The future belongs to medical software. Every tech insider, financial adviser, and software survey tells about it. Healthcare industry is going to be disrupted in the next decade and not by one big platform but by many local ones. Smartphones and smartwatches allow 24/7 data gathering and also make it possible to monitor a patient’s condition distantly.
This data is priceless as it can be used by doctors and healthcare specialists to significantly shorten the time it takes to detect problems. Healthcare software allows hundreds of other exciting possibilities: no need to visit your practitioner for a prescription, virtual consultations, assessment of patient’s data globally wherever he or she is, test results send to your mobile device, etc.
All these benefits it delivers would be unimaginable without EHR software and its integration into every private or government-run medical facility to optimize medical industry and thus revolutionize how we approach medical treatment. The reality goes even further and AI programs were reported to give a better performance when reading patient’s scans and reaching a diagnosis.
In the following blog entry we are going to focus on the software side of things: how to develop EHR system, how to integrate it, who are going to use it, how much does it cost, what certifications must be obtained, what regulations followed, is it better to do your own custom system from scratch or purchase/subscribe to the existing modules and libraries.
My goal is to help you understand where and how healthcare industry meets the digital upgrade.
To be fair, like any tech-journalist, I conduct research before writing anything in this blog or elsewhere. And while doing my research on Electronic Health Record and medical software I was astounded by the amount of bullshit out there. There are tons of stupid abbreviations (you will see them even here further down the line) and a 1000 and 1 thing which sole aim, it seems, is to confuse the reader and make a possible client in need of medical software either feeling very stupid thinking “what the hell did I just read”. The articles and blog posts I based my research on contained some 25% of real info but everything else was meaningless filler.
For your sake and because I take pride in my work, I will tell you everything you need to know and I will treat you like a human being. The true secret of successful engineering and efficient software development lays in not complicating things for complexity’s sake. That’s it. And this lesson should be carried further even outside tech and IT. Everything should be as simple as possible but not any bit simpler (Einstein said that). It is hard enough to understand how software works and the process is already difficult, so making it even more difficult just because it is (behold!) medical software that we cover is not a viable option.
Honestly, I had easier time reading what programmers, coders, and real engineers have to say, even with graphs, pieces of code, and equations. When I got to medical software, I instantly smelled somebody trying to make me think like I’m a fool and need a consultation immediately. You will ask for it, though it will happen not because I omitted something here but because the information I share is going to make you come with new questions. And that’s how it should work.
You won’t feel stupid after and there will be no confusion, I promise you. And even though it is medical industry we’re talking about, we essentially cover software development from a business point of view, so there’s no need to be a doctor or a scientist to understand it. Let’s start!
- Types and names of the systems
- Custom vs. Ready-made
- How to start
- Reasons behind your request
- How fast do you need it
- List of client requests and needs
- EHR systems for medical practitioners
- Scrum methodology
- Choose experienced development team
- Market trends
- Get estimation from BA
- The estimation process
- Detailed description of what you want
- Front end and design
- Open source ready made modules benefits
- Security measures and regulations
What is it and what it is used for, types and names of the systems
Electronic Medical Record (EMR) or Electronic Health Record (EHR) is first and foremost a software product. You may ask what kind of product. Well, it is a system. Most modern hospitals in the West have them. Not all medical facilities in the rural areas adopted them but in Canada, America, and Europe this process now is full-on.
This is the most common definition of the EHR system:
An electronic health record (EHR) is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.Wikipedia
EHR systems are designed to store data accurately and to capture the state of a patient across time. It eliminates the need to track down a patient’s previous paper medical records and assists in ensuring data is accurate and legible. It can reduce risk of data replication as there is only one modifiable file, which means the file is more likely up to date, and decreases risk of lost paperwork. Due to the digital information being searchable and in a single file, EMRs (electronic medical records) are more effective when extracting medical data for the examination of possible trends and long term changes in a patient. Population-based studies of medical records may also be facilitated by the widespread adoption of EHRs and EMRs.
EHR systems are a very big and encompassing definition. They include dozens of different subsystems and came to be used when naming everything related to the digital healthcare. Most importantly, EHR system are a database of individual medical records in digital form with test results, scans, medical assessments, prescriptions, dates, photographs, personal info, physical measurements data, etc.
Digital optimization meets medical industry, and EHR systems are the ultimate crossroads here. The simplest systems range from booking apps to 1-on-1 doctor-patient chats. The most complex system can be connected to your smartwatch and even allow video streaming when connecting patients with their physicians. You can develop a simple MVP and then add the layers of functionality on top of it. Whatever option you choose, you should have clearly outlined user stories in the very beginning of your project.
There are many systems at play here. Let’s start from the easiest one – appointment booking. A patient has an app. He opens it to see the visiting hours. He can do it with his mobile or with his computer (preferably both). The clinic receives a notification that certain time is booked. When the time arrives both the patient and doctor are reminded about the appointment. Got it? It’s easy. Same user story can be applied to schedule and book appointments at barbershops or makeup salons as well as any other kind of service vendors.
To have an app can’t hurt. On the contrary, it will distinguish your clinic from those of your competitors. The app itself will remind user to get back in case he needs the services again. Not only it optimizes the whole experience, it increases patient retention rates.
Do you need a Medical Booking App?
But there are much more complex systems. For example, a small rural clinic with the personnel of 50 employees. Let’s say they need to go digital fully and for the first time. They have outdated internal systems that have no connection with the patients. Most of the times the patients make a call or come directly. In the center of it all won’t just be a booking feature. Local residents will have an EHR or EMR profiles to indicate who they are, where do they live, and their whole medical history.
The newest kind of system will allow to measure health indicators of the patients with chronic diseases (their heart rate, breathing, cardiovascular metrics) outside hospital, using data from their smartphones. Doctors can keep track of what patients eat, how much they exercise, walk, sleep, etc. This data is valuable for both patients and doctors. It can be further used to conduct research and gathers statistics.
Then, the system recognizes not just the patient but his record, redirects him to his family doctor, releases prescriptions, notifies doctors and nurses, connects with insurance providers, etc. The whole process is fully digital. Now that is not just your average booking. The functionality of such system will save tons of time and may even save lives while at the same time reducing effort it takes to service each patient.
Custom vs. ready made
One of your main tasks is to decide whether you could use some ready-made solution or if you should make your own custom EHR system from scratch. Before making a decision you should weigh all the advantages and disadvantages of both options. Our company’s policy is that custom decision is always better because it suits your individual needs and has better functionality.
Ready-made solutions are third-party modules that you can integrate in your system. They require maintenance and even though they are much easier to develop and also less costly, you still need a development team to integrate them,
When you go with custom solution, you get a perfectly suitable EHR system that is tailored to your needs. You and the team decide what goes where, how user is going to benefit from the system, how it’s going to be designed, etc. It is much better because little details matter and when you choose to use a ready-made solution, you may be limited by the functionality and features that are included. You also trade your ownership for a dependency on the integration. There are tons of ready-made options out there but the majority of hospitals and medical practitioners decide to develop their own in order to have a complete command over it.
How to start: formulate your idea and your needs
Before proceeding with development you should ask yourself a set of questions (make a list). Project managers and business analysts are going to ask what problems you have and what pushed you towards development. In other words, what tasks the system is going to solve? Is it booking? Is it cloud data storage of patients’ record. Will it be mobile, desktop or both? Will patients and practitioners will have access to the system or is it going to be used only internally?
Software engineers can only resolve those tasks that are formulated clearly and precisely. In the development specifications every feature like payment gateway, file attachments, comments, and notification is going to be outlined and estimated. This is done for you have a clear and precise vision of what is going to be developed and how.
What are the reasons behind your request
You should also consider marketing side of your project. Why you decided to develop it now? It is because of your competitors or maybe because you now have more clients and more staff, so it is harder to track and monitor everything? Are you going to sell the end product or use it in your medical practice?
Your medical practice needs digital optimization?
The more you know before you start, the better. A clear vision of what you want to have in the end will guarantee that EHR system is going to satisfy all your needs and wants. Some of our clients already have systems and decide to upgrade them tom for example, include a mobile application. Others have small practices that they want to expand and they develop newer and faster EHR systems to keep up with the racing speed of change that underscores all kinds of business evolution processes.
How fast do you need it
Speed to market matters. Do you have a strict deadline? The faster you need your EHR system to be ready, the more expensive it will be. To complete a project faster means adding more people to the team. In case you don’t need it that fast the usual time-frame for the development of an average EHR or EMR system is 3 to 6 months. Consider whether your project may be shipped in this time or not. The bigger team will deliver it faster, though the price will be higher. Time is money and so you must define what conditions for you are more critical: budget or deadline.
List of client requests and needs
You have a final say of what goes in your system and how it is going to work. But all successful products have one thing in common: they care about end users. Therefore, you should do a research yourself or let the team prepare for you. In the conducted research the patients and the doctors will outline the features they would like to have in the EHR system you are going to deliver.
Every proper EHR system is only as successful as much value it delivers to the end users. If it’s not going to solve real problems and bring real value, then what’s the point? The more input the end users have, the better, and if they have a say in how the final product is going to look like, your EHR software will be much more useful. Lack of user feedback results in a system that is developed from up to down. But it should be developed from down and up.
Often, though, EHR systems are designed very ugly and User Interface and User Experience (UX and UI) lack simple features like a certain field, some button here or there, some necessary tab, etc. Remember Windows Vista? That was one disaster of a project because it didn’t deliver what the users needed. It deliver what the development team thought users needed and such a guess resulted in some of the worst software product that has ever been created.
EHR systems for medical practitioners
So, let’s assume you are a medical practitioner or an investor or both. For example, a dentist. You have a pack of loyal patients who use your services. You have an office with assistants, an accountant, a nurse, a number of doctors, tons of medical equipment, suppliers, etc. You also have patient records. All these is data. We make this data digital. Many small clinics still use phones and google sheets. This needs to go if your business is to survive and jump on the next level, right?
EHR system will keep track of all your patients. You are going to access the system from your mobile or desktop computer. Your patients are going to do the same. The system will recognize as admin and your patients as users. It can also be shaped to allow special access to your doctors. There will be two roles: a doctor and a patient. Patient will see doctor’s info, his schedule, experience, name, education, etc. Doctors will see patient’s history in the profiles with attached scans and photos, medical assessments made in the past, perhaps even by different doctors, etc.
The most modern system will allow not only to keep record of what happens inside the clinic and when. Imagine virtual visits. Smartphone cameras today are so perfect that a doctor can make an assessment even without real visit. It will be enough to prescribe painkillers or suggest medical procedures. This also happens inside the EHR application on your desktop computer or a mobile device.
The availability of the patient’s record 24/7 online is an ultimate digital advantage. These records cannot be lost or destroyed. Data can be transferred from doctor to doctor and every photo, scan, prescription, physical parameter info can be instantly accessed. This saves tons of time and is very comfortable for both patients and doctors. Medications can be prescribed online without a visit and a consultation can be given virtually.
What else? Mobile Health Systems can be integrated with smartwatches to keep track of the patient’s condition outside the hospital. Your doctor can see how many calories you burn daily, how much do you sleep, eat, walk, run, etc. This data is priceless. 24/7 monitoring of chronically ill patients can save their lives and it allows for a more detailed diagnosis and a better treatment. Mobile health apps can remind patients that they need to take a pill or eat a certain kind food in the morning, do exercise, sleep more, etc.
What is Scrum? It is a methodology used by software development agencies for the most smooth and precise, clean and fast project organization. It means that the project is divided into sprints and blocks of code are shipped bi-weekly or weekly. It allows introducing changes on the go (if the need arises) it makes possible to update the investor on every stage of the development.
Scrum guarantees that at every point in the software development cycle all team members know what they are doing, what is the plan, and how they’re going to proceed further. Most of all, Scrum is about communication. Project managers and business analysts work with a client, development team understands precisely what the client wants with BA and PM as middleman messengers.
Such approach eliminates the possibility of miscommunication (developer does what shouldn’t be done) and the delays (developer doesn’t do what needs to be done). Scrum is the most popular and widely used software development methodology with daily meetings and sometimes even hourly updates if the product is about to be released. Developing a complex EHR system is impossible to do with Waterfall process (the usual engineering methodology).
Did you consider hiring a Scrum-Master for your EHR project
Choose experienced development team
How to secure the success of your project? EHR system is not just another app. People’s well-being depends on it. Therefore, you should be absolutely sure that you work with a team of experienced developers who know what they do. How to make sure? Conduct a research about the agency of your choice and find out whether they can be trusted.
Outsource software development companies put a lot of effort into building trust with their clients. Therefore, look for the reviews of former clients, look at the company’s portfolio, etc. The development of EHR and EMR systems is rarely simple to do because it requires a lot of skill. Look for senior developers you can trust because experience is everything.
Our company has a lot of experience in building medical software solutions and even though we cannot disclose the information (because of NDA), we are glad to share some of specifics during a free consultation. Please give us a call to find out more about all the ins and outs of EHR software development.
Always consider your target audience and market trends. Older people are less likely to have a smartwatch. Moreover, they are very skeptical in regard to sharing their health info. But if advised by a doctor, they most definitely will install the app and allow to monitor their health daily. It is enough to tell them it will make them healthier.
Younger people are the majority of smartwatch owners, although they are rarely chronically ill and don’t need monitoring. Nevertheless, you can develop an EHR system for certain niches of chronically ill people like patients with diabetes or those that have a heart condition.
The lives of this kind of patients can be significantly improved if they are digitally involved in being medically treated in the most modern way. And it is true that more and more software development companies move towards development of EHR and EMR systems.
Do you want to use the product or sell it to a potential buyer, do you have investors?
It is beyond important how you monetize your product. Will you be the owner? Do you have co-investors? You can rent your product on a subscription basis or you can use it for your own clinic. A product is a product but if you’re going to sell it, you should know precisely who you sell it to and why. These considerations must be followed during the development. Ask your sponsors what they’d like to see in the final version of EHR system.
Get estimation from BA
So, how much is it going to cost you? It depends. The average gap is $45-75K. But a lot depends on the functionality you’d like to have in your app. The more functions there are, the more costly your EHR system is going to be and the longer it will take to develop one. Keep in mind that you must develop MVP first.
Choose absolutely crucial features that you need to have in your EHR system. Then, start developing a prototype. This is going to be your core functionality ready to be released and used by end clients. Then, you can do updates and gradually upgrade your EHR system, adding features that are not crucial but nice to have. Usually, what these features are becomes clear when you receive your first real user feedback. Testing your system on real users provides precious feedback and allows to correct the course of your final development stages.
Updates are shipped to make the ready system better and to see how users react, whether they are comfortable enough with what they get. Most of the times incremental changes are absolutely necessary because you cannot know the end user’s motivation for sure, especially if thousands of people are going to use the app.
The estimation process, list of features
What happens when you give us a call? We listen and estimate the scope of your project, what do you want, what you need, how fast, what is your budget. We connect you with a senior developer responsible for the architecture side of the project to envision the future of your desired goals.
With the ready list of features you are going to know the price and ETA of your project. As for the features, BA and senior developers will advise you regarding how to better implement the functionality that you want in your EHR app. BA connects the business logic of your EHR system with technical nuances and software abilities. In other words, whether it can be done and how to do it.
Do you need a quote for your EHR project?
Give the detailed description of what you want
It is absolutely necessary to have a vision because, even though our team can give you any kind of advice, it is, essentially, your project and you are its visionary. Your objectives and our implementation. The ultimate goal is for your aims to correspond with our abilities but we are always more than willing to do extra work and make sure you get what you really need and want.
Communication flow is one of the pillars of every great project. Building a proper, effective, efficient, and valuable EHR software is impossible without quick updates done daily. In GBKSOFT we specifically add extra time to make sure that all communication aspects of the development process are handled on time to avoid misunderstandings and delays.
The value of miscommunication is high and when team members have a communication breakdown the problems that arise may result in days or even weeks of lost time. It can postpone the release and even sabotage the whole project since all features and integrations must work properly and to do that every aspect of teamwork should be reported in great detail.
We have experienced back end PHP developers ready to work on your EHR system. We have previously covered the many benefits of PHP and we still think that it is one of the best programming languages for commercial purposes. PHP allows very fast coding with quick sprint releases.
It is also very easy to find PHP developers, so in case there will be a need to expand the team, it can definitely be done, Since PHP is easier to learn than many other programming languages and thanks to the vast open-source community that supports it, PHP has a wide range of ready-made libraries and code modules available online for free. With the help of that your project can be developed and released pretty fast if you have strict deadlines.
Front end and design
Do you need front end and back end development for your system?
MVP – Speed to Market, Release ASAP
It is absolutely necessary for you to consider the release of your MVP first for the aforementioned reasons. But also in order to find out what works best and what doesn’t work while testing the product in conditions of real environment it is critically important to make sure you have a working prototype before working on the final complete version of your EHR system.
MVP allows making important upgrades and adding improvements that make your EHR system just perfect. On average, the MVP of your project costs around 65% of its final price. Depending on the features, your MVP is going to cost around $55K but, again, a lot depends on the features you’d like to include. The more features there are, the more expensive the final product will be.
At this stage your task is to absolutely know what features you are going to have in your EHR system and what is going to make your patient benefit from your value proposition. Are you going to integrate virtual 1-on-1 patient consultation? Do you want only a booking platform or you’d like to eliminate paperwork completely and have a system that connects with all medical data of your patients?
Keep in mind that you should come up with all the core features in the beginning. These are the features that your project just won’t do without. Does your EHR system is going to include 1-on-1 communication with a doctor? Do you need a chat-bot to communicate with the patients? Can patients receive notifications and updates via their smartphones or email? Can they pay or integrate their Healthcare Insurance Provider linking it to the system you are going to develop? Answer these questions while on a call with our EHR Expert Consultants to have a clear vision of your software development product cycle.
Open-source ready made modules benefits
You can use the following Open Source medical software modules in your project development cycle. However, their integration is itself a software development process, though is saves a lot of time, still you need to know what modules to use and how to properly integrate them in your project.
You will be helped by Business Analysts and Project Managers as well as Senior Developers before you know exactly which modules are going work for you and which are not going to work. Custom development definitely means that some parts of your final EHR software system are going to be written from scratch. Nevertheless, there are ways to cut the development time down, using shortcuts for certain processes that are all alike in different medical systems.
Popular EHR Systems and Third-Party Modules
- Open Dental
- GNU Health
- Vista EHR
- One touch EMR
- DoliMed EMR
- Nosh EMR
- LibreHealth EHR
- HL7 API
Security measures and regulations
Your EHR system must comply with all the necessary regulations. First of all, it needs to comply with GDPR regulations in case your users will be from Europe and if you’d like to register your product as European. If you are going to operate in the United States, then your business model should consider HIPAA (Health Insurance Portability and Accountability Act) to know how you should manage the patient’s health data protected by this law.
In the recent years some big development giants like Google faced a bunch of media scandals that featured violations of privacy in regard to the privacy of patients and their health data. Without any doubt, the data in question is very private and patients’ medical histories should be handled with maximum care and precision.
Good publicity and a guarantee that user’s data is safe in your EHR systems are the best way to retain your patients and make sure they will use your EHR system. HIPAA regulations are specifically designed to ensure that patients’ info is handled in a quality manner and that it is safe for whoever uses it. Living in the age of cyber warfare, that is beyond important for every company that gathers and put patients’ data to use in their EHR and EMR systems. Otherwise, providing this data is breached, it can hurt not only your company’s image but your patients as well.
Hosting your project is handled by your software development provider. We take it on ourselves to deal with every bit of hosting process to guarantee that the release of the final product is going to be as smooth as possible. That is important for the overall healthiness of your EHR system and we provide maintenance and support on the initial stages of product release cycle.
Our back end developers oversee the final implementation of EHR system in your business. They also take care of the submission of your final product to the AppStore and Google Play Market. That is done to ensure your product can also be advertised as accessible via the most viable distribution channel.
Do you have issues with regulations, security, and hosting of your EHR system?
The following is an excerpt from “Why physicians switch electronic health record vendors,” published in “Business and Health Administration Association Annual Conference 2019.”
“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.”
The researchers from KPMG also claim this:
“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.”
The EHR system is all about distributing the information between the vendors who provide medical care and the patients. Even if your users change the clinic, the data format is universal, so your system is going to have information stored in widely accepted formats.
Why now is the best time to develop and release your EHR system?
As was highlighted above, the year 2020 is going to be very fruitful for all kind of Mobile Health apps integrated with IoT devices and connected to EHR systems all over the world. Healthcare and medicine are among the most conservative industries out there. Therefore, now is finally the time to disrupt, since the widespread distribution of IoT devices, the proliferation of the 4G and 5G across the globe result in higher adoption of digital technology in the sphere of medical services.
The previous decade exhibited a lower barrier of global access to medical help and that means that even countries like Mexico, Brazil, and Argentina are looking forwards towards the digitalization of medical service business and healthcare insurance agencies in the years to come. And is going to happen starting today. So yesterday was the best time to start the development of you EHR solution. Today is absolute must, especially if you’re in medical business yourself and would like to keep the competition at bay.
So, what did we learn today? First of all, don’t be afraid of the complexity. In case everything is done right, there will be none of it. And many problems can come out of your imagination because, of course, you put your money in it, you may not understand how some back end systems work, etc. Do you need it? No. Does flying a plane requires you to know how the aircraft is designed and how it works? Does the absence of this knowledge stops you from flying it? No. Therefore, don’t get spooked if you don’t know something.
Not a lot of effort is required for a small project though, like a booking/survey of the patients coming to a private practitioner in order to save his time. For a bigger clinic with some systems already at play the implementation of the new system will take longer and it will be more expensive. As it was earlier and above, you should clearly define a specific set of problems that you’d like to solver with EHR system.
Keep in mind that you should follow regulations and have all the proper licenses if you are the owner of medical practice. In case you are an investor your project should be GDPR- and HIPAA compliant. There are 2 ways for you to proceed: build a custom EHR system from scratch (first doing MVP) and make it encompassing enough to include all required internal communications, analysis, tracking, etc.
Sharing is Caring
You will work with a team of Business Analyst (product owner), project manager, senior software engineer, and tester. Thanks to scrum your team is going to update you constantly. Your SaaS project will be estimated to give you the price and time it will take to complete it. You absolutely must consider market trends and the demands of end users. The features you decide to include in your EHR software should definitely solver concrete problems and save time/increase revenue (your ROI).
The future belongs to medical software. It can save millions of lives. Just think about: live monitoring of people with conditions and instant medical assistance for them, medical alerts (Apple smartwatch saved a life not even once), no queue when you come to a doctor, practitioners in different states and different countries can access your health history, digital record of all your injections, the list of tests and result, integration with insurance companies and payment gateways, virtual visits to your doctor, emergency medical assistance 1-on-1 via live streaming, etc.
EHR systems upgrade the communication process between hospital staff and patients. Your family doctor in your pocket is going to monitor you even when you’re outside the hospital. It already happens and both me and you are moving towards such systems. Catch this train to be the provider of modern cutting-edge software that improves human lives, safeguards our health, and makes medical assistance much more accessible, for instance, to disabled people.
Whether it is a 500-staff hospital or one-person practice, such EHR systems with rich functionality promise to deliver the next level of medical care. This is the future and the future is here. Don’t let anybody tell you it is complicated or difficult because it is quite possible. Stay healthy and be well!
Do you have any questions about the development stages of your EHR software?