If you are looking into developing an EHR system, Glorium has a range of expertise on the topic. We’ve compiled this guide based on the experiences of our healthcare clients. Continue reading to get your most critical questions answered and learn more about avoiding the pitfalls associated with developing an EHR system.
EHR, EMR, PHR, what’s the difference?
First, let’s define what an EHR system is and how it differs from other solutions that go by similar abbreviations.
There are three types of electronic health records and systems that support them:
Electronic Health Record (EHR) — stores the medical information of every client. The custodian is a specially authorized center (Health Authority). Medical records are official data and may be available to other authorized centers and similar medical services representatives, laboratories, government agencies, institutions, and so on. This information is shared across authorized institutions to provide a better and faster patient experience.
Electronic Medical Record (EMR) — stores information for a specific medical area (for example, dentistry). The custodian is a clinic or practitioner. EMR is usually an electronic version of the patient’s medical history at that particular institution.
Personal Health Record (PHR) — stores partial medical information. The custodian is the patient (or their representative, for example, a family member).
This article will discuss EHR systems – the most difficult to develop and with the strictest security requirements.
EHR system use cases
The most common use cases are responsible for developing a particular EHR system’s architecture. Here are the most common features that almost any EHR system should include:
- Patient account. Dramatically improves the patient onboarding process by allowing anyone to sign up for a doctor’s appointment, find any prescription information, and check on the laboratory updates.
- Electronic medical record. Allows for a) document medical examinations, including initial assessment, epicrisis, and diary entries, b) registration of patient diagnoses, and c) medical appointment registration and archiving of the results.
- Digital document workflows. From patient intake and medical consent forms to various agreements, every step of the client workflow has to be digitized.
- Patient insurance management. Improves the efficiency of working with insurance companies by automating business processes. This includes administering patients, prices, and services based on an individual insurance company.
- Laboratory accessories: direct integration. Assists with automating interactions with a laboratory and instantly imports all relevant data to a patient’s medical profile.
- Medical knowledge base. Provides any doctor with access to promptly updated official recommendations and well-established treatment and diagnostic standards.
An EHR system is intended to provide centralized access to the entire cycle of medical services for patients and doctors. This creates several benefits for every party involved:
- Doctors and physicians can access all information for a patient from one place. They can schedule appointments and access a patient’s medical history even if it were logged by other doctors.
- Patients get prompt reminders, notifications, and access to billing information. They can quickly sign up for an appointment without going to a clinic in person. Patients can easily access insurance cards and information.
- EHR implementation reduces the stress associated with the privacy and security of medical records and patient information for clinic administration and authorities.
Things to consider before planning EHR development
Several standard questions need to be answered by every client at the stage of project evaluation. Below are the most important ones to keep in mind.
Meaningful Use compliance when adopting EHR
“Meaningful Use” is the name for the Center of Medicare and Medicaid’s (CMS’s) EHR incentive program. It provides commercial benefits to medical institutions that use relevant EHR systems in meaningful ways to serve patients and healthcare providers alike.
Despite the fact that government incentives have already been depleted, it is still considered a standard and a minimal requirement for every EHR.
When implementing EHR, the stages for complying with Meaningful Use include:
- 40% of all prescriptions in your organization must be issued electronically via the EHR system at the first stage of Meaningful Use implementation.
- Stage two simply requires the use of e-Prescriptions for at least 50% of all cases where doctors had to issue them.
If the EHR system was designed correctly, you will easily exceed those numbers as all the chains of your medical organization will be integrated within a single EHR and can access the system using a single sign-on (SSO) with their local credentials.
HIPAA and GDPR compliances as guiding principles for EHR development
Today, being HIPAA and GDPR compliant is a must for any EHR system. You can object by saying that the latter is a requirement of the European Union only, and you would be right. However, suppose you were able to build a system that adheres to both regulations.
Both HIPAA and GDPR impose strict requirements on the processing, transmission, and storage of user information. Any modern IT architecture is built on a modular basis, based on microservices. Your engineering team is responsible for ensuring that safety requirements for every part of the system are satisfied.
Be aware that HIPAA compliance will most likely require more than technical implementation:
- Well-written privacy and security policies in place
- Regular employee training or even certification
- Strict third-party partners and vendor security assessments
- Incident plan in place
Build with modules
The modular design means that you can begin by starting small. Your system’s MVP may only include a few modules, for example, the doctor’s and patient’s admin sections. Everything else you can add as your business requirements expand, and your company grows.
The main points to consider are working with the technology stack that allows you to build on modules in the future and monitoring the correct maintenance of project documentation. Who knows if the same team will be working on development in a year or two?
Don’t compromise on technology
To build an EHR, we at Glorium use a stack of a dozen technologies that can be grouped depending on a specific project.
For back-end development, we mostly use .Net, Java, NodeJS, Python, and PHP. We use industry-standard MySQL, Postgres, MS SQL, Oracle, and MongoDB for creating and managing EHR databases.
No matter what cloud provider you choose, one of the following three will most likely meet your needs – AWS, Azure, or Google Cloud. The only exception is if you intend to deploy your EHR on-premise. This is possible despite it being a more rare case in the development industry.
There has been a recent and more frequent occurrence of companies considering the development of mobile clients, which is convenient for doctors, mobile ambulance teams, and patients who get quick access to their offices directly from their phones.
In mobile app development, we have settled on Kotlin, Java, Swift, Objective-C, Xamarin, and React Native as our basic technologies.
In-house VS hired development teams
The cost of development is always the number one concern. Issues with pricing will be dependent on whether you plan to hire a team to have on staff or work externally with trusted developers.
We don’t need to analyze market prices as these are easily found by doing some independent searches. Just be aware that your minimal development team should include the following roles:
- One business analyst/project manager
- One UI/UX designer (if you’re lucky enough, they can be the UX writer as well)
- Two back-end engineers (building the core of your product)
- One QA (ensuring that the service provides what it has to and there are no bugs or UX glitches)
- One front-end engineer (this person is responsible for developing the graphical part of the website and its features)
- One DevOps engineer (in case you need to set up cloud infrastructure)
Another problem is the lack of relevant experience. Just being a good developer isn’t enough. Developers involved in the scope of this project should have experience developing similar healthcare projects. Experienced healthcare developers will help you significantly speed up the development process while maintaining quality and the need for only a minimum number of specialists in your team.
We provide these types of teams to work on our clients’ projects. If you want a consultation on your project or to clarify the price for specific work, feel free to get in touch with us today.
If you plan on hiring remote developers yourself, expect an average market median of $50-60 per hour. The development of a medium-sized project will take several hundred hours of work for each team member.
Understand the software development life cycle
Most development companies use the agile approach to manage product development. Chances are, any team you turn to will use this approach. In short, here are the main stages of product development according to Agile methodology:
In most cases, the Ideation and Product Definition stages are already known to the customers. EHR is a common type of system in the healthcare market, and its idea and business goals are a no-brainer.
So you can expect to start with stage 3, which is Prototyping. Whether Market research and Business planning are something you can do in-house, Prototyping and MVP are those phases where your development team should step in.
At Glorium, we start working with clients as early as stage 2, helping to define critical functionality and customizing its layout for a particular project’s needs. The earlier you include your development team’s project manager into the discussion, the better the chances are that you won’t face any problems or bottlenecks during the development stage.
We encourage you to contact us even if you haven’t settled on whether you want to develop your EHR system or not. Talk is cheap, and in our case, it’s completely free.
We would be happy to take you through the process, development market, and pricing, so you can better consider your future plans for the development of the EHR system.