Building A Custom EHR System: Practical Examples, Cost, Compliance, And Features

For a start, we should define the difference between these 2 notions. They may seem totally identical, but in fact, EHR and EMR have some distinctions. So EHR vs EMR - what are they?

Electronic medical record (EMR) is a digital chart of a patient that is stored in a database of a hospital. EMR software is created separately for each disease by a doctor. It means one EMR is created for one practice. EMR replaces paper records and it has a few obvious advantages like the following:

• Tracking data over time
• Physicians always receive notifications with reminders that that or another patient should undergo a planned check-up or screening
• Also, physicians can quickly check test results like a blood test or MRT
• Monitor how good treatment is, what improvements are there. If something goes wrong, the treatment process may be revised.

However, as it was mentioned above, EMR is used only for one practice. So it is not convenient to have plenty of EMRs if other physicians need to observe you. So EMR is not an ideal option.

What is electronic health records (EHR)? It is also a digital chart but it has much more functions and capabilities. EHR not only store information about a patient in one practice. EHRs are used to share information between different doctors and healthcare providers like laboratories, so all information can be stored in one file. Thus, EHR can be managed by various healthcare specialists that may even work in various cities and countries.

That is the main difference between EHR and EMR. In fact, timely shared medical information may even save lives, so EHRs are very important in today’s world. And in order to deal with EHRs more effectively, it is better to create special electronic health records software that will be handy both for doctors and patients. Now let’s proceed to the main benefits EHRs have and how EHR can be used successfully.

Before you make a decision to build EHR software for your business, you should understand all strong sides EHR software may bring. We will divide benefits into 2 categories - for physicians and patients.

• Reliability. EHRs can be found easily from any point of the world and they have backups in case of any system failures. It means that all files can be restored and it is impossible to lose them.
• Permanent updates. Electronic charts are always updated according to preventive care guidelines they are connected with. Besides that, all updates are performed instantly and all users will be notified about it.

• Reduction of possible mistakes. Digital information is always easy-to-read, unlike handwritten data that is often unclear. That is why one physician will always know what prescriptions are indicated there written by other specialists.
• History. All history about patient’s diseases is stored in one file that which is very convenient.
• Marking. Physicians may mark in patient’s chart information that one or another drug should be recalled.

• Group management. A physician can create groups of patients in one practice, manage them and customize according to their needs.

• Timely care. Authorized specialists have 24/7 access to EHR from any point of the world. Hence doctors may help their patient quickly and timely at any time.

• Appointments management. All appointments with doctors can be managed and scheduled via EHR software. Also, it is possible to set up a notification about these appointments not to miss anything.
• Medical data tracking. Patients may track all lab results, notes of doctors, prescriptions and so on at any time.
• Integrated communication. Of course, any software becomes better when it allows its users to chat with each other. Patients can communicate with doctors when they need help.
• Cards scanning. Patients can scan their insurance cards quickly via EHR software and then all the cards are stored in the system.
• Reminders. Reminders about bills or about appointments can be sent automatically when a user makes custom settings.
• Cloud hosting. As it was mentioned in the advantages of EHR for physicians, all medical files are stored in the cloud and they cannot be lost or damaged. Especially if blockchain services are used for storage.

In fact, EHR system is a patient portal that also contains educational materials for patients and they can always increase their level of engagement. So it is beneficial for both parties. Our experience in the development of healthcare software helps us reduce software development time which leads to lower costs. But if you plan to create a custom EHR software for your clinic or just make it your startup, what should you start with? There are several important steps you should know about for building an EHR system, see them below.

First, you should start your way with HIPAA/GDPR compliance.

Let’s consider it in details.

When you create EHR software for the USA, you should make sure that your app is HIPAA compliant since EHR software processes and stores personal health information. HIPAA stands for Health Insurance Portability Accountability Act. HIPAA contains many rules and regulations your app should comply with. Technical issues of EHR software development are covered in paragraph 164.312. By the way, we have built GDPR compliance checklist which may help you verify how your website or mobile app is GDPR-compliant. Feel free to use it.

HIPAA guidelines require your EHR system to provide the confidentiality and security of protected health information of users.

As for GDPR compliance, this new law that came into effect last year on May,25 was elaborated for EU. It means that all businesses that include processing and storing of personal data of EU citizens should comply with GDPR and provide individuals with a high level of security. As healthcare providers work with patients’ personal data, they need to notify patients that processing of their data meets all GDPR requirements. You can read our detailed article concerning GDPR compliance.

On the whole, custom EHR software should be built for web first since there are many features and particularities that are better used as a web application. However, EHR system in mobile is also should be available since it helps improve patient-physician communication and, also, a patient may increase their education in the medical area.

Besides that, mobile EHRs mean portability. Users and patients may solve many important issues right on the go. Mobile EHRs facilitates a better involvement of patients in the treatment process. And to make sure that your custom EHR system will be met by new users warmly, build mobile app both for iOS and Android operating systems.

It is a must-have stage and custom EHR system should be certified officially. Users should be aware that your software is legal and won’t be malicious.

• Thus, EHR system for the US-based citizens will require ONC-ATCB certification ( Office of the National Coordinator - Authorized Testing and Certification Bodies). After certification, healthcare providers and patients may feel the confidence to your product and that software meets all required standards.

• On EU territory, you will need to undergo EuroRec certification. It performs the same functions as ONC-ATCB but only in the European Union.

Without certification, you will have no right to distribute your app, and you will gain nothing.

There are a few standards that are used for healthcare information exchange. These standards are CCD, CCR, HL7, CCA, etc. It is impossible to predict what standard you will use, everything depends on the particularities of EHR software you need to create and what country you create it for. Our specialists will advise you what standard should be adopted.

It is required to migrate data from old-school records to new EHR software. Clinic owners can hire employees that will help them perform this routine job. Also, it is also recommended to hire admin that will manage EHR software and upload medication histories of patients.

To understand how popular and profitable your EHR software is, you should monitor some important metrics like:

• ROI calculations to assess the profitability of software
• Throughput of records to understand the efficiency
• Quality of care which requires the collection of patients’ feedbacks
• Physicians’ satisfaction with the help of their feedback as well
• Quality of functionality monitoring data error rates

Also, we cannot ignore Health app made by Apple that makes it possible for iPhone users to visualize and store securely all their health records in one place. It is available for all US-based healthcare organization at the moment.

The point is that all US clinics may self-register on Apple's website and connect their compatible EHRs with Apple Health Records system. It allows all patients and doctors aggregate all health records from different clinics in one place, download all medication history on iPhone and keep track of it.

Thus, if you are a caregiver organization from USA, our development team will build your EHR systems considering compatibility with Apple Health Records. It can be much more convenient for your patients to monitor everything locally, without the necessity to use a few different EHR systems. So we always move with the times and create your software taking into account all innovations in digital world.

All these steps will help you create a high-quality product and not to miss something important during EHR development stages. Now it is the time to speak about minimum viable product development and what basic features it should include.

Any EHR software should be built with the following feature list that makes a skeleton of the service:

Note: As we have large experience both of healthcare software development and other types of software, we have created a kit of basic features that are often integrated into healthcare app. This kit helps us integrate features twice faster, so we can build your project faster, and deployment time is also reduced. We call this kit BasicProject or Starter. For example, if charting feature implementation took 80 hours before, we can build it for 40 hours now.

Also, keep in mind that a custom EHR software should have an intuitive user interface that is simple but attractive. Mind to add drag-and-drop capabilities to your software, columns, tables, and so on. That is what EHR software features should look like.

In addition, your app should be available 24/7 since patients and doctors may need to access medical information at any time of day and night.

Let’s study EHR implementation cost breakdown. UI/UX design cost will be approximately $4,000 - $5,000 for web and $5,000 - $7,500 for one mobile platform. Average cost of EHR implementation will be min $36,700 - max $59,000 for web, and min $25,900 - max $65,800 for one mobile platform.

We take $50 as an average hourly development rate. To estimate the average cost of EHR system for two mobile platforms, just multiply this cost by two. You can find an estimation for web and mobile in PDF with each feature clicking this link.

As you probably know, it is impossible to indicate a custom EHR software cost accurately, because everything depends on specific requirements and the number of platforms (web, mobile), so we have provided you with a rough estimation of an EHR system.

To build EHR system, the following tech stack can be used:

• Languages: Java, Python, Swift, Kotlin, JavaScript, PHP
• Frameworks and libraries: Angular, jQuery, Django, Node.js, Bootstrap
• Databases: MySQL, PostgreSQL
• Analytics: Amazon EMR, Google Analytics, Optimizely
• Web server: Apache HTTP Server, nginx
• Utilities: Cloudflare, Microsoft Azure, Amazon S3
• Payment gateway: Braintree, PayPal, Stripe

• 3 web developers (1 back-end developer, 2 front-end developers)
• 1 Android developer
• 1 iOS developer
• 2 QA engineers
• 1 Project manager

If you need to build a software related to the healthcare area, you should find a reliable software development team. To save on development costs, you’d better outsource the development to another country where the hourly rate is not very high. Eastern Europe is the region where the average hourly rate is $35 - $50.

Cleveroad is a healthcare software development company with experience in medical and healthcare solutions of different complexity level. For example, at the moment our team works on the on-demand mobile app to find and call a doctor in a certain region. It is like Uber for doctors. So our developers can build a custom EHR software according to your requirements and needs. Just contact our requirements managers and they will provide you with all the information you need. We think that this guide was helpful and now you can make the right decision on what EHR software you need. So be clever, and follow the right road!