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Even though over 96% of non-federal acute care hospitals have adopted an electronic health record system, there is still a high demand for quality EHRs. Many health providers look for custom EHR software tailored to their operational needs. Their motives are clear – only custom EHR development can ensure maximum optimization and automation of internal processes.
Yet custom EHR software development is a large-scale project that requires lots of financial and human resources. When building an EHR system, you may need to engage a healthcare development company like Binariks to get the necessary expertise.
This guide shares some of our knowledge on how to create an EHR. Keep reading for more details on developing EHR systems.
Some benefits of EHR systems
Before discussing how to create an EHR system, let's discuss why you need it. EHR system development benefits every party, from software providers to patients. Here are the main advantages for each group:
- For software providers. Companies that create EHR software enter the field with continuous demand for innovative systems. The electronic health market is steadily growing at a CAGR of 3.30% to reach 33.69 Billion by 2030. Thus, a reliable multi-functional EMR/EHR system will always find its users.
- For hospitals. Hospitals using electronic health records optimize many processes through automation and enhanced data management. Regulatory reporting also becomes easier as transparency increases.
- For medical teams. Doctors have all data about patients collected in one dashboard. It allows them to make informed treatment decisions and collaborate with other medical teams. Besides, many latest EHR systems leverage predictive analytics to support diagnostics.
- For patients. Patients get more influence over the treatment process thanks to easy access to their records. Most importantly, building a custom EHR system enhances the overall quality of healthcare services, which directly benefits those who use them.
- For governmental agencies. The government has encouraged EHR adoption by all means since it makes the healthcare industry more centralized. All interactions between healthcare providers, patients, and other parties involved are recorded.
- For researchers. Transition to electronic systems supplies researchers with large volumes of data they can use to estimate different treatment approaches and outcomes.
It's worth noting that the benefits of custom EHR system adoption and off-the-shelf solutions differ. Both provide revenue cycle management, interoperability, mobile access, artificial intelligence, and telemedicine EHR software development to reduce expenses. Custom platforms are generally more effective since they are designed specifically for your organization. It means they have only the necessary functionality, smoothly integrate with the services you currently use, and have the required level of scalability. Even though ready-made solutions cover the standard needs of a healthcare organization, you will face limitations when using them long-term. Off-the-shelf products won't ensure enough flexibility to modify your electronic medical record system as your needs change over time.
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Typical EHR system architecture
Architecture is one of the primary things to map out when building an EHR system. It defines the functionality, usability, efficiency, and portability of the software. Hence, it's life-critical to do everything right at this stage.
Check out the main components and structure of an EHR architecture below:
User interface
UI is a fundamental component of almost any clinical application, including EHRs. Its primary task is displaying and entering patient health records. The user interface also provides inputs to the clinical decision support system (e.g., records a recommended treatment) and displays notifications or clinical guidelines to users on behalf of the CDSS.
Record services
Record services are responsible for managing patient health records. They interact with the UI and CDSS components to enable data entering, health records search and retrieval, data extraction, and exchanging records with other systems and applications.
Terminology services
Terminology services represent events that happen in the real world by managing the database. It's called semantic interoperability and implies using clinical terminology codes to exchange information between multiple systems. Terminology services interact with CDSS and perform processes like installing or updating SNOMED CT from release files or querying concepts.
CDSS (Clinical Decision Support System)
The clinical decision support system encompasses multiple tools that provide clinicians, staff, patients, and other entitled parties with relevant information (output). The CDSS interacts with all main EHR components to execute the decision support logic.
CDSS (Clinical Decision Support System)
As you can see from the image above, the EMR user interface interacts with the record services to enter and store health data. It also provides input to the clinical decision support system and displays alerts based on the CDSS output. The CDSS processes the input from terminology and record services to identify whether the CDS conditions are met, and the response (alerts or knowledge resources) can be delivered back to the user interface.
Planning to create an EHR system or modernize the existing one? Look how we can help! Learn more
Must-have features for EHR systems
Functionality is another critical aspect of this "How to develop an EHR system" guide. Although custom EHR software development implies you can add whatever feature you want, some functions are essential. So make sure to focus on them when you build an EHR system.
Intuitive user interface
EHR systems connect multiple users with different levels of computer proficiency. Therefore, they must be simple to use. Always create software with standard UI logic, intuitive navigation, and clear design.
Electronic document management
Convenient document management is the primary task of any EHR system. When you start to create your own custom EHR, be sure it reads multiple document formats and automates routine document management.
Informative profiles
Provide healthcare teams with all-in-one patient profiles where they can view detailed information about a specific person. Such profiles usually include demographic data (name, age, sex), medical information, lab tests, medication, treatment plan, insurance, and other info. Patient profiles allow everyone who provides health services to the patient to stay on the same page and synchronize their efforts.
Task management
Build EHR software using algorithms that enable manual and automated task distribution. It will allow you to organize the work of everyone using the system and optimize their performance. Clinicians will engage with patients instead of doing administrative tasks.
E-prescribing
Add a section that contains all prescriptions to increase the visibility of the patient's health. It must also enable physicians to prescribe drugs remotely and forward this information to drug stores. The e-prescribing portal may include information about side effects and doses to help medical teams with decisions.
Patient portals
Give patients access to their treatment details and personal information to keep them updated. Some electronic health record systems enable patients to message clinicians or arrange a direct video call for consulting.
Charting and documentation
The healthcare industry is strictly regulated and requires lots of documentation to prove compliance. Documents are also necessary for insurance claim processing and patient management. Thus, you must be able to generate detailed documentation and charts for each patient's case automatically based on the data that enters the system.
Instant messaging
Messaging capabilities allow medical team members to communicate more efficiently within the system. You may even integrate an online chat option to connect patients and clinicians directly. This feature will considerably simplify communications and information exchange.
Appointment scheduling
An in-app calendar enables patients and administrators to schedule meetings with physicians based on available slots. The system automatically records these meetings to organize the work of medical teams. Read also: EMR appointment scheduling .
Comprehensive reports
Implement tailored reports to cover the most common cases when patients or clinicians may request information. PDF format is the industry standard for reporting, so you may need HTML to PDF conversion for implementation.
Integration with labs
Integrate your system with associated labs to instantly upload test results and start treatment as soon as possible. It will speed up the treatment cycle and benefit the quality of care.
Access control
How to develop an EHR system that is secure? Create software with granular user permissions to control who can access data and under what conditions. It will also allow you to redistribute tasks among various teams to avoid confusion.
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Additional requirements and modules for EHR system development
There are several additional requirements and services to implement besides the listed functionality. Security is the first one. Every quality EHR system has multiple security measures, including automated session termination, data encryption, data signatures, and multi-factor authentication. They minimize the risk of data breaches and ensure that only authorized users access records.
As to additional modules to use with an EHR system, we recommend implementing the following solutions:
Medical billing module
Connect your EHR with a billing solution to efficiently handle payments and reimbursements. It will enable you to generate invoices, track payments, compose and send claims to insurance providers, view claim status, automatically code patient information, verify eligibility, and optimize finance and insurance management operations in many other ways.
Telemedicine module
Integrate your system with telemedicine software to offer patients high-quality video and audio consulting. They will be able to talk to a doctor right from their account to discuss treatment options and other concerns. For ultimate convenience, the telemedicine module should also support screen sharing, consultation notes, and scheduling.
Voice recognition capabilities
A speech recognition system integrated with an EHR allows information input through voice instructions. It also enables medical teams to navigate electronic health records using voice commands. Note that such a solution may require using headsets to improve voice recognition accuracy.
With additional modules, you can expand the functionality of your system and adapt it to the needs of end users. They are usually not included in the core functionality as not every healthcare provider wants such features.
Technology stack for an EHR system
The tech stack to build your own EHR product will depend on what capabilities you want. Still, there are some common choices for frontend, backend, and integrations Binariks uses for our customers. They are necessary to implement the core functionality of electronic health record systems.
Backend development
Backend engineering involves building the database layer of the EMR system where the most critical data processing operations happen. Laravel and Ruby are the top choices for backend mechanics, among other technologies:
| Programming language | Ruby, Elixir, Python Laravel, PHP, Java. |
| Database servers | PostgreSQL, MySQL |
| Web frameworks | Ruby On Rails, Phoenix |
| Web servers | nginx or Apache |
| Hosting | AWS |
Frontend development
Frontend includes all software elements EHR users interact with, namely the UI of the patient portal and internal system. The top choices for building an intuitive user interface are Javascript, HTML5, or CSS3. Check out other technologies used in the table below.
| Web platform | iOS platform | Android platform |
| Programming languages: JavaScript, TypeScript | Programming languages: Swift 5, Objective C | Programming languages: Kotlin, Java |
| Markup languages: HTML 5, CSS | OC: Mac OS X (last version) IDE: Xcode 11, App Code | OC: Ubuntu IDE: Android Studio |
| JS frameworks: Angular, React, Vue | SDK: iOS SDK, Cocoa Touch | SDK: Android SDK (last version) |
Integrations
Besides the main tech stack, you may need APIs for connecting external and internal interfaces as well as third-party services. Here are some APIs to consider while developing EHR systems:
| Functionality | Solution |
| Analytics tools | Google Analytics, Flurry, Firebase, Mixpanel |
| Payment gateway | Stripe, Paypal |
| Social media integrations | Facebook, Instagram, Twitter |
| Delivery | FedEx, EasyPost |
| Maps and navigation | Google Maps, Google Places |
| Forms | Form API, Formidable Forms API |
| Insurance | Onederful |
| Communications | RingCentral API, TrueConf API |
| Schedules | PostHook API, SimplyBook.me API |
Overall, the selection of integrated services depends on what functionality the final product must have. Nowadays, you can connect basically any feature, and there are hundreds of add-ons to choose from.
Growing technological trends for EHR systems
Custom EHR software development companies that pursue innovations power their systems with machine learning and AI. These technologies bring advanced functionality and additionally improve the performance of medical teams.
For instance, machine learning can facilitate data mining in medical systems. It processes the accumulated data sets to round up relevant information and support decision-making. ML also simplifies medical research by gathering relevant information across multiple EHR/EMRs. Apart from data search and extraction, ML and AI technology enable predictive analytics, natural language processing, medical transcription, smart report generation, and data visualizations.
Thus, if you want to create a solution that offers more than its alternatives, machine learning and AI capabilities can help you with that. Of course, the software development process will be more complicated in this case, but the resulting functionality will exceed end users' expectations and turn you into a market leader.
What to consider when building an EHR system
Despite the tech aspect of building your own EHR being the most critical, you should consider many other subtleties. Like any healthcare application, electronic health records systems must be compliant, certified, interoperable, and meet several other requirements.
Compliance with regulations and standards
Every healthcare tech business entering the US market needs to achieve HIPAA compliance. The Health Insurance Portability and Accountability Act regulates the security of personal health information processed by software and gives patients more control over their records. It outlines physical, technical, and administrative safeguards software providers and adopters must implement to stay compliant.
Apart from HIPAA, your EHR solution may have to comply with GDPR (for serving European users), the HITECH act, FDA standards, HL7, DICOM, and other applicable regulations.
Interoperability and data transfers
Every component in your system must smoothly exchange data with other connected services. You need to follow FHIR or other HL7 interoperability guidelines to achieve this. They can guide you on standardizing data formats and implementing flawless data sharing.
Also, note that you may need to migrate data from legacy systems used in the healthcare organization that moves to a newer EHR. It usually creates additional difficulties due to unmatching or outdated formats of data records. Read more: FHIR Implementation Plan .
Mobile-friendliness
A web platform is the main electronic health record software version since medical teams usually use EHRs on their desktops. However, the platform should also work on mobile devices or have separate versions for iOS and Android. Mobile-friendliness has two significant benefits. First, it makes EHR more accessible to patients who can use telemedicine features or check information from their smartphones. Second, healthcare teams become more mobile. They can respond to urgent issues from anywhere, be it a hospital lobby or patient room.
Certification
Once the custom EHR is ready, you must certify it to verify the quality and reliability of the solution. For US-based companies, ONC-ATCB (Office of the National Coordinator - Authorized Testing and Certification Body) EHR certification is required . Those who operate in the EU need to go through EuroRec certification. These are basically the same but intended for different markets.
Performance analysis
Evaluate the return on investment and efficiency of the developed system to learn whether your investment pays off. The estimation will show how to improve the EHR and what additional capabilities are necessary. You may also assess patients and physicians' satisfaction.
Approximate cost of EHR system development
The cost of EHR development varies depending on the system complexity and the size of a healthcare organization. While for small practices, the price tag is hundreds of thousands of dollars, in large healthcare facilities with many departments, it may reach even millions. Thus, the surest way to estimate the cost of a custom EHR is to contact a software development company like Binariks. You only need to fill in the form to get a response and learn approximate pricing.
When you implement a ready-made EHR, the initial costs are lower, but you will need to pay a fixed monthly subscription for years. According to the official Health.IT estimates , the annual fee for in-office systems is $4000, while off-the-shelf SaaS solutions cost $8000. The cost of purchasing an EHR system and installation ranges from $15,000 to $70,000 per provider. On-site deployment is usually more expensive than cloud-based SaaS EHRs.
Do you need an EHR system development team?
EHR system development requires a lot of experience, so you'd better delegate it to professionals. If you decide to do everything in-house, you will need to assemble an engineering team yourself, which increases spending and time to market. You are also more likely to make mistakes and create solutions with performance, interoperability, or regulatory issues.
When you hire developers from a custom healthcare software development company like Binariks, you secure yourself from trouble. We rely on years of experience to design a tailored EHR development and implementation plan for you. Binariks will provide the necessary specialists from our talent pool shortly to start working on your project within weeks.
Binariks can assist you with any tasks from full-stack development to MVP creation or consulting. You get a partner that will stay with you during all EHR development and maintenance stages. Contact us now to discuss your project.
Final thoughts
A custom electronic health system allows healthcare organizations to achieve much better performance than third-party EHR solutions. Such software is tailored to the business and operational needs of a specific organization. Even though the initial investment is high, the maintenance cost is much lower, which cuts expenses in the long run. You won't need to pay a subscription fee and, most importantly, have only the features you actually use.
Yet you must note that custom EHR development or even implementation of third-party systems may be challenging without expertise. You need skilled software engineers and tech specialists aware of healthcare regulations, interoperability standards, implementation subtleties, and other nuances. Thus, outsourcing to an external provider is an optimum choice for most businesses investing in EHR development.
