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How to create an EHR: cost, development, features

Advantages and challenges of creating an EHR

April 04, 2022

16 minutes, 29 seconds.

An electronic health record (EHR) is a digital version of a patient’s paper medical chart and is crucial to maximizing profits while providing the highest quality of care. The implementation process can take time and be costly, but the benefits compared with paper records far outweigh the costs of electronic medical records. To help your organization adopt an EHR system quickly and efficiently, you have to include your staff in the decision-making process. This article describes how to develop and effectively implement EHR software and how much does an EHR system cost. 

Implementing a ready-to-use electronic medical records system (whether commercially licensed EHR or open-source EHR) is the fastest way for healthcare organizations. It means integrations with practice picture archiving system, referral management system, billing, labs, patient portal, etc. It can also mean meeting the requirements of an external system) and step-by-step targeted on-demand customization (creating specialty-specific templates or changing user interfaces).

Not every ready-to-use EHR is ready for cost-effective customization. An experienced EHR consultant can help select a ready-to-implementation-and-customization EHR system or company that sells EHR software tailored to your business needs.

Advantages of EHR systems

After implementing the EHR, your practice will have a fully functioning, modern system that will hopefully improve your practice’s profitability and the quality of healthcare services you provide. 

Here you can see the advantages of implementing the EHR:

  • More timely, efficient, and comprehensive medical care for patients.
  • A more friendly user experience and optimized day-to-day workflow.
  • Complete documentation of rendered services and patient visits.
  • Greater patient satisfaction due to simplified billing and decreased wait times.
  • More increased appointments, more efficient scheduling, and reductions in cancellations and no-shows.
  • Reduced aging accounts receivable in the collection and increased revenue and claims accepted by payers on the first submission.
  • Improved connectivity with hospitals, labs, and specialists that work with your practice.
  • Accessibility to the patient’s data in an easy-to-understand form.
  • One Window information panel about the patient’s condition and care.
  • More smooth patients treatment.
  • Schedule meetings and appointments.
  • An EHR system helps doctors make preventative care more accessible.
  • Set doctor appointments via an EHR.
  • The patients can receive notifications and reminders about appointments and billing. They will know how to build preventive measures and take precautions.
  • Forwards educational content related to the patient’s condition or disease.
  • Provides a patient portal for storing insurance cards and other types of cards.

Must-have features of an EHR system

These are some essential features included in the development of EHR. You cannot use the software without these features. You have to know how to develop an EHR with the essential elements. Different medical institutions prefer to have an MVP version first because it allows them to understand the product. 

There is also the fastest way to get seed-stage funding and start an EHR business:

  • The EHR prototype.
  • The minimum viable product (MVP) of an EHR system.
  • The Proof-of-concept (POC) of an EHR computer software.

If healthcare organizations or medical startups want to build their web-based EHR system, they must develop EHR software from scratch. Supposing, you need complete control over your EHR software features, including the possibility of scaling your system as your business grows or entering a market with a new EHR software or user-friendly design. In that case, this option seems to be the only available way. You don’t need to have “per provider” access restrictions and don’t need to pay license fees with your custom EHR, and you are protected from switching/changing EHR systems (relevant for healthcare providers).

It also helps the founders get feedback from the staff, labs, patients, and other users. After the MVP version of the new EHR software is ready to be implemented, the developers can improve it to get a better outcome. They will know how to develop a version with more additional features.

Usually, the MVP version includes the following features:

  • Patient portal: developed for the patients to give them the ability to view their medical records. The patient portal usually includes the previous reports and treatments as well.
  • Medical history: can include the medication and immunization history, growth chart, family and social data, allergies, habits (e.g., details about smoking and alcohol use), surgeries, obstetric information, etc. This feature logs the patient’s conditions throughout their life. Information about patients’ medical history allows doctors to collect insights and understand the causes of the patient’s current condition.
  • Medical encounters: include the chief complaint, history of present illness, physical examination results, vital signs, assessment, and treatment plan. When someone visits a physician, the doctor puts the gathered information on the patient’s current condition in the medical encounters section. 
  • Orders and prescriptions: stores and creates the medication prescriptions orders. Doctors can print them or send them electronically to the pharmacy straight from the point of care. 
  • E-Prescribing: this allows physicians to send prescriptions electronically. The development of E-prescribing is significant for creating an EHR. This feature will enable doctors to notify other personnel about drug allergies and other conditions.
  • Progress notes: chronological, regular updates on the patient’s condition. They can be entered by all clinical professionals participating in the care: doctors, nurses, pharmacists, dentists, etc. Progress notes are used mostly for hospitalized patients. 
  • Test results: biopsies, blood tests, X-rays, and other similar examinations are managed and stored primarily as images (e.g., MRIs) using formats like DICOM. Test results can be handled elsewhere, in which case the chart will likely contain the reports as text. 
  • Management of prescriptions and documents: this feature allows medical staff and doctors to add information to the patient’s digital chart. Developing this feature in the EHR system is beneficial for both patients and doctors.
  • Integration with the laboratories: this can help to solve various tasks. It allows sharing of tests, reports, and other sorts of information.
  • Chat and messaging: EHR software allows patients and doctors to get on direct messaging. A straightforward chat option makes the electronic health record system even better for both types of users.
  • PHI Copying: According to HIPAA, the charts should be either printable or convertible to a popular electronic format, e.g., PDF, to give patients the possibility to have a copy of their personal health information (with certain caveats).  
  • Guidelines: including information like weight parameters, normative lab values, screening recommendations, dosage guidelines, etc., gives the doctors a benchmark to quickly measure patient stats. A reference point like this helps physicians provide better treatment. Patients can also access this information via the patient portal, which allows them to know better about their health.
  • Customizable/specialty-specific charting templates: the system has to be adapted to accommodate the needs of different doctors. For example, a dentist wants to include some information in the patient charts. It means that the charts have to be highly customizable or include in the charting module some specialty-specific templates.
  • Speech-to-text: allows doctors to dictate notes instead of typing them and save time for patients. The physician’s spoken text can be transferred straight to the EHR/EMR and reviewed by the same doctor later, or it can be sent to a medical scribe for a preliminary check first.
  • Scheduling: allows the physicians to allot time slots to the patients through the EHR system.
  • Access and control: giving custom access rights to the doctors and nurses is essential for compliance. Without this feature, the EHR software development is incomplete. 
  • Cloud hosting: creates a backup and allows access to the users anytime, anywhere. All the data and information must always be available on the cloud.  
  • E-visits and medical consultations: this feature connects physicians and patients quickly and securely through live video, which is telehealth’s main idea. It enables face-to-face two-way interactions on a computer or mobile device with high-quality audio and video. Secure communication can be held by a wireless, wired, or Internet connection. 

EHR software development tech stack

Tech stack provides the answer to how to create EMR software and refers to the usage of technologies. The following tech stack can be an example of how to build an EHR system.

Libraries and frameworks: Angular, jQuery, Django, Node.js, Bootstrap. 

Languages: Java, Python, Swift, Kotlin, JavaScript, PHP.

Utilities: Cloudflare, Microsoft Azure, Amazon S3.

Payment gateway: Braintree, PayPal, Stripe.

Databases: My SQL, PostgreSQL. 

Analytics: Amazon EMR, Google Analytics, Optimizely.

Webserver: Apache HTTP Server, Nginx. 

App frameworks: Laravel.

Hosting:  AWS, VULTR.

EHR system development costs

How much does it cost to create an EHR software? One of the biggest concerns in developing EHR is the finances. In the next section of this article about building an EHR system, we will talk about the costs of EHR software development.

The creation of MVP for the EHR software includes some essential features, which are mandatory and help build a foundation for further electronic medical records systems and calculating the cost of the electronic health records development. The final software won’t reap the results without any of these features. But how to be sure that your software is the best?

There are three possibilities for how you can develop your software.

  1. Employ an in-house team to develop EHR.
  2. Hire a local development company or agency in your city.
  3. Outsource the task. 

All ways are good, and the difference lies in the output quality and cost of EHR software. Outsourcing is a cost-saving strategy. You can hire an outside team that creates EHR software for you. It will reduce the electronic health records cost. You can find a lot of developers who will know how to build the system you need.

The important thing is to choose the proper mix of quality and price of the final product. You have to know how to select a good team that can serve the appropriate purpose. The final cost of an electronic medical records software always depends on the features added and inclusions in making a custom EHR solution. 

How to build an EHR system?

Fewer stages of the EMR adoption are more challenging than the phase of implementation. Most problems occur in the earlier phases, and shortcuts could lead to catastrophic issues later. A botched EHR implementation can reduce patient confidence and harm your relationships with other healthcare providers by damaging your revenue cycle for months. 

Validate the idea 

You have to always check the software’s validity before knowing how to create an EHR. Get several requests from your clients about custom electronic medical records costs. After this, analyze the potential and probability. You need to ensure that you can develop customized EHR software and stay within your budget.

Start with the client’s requirements. You have to understand them fully. Make a list of questions about all the details of the development process. It helps get a fair idea about what clients are looking for and clears their expectations from additional features added to the electronic medical records software.

It is essential to understand what issues the doctors and nurses in a hospital are facing and the users’ pain points. 

  • How much time does it take for them to fill out forms?
  • How about communication with the doctors and other patients?

Asking such questions gets you closer to the client’s needs and a better understanding of how to create EHR software. Another critical moment of the success of EHR system development is testing the business plan. Test the product with potential customers by including doctors and nurses.

Making a checklist of all the steps you anticipate will need to be completed is the first step of implementing an EMR system. Consider carefully who will complete the task: managers, healthcare providers, patients, or IT staff.

Critical tasks include budget planning, stakeholder recruitment, transferring data, scheduling implementation, establishing go-live activities and metrics for success, and providing training and live testing.

Specify your finances

The precise cost of EMR development will depend on your organization’s size and the software’s features. Network and hardware upgrades, data backups and storage, vendor training and consultant fees, and cost per employee can all affect your budget and raise the costs of electronic health records.

In the early stages of EMR development, the initial loss in productivity is unavoidable, and you should consider that. The dedicated team will need training organized by staff and providers, and it may require additional time beyond that to get used to the new system, which may come out of their patient care hours. Your organization can benefit from increased productivity and a more streamlined workflow once the system is fully implemented.

Discovery and Prototype

The discovery phase is an essential part of developing an EHR. It needs to identify the features of the EHR software to the development technology, which means that you need to create a flowchart of the procedures and processes. 

Another important thing is to figure out the technology stack. It is the responsibility of our professionals. The development process will continue with the technologies, and an EHR software creation also involves electronic health records cost estimation.

Once the business analysis and cost of EHR software estimation are complete, the development can start. To understand how the software works, you need to develop a prototype first, which will help you make it better.

To accurately represent your patients’ information and your medical practice within the software, you have to set up a new EHR that does a system configuration. That means the providers who will be using the system and programming in your practice’s location(s). It would help if you also designed your practice’s clinical workflow to create clinical templates. The templates are required to meet Physician Quality Reporting System standards outlined by federal regulations and Meaningful Use. Follow the rules to ensure your practice does not incur Medicare payment penalties.

Development and Design 

Designing is the next step in the EMR software development life cycle. You can develop a basic design of the EHR software as per the specifications. After that is time to decide what the first design of the solution will look like.

Create modules of the major segments with the help of service-oriented architecture. It will be helpful for the following:

  • To streamline the tasks.
  • To fast-track the development process
  • To conduct efficient performance checks and screening.

The scalability is easier when the EMR software development works in this manner.

Enrollment, credentialing, and other details about payment depend on the payers’ responsiveness. Sometimes, changing payer enrollment from one PM system to another can take weeks or even months. It’s important to include enough time in the implementation process if the enrollment and credentialing steps take longer than expected.

Debugging and Testing 

The quality assurance team identifies the bugs during the testing stage. They check the design, monitor other operations, and go through the development stages. The quality assurance team understands how to build a better version of the existing EHR.

The essential issue is to know whether EHR software can solve the problem. Usually, testing and debugging continue until and unless the development goals meet with the functioning of EMR software.

Outline all the steps of your organization’s current workflow by asking the following questions:

  • Is it needed?
  • Does it add some value for the patient?
  • Is it being done by the right person and in the proper order?
  • Does this require training or physician skills?
  • If not, can another person complete the task?

You can significantly increase the likelihood of a smooth rollout and minimize any inefficiencies in the use of EMR by optimizing your workflows before EMR implementation.

Maintenance and Launch 

The development of EHR software is specific to the user’s requirements. You can launch the product in the right environment and market. It helps understand where and how to make changes to the final solution.

Launch the MVP version to get feedback and analyze the performance. It is easier to change certain features of an EHR system development with some insights.

You can add, edit or delete the already given features to scale them up to the requirements.

How to make your EHR software HIPAA compliant?

Every healthcare entity must focus on HIPAA-compliancy to ensure that the software protects the patient’s medical data.

The hospitals need to be HIPAA compliant even if they are using a vendor’s services for management. It means that the EHR system must also undergo stringent screening and checks.

There are 75 security protocols under HIPAA. It is imperative to follow all of them to be compliant. You have to ensure HIPAA compliance when looking into how to create an electronic medical record system.

But it needs more to develop a HIPAA compliant EHR. Safeguarding the PHI (patient health information) is the major aspect of being HIPAA compliant.

To develop HIPAA compliant software, you need to follow a specific process and understand what to do to achieve HIPAA compliance, what not to do to become this certification, and how to work with an EHR System that is HIPAA compliant.

Before the EMR software development begins, ask your client about their HIPAA compliance.

HIPAA compliance involves the EHR software development in the following aspects:

  • Privacy and Security Regulations.
  • Employee Training.
  • Administering the documents.
  • Vendor and Business Management.
  • Contingency or Incident Plans.

EHR software is far-reaching and complex, so be prepared to engage in troubleshooting and risk mitigation. Naturally, this is a risky and delicate thing to do. Here are a few suggestions about how to protect yourself against some of the potential risks during the development:

  • You need a system with a friendly user interface. Any EHR system can either hinder or streamline operations in your healthcare practice. Make sure the chosen user interface of the system is intuitive and simple to learn to guarantee the new system has the desired effect. It will help increase the effectiveness of your system, all without depressing productivity and make the transition easier for your staff.
  • Try to include your staff in the process of decision-making. The best way to determine if your team is prepared to adapt to the new system is to have them in decision-making. Do they find that some interfaces are more user-friendly than others? What trainings are the most helpful for them? What does their preferred workflow look like? All these can help you choose a system with your staff in mind and make the implementation of the new system much more accessible. Including different departments in the decision-making process brings invaluable insight when making a final decision.
  • Integrate all software with your new EHR system. 
  • Assess your practice before beginning the implementation. Providing an accurate and honest assessment of your healthcare practice’s workflow, current finances, and capabilities is a major part of devising a successful implementation. During the development of clearly stated future goals, and through this assessment, a practice’s administration can more effectively set and track metrics of success for the new system.

How will VITech help you create an EHR/EMR system?

At VITech, we know how to create an EHR system highly efficient for healthcare providers and convenient for patients. Good EHR software can make a big difference to the industry. 

As a developer, we understand how to create a fantastic platform and all the nuances of the development process. We know how important a good system can be for our customers.

It helps with processing and management, and it streamlines the administrative system. It will help any healthcare institution succeed and grow. Our knowledge can help medical institutions build efficient EHR software with a great ROI.

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

We have worked on several healthcare projects and have deep expertise in the niche. Our track record includes customized and complex healthcare solutions. To know more about them, go to our case study section. 

Conclusion

Healthcare is one of the fields that significantly change thanks to digitalization. New technologies simplify the consultation process, help doctors manage healthcare data and move all patient-physician interactions to a brand new level.

EHR software reduces the paperwork and grants access to patients’ healthcare data in just a few clicks. It significantly improves physicians’ productivity and can increase the revenue of a healthcare establishment. 

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.

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