different levels. Medical personnel should only have access to the information that is within their responsibility. This enhances the overall system’s security.
- Report generation
It is important to have the ability to create reports with particular information like procedures, medication, demographics, and more. It also makes sense to have the ability to generate administrative and clinical data reports for analysis and further work enhancements in a clinic.
On the patient side, EHR development can also include the following functionality:
- Patient profile and portal
Clearly, if the EHR development assumes that users are patients, so it is necessary to create personalized pages. These profiles may contain personal data, medical history, and health records.
As well, it makes sense to store all the patient information in the cloud. Utilization of cloud services allows users to access data from any portable device. At the same time, EHR development with a cloud solution can be implemented in a highly encrypted and secure way.
Basically, the patient should be able to check the following details:
- lab tests and results
- treatment history
- billing and payment information
- prescriptions and medications
For more advanced EHR development, it is possible to add other distinct features, namely:
- requests for medication renewal
- payment and transaction-connected functionality
- inclusion of educational materials for patients
- ability to chat internally with health care providers
Specific Features of EHR System Design
The design, as a part of EHR development, plays a crucial role. It is necessary to create the EHR design via the lens of human information processing and perception. Then, designs indeed contribute to intuitive and smooth software function.
Therefore, keep in mind the following considerations during EHR system design creation:
1. The EHR design process should be iterative
Great EHR designs focus on user needs initially, which is why it is also important to have a well-planned software concept and detailed functional documentation.
The documentation should be based on user reflections and needs. For a better outcome, it is highly advisable to have a consultation with doctors, nurses, patients, and other parties involved in the system beginning in the early EHR development stages.
Then, the designer, along with the dedicated EHR software development team, finds the right direction for intuitive EHR data representation in design with great functionality.
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2. Easy documentation and reporting layouts for practitioners
Since the software deals with a great amount of data, the EHR usability in this regard is very important. So, try applying the following hints, namely:
- remove unnecessary checkboxes
- optimize fields for filling in information
- remove data replication
- use voice commands for texting (advanced feature)
- apply easy-to-use templates and forms
- create pre-defined drop-down fields (e.g. medication orders based on the diagnosis)
Practitioners should be able to document and report information easily. One of the top challenges in EHR development deals with physician frustration regarding complicated and non-user friendly software. Built-in shortcuts and search intelligence can help to limit work with documentation. Then, practitioners can spend more time with patients and do their direct duties.
Moreover, the data should also be standardized across the whole system so that it has the same patterns and unified terminology. The International Classification of Diseases, Ninth Revision or Tenth Revision (ICD-9 or ICD-10), Systematized Nomenclature of Medicine (SNOMED), National Drug Code (NDC), and other dictionaries can be used for proper documentation in EHRs.
3. Well-thought-out processes, roles, and responsibilities
The EHR workflow should start with review and update (if any) in the patient’s medical history. This can be smartly delegated to the patient before they visit the practitioner. As well, doctors should not be overwhelmed by tasks. Rather, the system should give permissions and direct tasks to nurses and other medical staff to perform their part of work.
A smart notification system and visual alerts will help to manage the EHR software by the corresponding party at the necessary time.
4. Patient-centric view in EHR design
Modern EHR programs take the patient story as the core of the service. All the data should be available, easy to digest, presented in chronological order, and understandable for both the doctor and patient.
5. Involvement of the developers for feasible EHR screen design
The platform and its scalability should be considered during the EHR design stage. The involvement of developers allows for the avoidance of inefficiencies and costly changes on the way, and it can improve a product’s operability and speed.
To summarize: Keep the EHR design as simple as possible; intuitive, relevant, and with an appealing color scheme. As well, the EHR screen design should be responsive to mobile and other widely-used devices in hospitals (e.g tablets). Last but not least, always think about the constant product improvement being showcased through the EHR design.
How to Build an EHR System
To build an EHR system effectively, you have to find a reliable software vendor and be prepared to get involved in every stage of EHR custom software development. In this section, you’ll learn about a model of collaboration with a vendor on the example of MLSDev procedures.
Stages to Create an EHR System
If you hire MLSDev as your EHR software development company, our collaboration will run in two stages: Discovery and Development.
During the Discovery stage, you get the finalization of the EHR software system in terms of business needs and technical implementation. As well, our team will roughly estimate the cost of EHR software development and your project duration.
Once the Discovery stage is completed, you can receive the following deliverables:
- Finalized project concept
- EHR system design (UX/UI)
- Product backlog
- Functional specification
- Project architecture plan
- Market and competitor analysis (on demand)
- Rough software development cost and timeline breakdown
On the Development stage, your plan goes right into the EHR system implementation.
During the Development stage, a cross-functional team is allocated to the project. The project work is organized and guided by a project manager. Depending on the system specifics, you may get a team consisting of:
- 1 x iOS developer
- 1 x Android developer
- 1 x Frontend developer
- 2 x Backend developers
- 2 x Quality Assurance engineers
- Project manager
- Business analyst
Then, working in accordance with agile software development methodologies (e.g. Scrum), we will bring the project to life involving responsiveness, high performance, and top-notch security.
To add, when you hire healthcare app developers from MLSDev, as an EHR software development company, you get special attention to your changing needs.
Cost to Develop EHR System from Scratch
When thinking about how to build an EHR system, the first thing you should know is the hourly rate. If you consider the average hourly rate in the Eastern Europe region (Ukraine - $40 an hour), the cost to create an EHR system will start from $60,000-$150,000 for the first working version for one platform (iOS, Android, or Web).
The cost will greatly depend on its concept, functionality, development approach, and chosen IT vendor.
If you are interested in developing a fully-featured project consisting of multiple platforms (iOS and Android), a user panel, a doctor panel, admin, and complex functionality, the price to develop an EHR system can begin at $300,000+.
So, the final cost to develop an EHR system depends on the following aspects for you to decide on:
- the complexity of the design
- the number of platforms
- the number of features
- the purpose of the software (e.g. help the elderly people)
Having a notion on these factors, you can get to the stage of cost calculation.
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Tech Stack to Build an EHR System
Custom websites are those developed from scratch. In terms of the technical filling, a custom website consists of front-end and back-end parts, which are interconnected with the help of API (Application Programming Interface).
1. Front-end - this part includes all the elements that the user interacts with. This is the client side of a product that represents the user interface and experience design of the EHR system.
The table below lists the most common technologies used for a distinct project platform.
|Web platform||iOS platform||Android platform|
|Markup languages: HTML5, CSS3||Programming language: Swift 5 (preferred), Objective C||Programming language: Kotlin (preferred), Java|
IDE: Xcode 11, AppCode
|Development OS: Ubuntu, Mac OS
IDE: Latest Android Studio
2. Back-end - the server side of the EHR system that works with information and corresponds to the place where the main service functions are performed and transmitted with the necessary results on the front-end.
The tech stack for back-end development is as follows:
- Programming languages: Ruby (recommended), Elixir, Python, PHP, Java, etc.
- Web frameworks: Ruby On Rails (recommended), Phoenix
- Database servers: PostgreSQL (preferred), MySQL
- Web servers: nginx (preferred), Apache
- Cloud server platforms: Amazon Web Services (AWS, EC2, S3, etc.)
3. API (Application Programming Interface) - a set of commands to connect the front-end and back-end, as well as integrate other necessary third-party services to empower the service functionality. Different types of electronic health record systems will need different sorts of API based on the required functionality.
The following table includes the possible services that can be integrated when you create an EHR system.
|Payment gateways||Braintree, Stripe, PayPal etc.|
|Social media integration||Facebook, Instagram, Twitter, etc.|
|Delivery services||EasyPost, FedEx, etc.|
|Analytical tools||Flurry or Google Analytics; Firebase or MixPanel, etc.|
|Maps & Navigation||Google Maps, Google Places|
|Email marketing integration||MailChimp, etc.|
|Healthcare APIs||Insurance: Onederful|
|COVID-19 APIs||COVID-19:Dataflow Kit COVID-19 Tracking, COVID-19 Stats, CORD-19|
|Medical records||Patient Knows Best FHIR|
|Forms||intakeQ, Form API, Form CheckUtils API, Formidable Forms API|
|Scheduling||YellowSchedule, Walgreens Clinic Appointment Scheduler API|
|DaaS (data as a service)||Innoplexus Publications IndexView, Innoplexus QueryParser Analyse|
|Education||Stanford University HIVDB GraphQL|
|Video Conferencing||StarLeaf Cloud API, SightCall API, TenHands API, AuraLink API|
|Logistics||Kwik Delivery API, Contentful Delivery API, Dropbuddies Delivery API, Postmates Delivery API|
|Chats||SnapEngage Chat API, Banckle Chat API, MessageBird Chat API|
|Schedules||W3C Cooperative Scheduling of Background Tasks API, Posthook API|
How to Find and Hire an EHR Software Development Company
Interested in knowing how to find a reliable software vendor?
We recommend trying outsourcing options. Regions like Eastern Europe are beneficial in terms of low rates and a high level of tech professionalism. For example, in a country like Ukraine, you can find an EHR software development company that will offer very reasonable rates ($40/h).
The benefits of hiring a team in Ukraine are broad. Aside from the advantage of cost-saving, you get high security, reach out to top experts, a broader skill set, quicker process organization, higher development speed, and better risk management.
The process for hiring a dedicated development team is simple:
- Do your homework (prepare a project description, business goals, technical requirements, budget expectations, pre-screening questions)
- Prepare a list of teams
- Run company screening
- Analyze the information on companies
- Select a team that best suits your needs
- Hire a team (prepare the non-disclosure agreements, sign a contract, discuss the deliverables)
- Arrange communication and collaboration procedures with a team
Note: before you hire a team, it is important to learn if an EHR software development company has well-established processes for software coding, testing, and information protection. To know this, you have to check:
- Code review practices
- Technology version control
- Security practices
- Documentation keeping
- The storage of vulnerable data
- Security of information inside the company
Elevated attention to security will pay off in time, as you will exclude the risk of data loss and information leaks, which is especially important when you want to create an EHR system.
Key Considerations in EHR Development
Now, let's discuss the important aspects involved in EHR development.
In brief, safety should be the top priority when dealing with EHR software development. For the privacy and security of EHR software, development should utilize data encryption protocols used for authentication, access, networks, trusted connections, etc.
So, consider the following aspects, regulations, and guides for EHR development, namely:
- Compliance with GDPR
The General Data Protection Policy controls collection and use of personal data in the EU such as names, addresses, demographics, and much more. This has direct applicability in the healthcare sector, whether public or private, where providers should ensure high protection of the data as well as incorporate a system to erase or correct information instantly.
- HIPAA and HITECH regulations
The EHR software program should be HIPAA (Health Insurance Portability Accountability Act) compliant, especially when targeting the US market. As well, HITECH regulations and FDA guides should be followed during EHR software development in the way the app is designed, programmed, and distributed.
Please note that regulations may differ by country and it is important to check them out in your target market before starting with EHR development.
- Proper EHR certification
1.The Centers for Medicare & Medicaid Services (CMS) presented the Meaningful Use (MU) program, which is a part of the HITECH Act. The intention was to promote usage of EHR in medical practices with the help of the EHR incentive program.
Meaningful Use implies EHR software certification, meeting the minimum standards of the US government. The process deals with a clear exchange of patient data between healthcare providers, insurers, and other parties. The process of meaningful use of CEHRT (Certified EHR Technology) consists of three implementation stages.
In the end, all CEHRT are entitled to the following aspects:
- protection of patient health information (ePHI)
- use of e-prescriptions
- application of the CDA - Clinical Document Architecture, the XML-based markup standard as a model for clinical documentation exchange
- usage of CPOE (computerized provider order entry)
- access to updated digital health information for patients
- utilization of CEHRT for better patient engagement and care coordination
- improvement in health information exchange (HIE)
- coordination with Public Health Agency or Clinical Data Registry for ePHI submission
2.ONC-ATCB is the initial certification (Office of the National Coordinator from Authorized Testing and Certification Bodies) for electronic health record technology in the USA. The certification body assists health organization with incorporating and updating their information technology.
3.As for EHR development for the European Union, the system should pass the EuroRec certification. This attestation is pretty similar to ONC-ATCB.
- EHR interoperability
Interoperability in the healthcare sector refers to what extent the systems, software, and devices are entitled to share, use, and expound data. The standard for this operation was created by HL7 with Fast Healthcare Interoperability Resource (FHIR).
This document is a guide for data formats, APIs, HTTP protocols, and more technical aspects with regard to EHR development. Some other standards like CCD, CCR, and CCA can also be used in the data exchange depending on the unique aspects of EHR software development.
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EHR Development & Blockchain Technology
Blockchain is a digital database that contains shared information or records of some data. These records, also called blocks, are linked together in a single chain. The system is decentralized, meaning anyone can get access to information. This can be very useful if you want to build an EHR system securely.
Blockchain is highly secure because each block is protected by the previous one, and the whole system is resistant to changes and offers secure data handling.
Depending on the type of your EHR software, using blockchain technology could help to improve a wide range of functionalities.
You can check where you can apply blockchain and develop an EHR system by learning more about this technology. How to create your own cryptocurrency is also a topic related to blockchain technology.
Here is a list of functionality that may be approved with blockchain:
- Secure storage of patient data – it gives shared access to patient data and allows users to handle it quickly while minimizing the risk of unauthorized access.
- Authenticity – since the data is secure, the chances of purposeful distortion are minimal. This is especially convenient when dealing with scientific projects and the intellectual property connected with clinical trials.
- Transparent prescriptions – the use of blockchain will help track prescriptions effectively and minimize the chances of fake orders. It might be very helpful to build an EHR system of improved effectiveness.
- Reduced risk of fraudulent activities – healthcare services, such as insurance, claims and donations, are sensitive to different fraudulent activities. Proper tracking, provided by the blockchain, may help you avoid corruption or misuse of funds.
- Secure billing – financial issues like fraudulent billing and fund losses are serious and can be prevented with the help of blockchain.
So, when implementing blockchain to develop an EHR system, you can benefit from the seamless tracking of patient data, funds, and medical devices. Additionally, you have secure payments and much more to make your EHR software more reliable.
Examples of Best EHR Software
Having a substantial market size of $28 billion in 2017 with annual growth, there are about 1,000 EHR service providers. The illustration below shows the top 5 EHR software programs according to Capterra report.
Let's briefly review the most popular EHR software programs.
1. eClinicalWorks is a top player in EHR development. It offers EMR, EHR systems, and practice management for healthcare providers. 70,000+ medical establishments in the USA use eClinicalWorks. Its EHR systems have great features for user engagement, telemedicine, monitoring, and management.
2. Allscripts Professional EHR is used for safer patient care, internal operations, and modernization for profit increases.
3. Cerner's Ambulatory EHR helps to furnish the necessary data at the right moment for clinicians as they provide ambulatory practices. Therefore, it ensures a better and quicker decision-making process, operation efficiency and safety, and great coordination across physicians, nurses, and so on.
4. Practice Fusion is the top, cloud-based EHR system across the USA and is used in 20,000+ medical institutions with 5 million patients monthly. This software provides easy-to-use functionality like charting and connection with laboratories with accessibility on portable devices.
5. EpicCare software allows healthcare organizations to enhance their operational effectiveness by automation. Clinical workflow, billing tracking, and payments are utilized well in the system . As well, it provides a tool for predictive analytics for better patient care.
Below is a table summarizing the information and specifics of the top 5 EHR software systems, their intentions, and unique aspects.
|EHR software||Target user||Device||Functionality||Pricing|
|eClinicalWorks||small to large healthcare providers||Windows
|- Appointment scheduling
- Compliance tracking
- Handwriting recognition
- Self-service portal
- Voice recognition
|Starting price $499.00/month/user|
|Allscripts Professional EHR||small to mid-sized physician practices||Web
Mobile - iOS (native)
|- Appointment scheduling
- Easy-to-use dashboard
- Compliance tracking
- Self-service portal
- Voice recognition
- Clinical decision support
- Streamlined admin tasks
- Financial functionality
|Cerner Ambulatory EHR||healthcare providers, employers, patients, governmental institutions||Windows
|- Appointment scheduling
- Quick-select charting
- Compliance tracking
- Patient portal & resources
- Voice recognition
- Dynamic clinical documentation tools
|Starting price $25.00/month/user
|Practice Fusion||from solo practitioners to large enterprises||Windows
|- Appointment scheduling
- Flexible billing
- Compliance tracking
- Self-service portal
- Voice recognition
- Patient portal
- Documents uploads
- Interactive & custom report
- Collecting billing information
- User access control
- Task and workflow management
|Starting price $99.00/month/user
|EpicCare EMR||large enterprises||Windows
|- Appointment scheduling
- Compliance tracking
- Self-service portal
- Predictive analysis
- Decision support tools
- Financial module
- Intuitive filtering tools
- Remote care
- Patient engagement
- Order management
EHR Software Development: Final Notes
EHR development, especially with regard to reporting apps in the healthcare system, will surely be a lucrative segment in the next few years. Web-based and mobile responsive EHR systems in the form of SaaS (Software as a System) provide benefits like improved data usage, backups, security, cost reduction, and work efficiency.
To start with EHR development wisely, it is necessary to undergo the following steps:
- Set up the exact goals for the electronic health record system
- Plan the EHR program adoption in the healthcare organization in advance
- Find the proper EHR software development vendor
- Create a detailed functional specification along with the chosen team
- Conduct polls and research within the target audience of your future software
- Design an intuitive and appealing EHR software program
- Develop EHR functionality in compliance with health industry standards and guidelines
- Consider incorporating technology innovations in consequent EHR software versions (Artificial Intelligence, Machine Learning, Big Data, Blockchain, etc.)
To conclude, the healthcare industry operates in an environment that is always changing. Do not forget to keep up with news regarding policies and software compliance, since cybersecurity and data protection is a core element in any EHR system.
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