Not so long ago, patients’ medical information was in the form of paper records – handwritten, bound together, labeled, filed, and put on a shelf till the next visit. In fact, this is still how things are done in many countries.
In the middle of the 2000s, the mass adoption of information technologies encouraged many healthcare businesses to start integrating electronic medical record (EMR) systems into their business processes as a more advanced alternative to paper records. EMR systems serve as a digital version of paper charts, containing all medical and treatment history of a patient within a practice.
As time went on, hospital app development started growing in popularity, making more and more providers around the US implement EMRs in their clinics, which made the US government recognize the necessity of enhancing communication between health providers by making their medical software interoperable. That’s how electronic health record (EHR) systems were born.
What type of system best suits your business?
So what exactly is an EHR system and how does it differ from an EMR system?
While EMRs allow for collecting, keeping, and managing patients’ data in one safe place, this data can hardly cross the borders of a practice, meaning it’s not available to other establishments – or even to patients themselves.
Unlike EMRs, EHR systems are designed not only to collect and keep patient information but to share it with laboratories, emergency rooms, hospitals, pharmacies, and other healthcare institutions. EHRs can accumulate information from all providers involved in a patient’s care – as well as from patients themselves – to allow for coordinated, patient-centered care.
Still, both types of systems have many features in common – for example, those related to data gathering and storage, documentation management, reporting, and billing. While an EHR system is best for large hospitals – which may need to share information with other healthcare providers on a regular basis – an EMR solution can be a nice choice for small practices.
Existing challenges for EHR systems
For now, 87 percent of physicians use either an EMR or EHR system in their practice. That’s not surprising given that as of the beginning of 2019, “all Medicare-eligible hospitals, dual-eligible hospitals, and critical access hospitals are required to use the 2015 edition certified electronic health record technology (CEHRT) and meet the new requirements outlined in the 2019 IPPS final rule” according to the Centers for Medicare and Medicaid Services.
Still, 40 percent of doctors aren’t satisfied with the system they use according to the Physicians Foundation.
As the demand for EHRs continues to grow, so do physicians’ expectations for these systems. According to Deloitte, many doctors expect improvements in the documentation management, communication and care coordination, prescription management, interoperability, and user-friendliness of their EHR system. Moreover, many providers surveyed in the Deloitte study mentioned the high cost for maintaining their EHR solutions, while others complained about a complete inability to customize the system without the vendor’s help.
This may encourage healthcare businesses to create their own, tailor-made medical platforms from scratch rather than using an off-the-shelf solution, by reaching out to a professional medical app development partner. Let’s see if we can help you figure out some useful functionality for your custom EHR system.
The key benefit of an EHR system is a significant reduction in paperwork for medical staff, helping them stay focused on patients and increase their productivity and job satisfaction. Let us quickly remind you how exactly an EHR system does that.
A medical records app should be able to keep different types of information conveniently and securely. The types of data you might want to store in a medical logbook app may include:
Patient’s general medical information including allergies, illnesses, surgeries, immunization status, and past and current diagnoses
Treatment history, including medications and clinicians’ notes from a patient’s hospital stay. This information can help inform discharge instructions and follow-up care and help patients smoothly move from one care setting to another.
Health insurance information, including a copy of the insurance card, policy number, and contact details
Emergency contacts of family members and information about caregivers and local emergency departments
Laboratory test results, which can be stored in the form of charts or graphs. An ideal logbook would offer some templates that could be used for common lab results such as heart rate, blood pressure, red and white blood cell count, cholesterol level, and urine tests. It would also be desirable to offer customizable features that allow users to create templates for rare medical tests.
X-rays and other medical images (e.g. CAT scans and MRI scans)
Patient’s personal statistics such as weight, pulse, blood pressure, and daily physical activities. Ideally, you can rely on automatic updates from medical devices and apps on a patient’s smartphone (for example, Google Fit or Apple Health).
Patient visit and round notes, etc.
Some of this data can be manually entered, scanned, or uploaded to the app by a doctor, while other data can be directly received from other sources. Thus, your EHR app may offer interoperability with pharmacies and laboratories – sometimes within your network, sometimes outside of it. The integration with laboratories and pharmacies allows physicians to send orders for lab work and prescriptions electronically, through an API. Additionally, once lab tests are ready, they need to be uploaded to the system to be available for healthcare providers. We’ll talk about interoperability challenges a bit later.
But how can you further automate and ease data input for doctors? Here are a couple of advanced ways to do so:
For years, dictation was a common way to record notes. Dictation is a good feature, but it requires doctors (or their assistants) to listen to and transcribe the recorded audio. Sometimes it may be inconvenient to listen to recordings; sometimes you don’t have time. So in addition to voice dictation, you should think of implementing voice recognition technology. Market leaders Vitaler and DrChrono have implemented a speech-to-text feature for doctors’ convenience.
Some technology providers like Vitaler, Flatiron, and Enlitic go further and use AI to enable auto-filling. The efficiency of AI in healthcare increases every year, and even the most skeptical providers are turning to this technology. Peter Liu, a researcher at Google AI, has developed a language modeling program that can effectively predict the content of physicians’ notes by analyzing a patient’s medical records. Last year, Amazon announced an AI-powered tool that extracts medical information that’s needed at the moment.
Provide customizable chart templates equipped with checkboxes, drop-down menus, radio buttons, and the minimal fields necessary to greatly speed up data input.
Digital health questionnaires
Asking patients to fill out health status forms is still common practice, requiring doctors to input a lot of patient data. Why not let your patients do this directly on their devices and then synchronize their answers with the doctor’s notes? It’s a huge time-saver.
Searchability and decision support
It’s important to let doctors conveniently navigate piles of digital healthcare data to access necessary information in just a couple of clicks.
But healthcare data is often complicated: according to Elasticsearch, 70 percent of all data kept within EHRs is unstructured, natural language data (visit notes, reference letters, questionnaires) that is hard for a search engine to interpret.
To let your users build queries for both structured and unstructured data, you need to use a search engine that can handle unstructured documents, offers a flexible API, and is highly configurable and scalable – Elasticsearch, for example.
It’s also advisable to present the results of treatment and whole treatment processes in progress dashboards. This way, you’ll make it easier for doctors to make informed decisions about a patient’s diagnosis, current health condition, and future treatment plan.
Speaking of decision support, you can also enable patient-specific reminders for planned screenings and other preventive care, as well as alerts regarding possible health risks and suggestions for best clinical practices to prevent chronic diseases.
Convenient reporting for doctors
Being able to gather, analyze, and report data about the quality of care is a key requirement under the Medicare and Medicaid EHR Incentive Program. Your EHR system should be equipped with a powerful analytics and reporting framework capable of generating all types of medical reports to meet your business goals and provide the best service. Aside from financial and billing reports, these reports may include:
Vaccination and medication records
Meaningful Use Reports (Medicaid)
MIPS ACI Reports (Medicare)
Clinical Quality Measures Reports (CQM), etc.
Bear in mind that the types of reports your system needs to generate will depend directly on your requirements.
Improved customer engagement
EHR systems make patients active participants in their treatment. According to the Agency for Healthcare Research and Quality, “engaging patients and families via enhanced communication can have a positive effect on patient outcomes.” This includes emotional health, symptom resolution, pain control, and physiological measures like blood pressure and blood sugar levels.
Providing a high level of engagement is possible by developing a patient portal. Let’s see what a really helpful patient portal should include to improve the user experience and increase customer loyalty.
No one ever liked waiting in line. Moreover, modern patients are unlikely to be excited to make a call to schedule their next appointment with a doctor. That’s why you should include an appointment scheduling feature. Not only does appointment scheduling via mobile and web greatly increase customer satisfaction, it also saves time for your staff, helping them spend less on phone calls and focus on more important tasks. What’s more, by integrating your app with push notifications or simple SMS reminders, you can significantly reduce the number of no-shows, which is bound to increase your revenue.
Sometimes, your patients need to get urgent advice or consultations without booking ahead and waiting in line. Enabling constant communication between doctors and their patients is vital for providing quality healthcare service and winning customer loyalty. And it becomes possible thanks to telemedicine, which usually takes the form of real-time chats (sometimes equipped with video and audio calls for more effective communication).
In-app chat is the primary feature of eCuris, a medical platform we developed for one of our clients. Moreover, chat functionality can be helpful for providing better communication between your staff. In eCuris, we designed group chats – called Circles – to enhance communication between doctors and patients, doctors and other caregivers, and caregivers and patients’ families.
Access to lab results and medication records
Patients expect their lab results to be ready as quickly as possible. It’s equally inconvenient for patients and staff if patients need to constantly call the office to find out their results. Your lab integration module should automatically upload lab results to the system and make them available via both the doctor’s app and patient portal.
What’s more, your lab integration module should show all results with explanatory notes next to each type of data. This will help both doctors and patients quickly understand which results are within and outside normal parameters.
When it comes to medication records, physicians can make use of e-prescribing, allowing doctors to submit prescriptions directly to a pharmacy so patients can easily pick up their orders.
Integration with wearables
To get a better picture of patients’ habits, general condition, and daily physical activity, you can parse data directly from patients’ wearable devices or health apps – such as Google Fit and Apple Health – though these platforms’ native APIs. Last year, Apple introduced Health Records – a feature that works on the basis of the Fast Healthcare Interoperability Resources (FHIR) integration to import patient health data from more than 75 connected hospitals and medical providers in the United States.
[Apple’s iOS Health Records feature]
Adequate data protection
HIPAA’s Security Rule requires all healthcare providers to take physical, administrative, and technical measures to protect private information. What does it mean for EHR systems?
Access control. Aside from traditional login/password authorization, your app should support different levels of access to content – for example, a nurse shouldn’t have the same level of access to data as a physician.
Encryption. To protect private user information from malicious attacks, you need to cypher your data, use the latest versions of tried-and-tested frameworks and libraries, and enable all app–server communications via encrypted transfer protocols such as TLS/SSL and HTTPS.
Audit trail. This is necessary to record who accesses information, what changes they make, and when.
While working on eCuris, we had to make sure that users only had access to appropriate data layers in the app to comply with FDA standards for medical app data security.
We also needed to make sure the access control system allowed users to access their information both on the web and in the mobile app via a secure HTTPS connection. To ensure smooth operation of the access control system, we created a separate module based on the open-source component CanCan. Other modules request data from this module to understand what level of access users have.
Working further on interoperability
Lack of interoperability between healthcare providers is a pain point for all parties involved in treatment: patients (who seek care from multiple institutions), hospitals, pharmacies, and laboratories. These parties face the loss of important clinical information, duplication of other information, unnecessary retesting, and mistakes in laboratory results.
To fight interoperability issues, the US Office of the National Coordinator (ONC) for Health IT has created a shared nationwide interoperability roadmap that describes a step-to-step strategy for achieving interoperable health IT infrastructure.
Within ten years, the ONC aims to create infrastructure that allows healthcare providers and patients to easily access, send, and receive health-related data.
The key to effective interoperability between healthcare providers lies in two aspects:
Creating and promoting an open application programming interface (API) that will allow for sharing of unified medical records. Ideally, this API should be easily set up and configured by medical workers.
Creating a unified standard for exchanging information between healthcare providers. The lack of a single data format often causes misunderstandings between healthcare providers. A non-profit organization called HL7 has put effort into developing the abovementioned FHIR standard for exchanging information between healthcare facilities.
The FHIR framework is already in use, helping medical applications effectively communicate with each other. For instance, the health insurance app Oscar follows the FHIR guidelines to partner effectively with the Cleveland Clinic. Using FHIR for data exchange, Oscar highlights the great potential of this framework.
However, creating an API that follows all standards is still not enough for providing interoperability – it’s fruitful partnerships with pharmacies, laboratories, and other health establishments that is key.
General tips for creating an EHR system
Here are some tips on how you can guarantee the highest level of accessibility for your medical personnel and patients:
Your telemedicine app should serve users with disabilities. Design your EHR system following the Web Content Accessibility Guidelines (WCAG).
Sometimes, doctors need to check information about a patient on the go or patients want to urgently check their prescriptions or lab results. For this, it’s worth investing in medical mobile app development.
Store your data in the cloud so patients and medical staff can access it from anywhere. Moreover, cloud solutions relieve you from the necessity to invest in costly physical servers that fill space in your hospital. Also, this option provides better security and the ability to recover data in case of a server outage.
If you’re running a large practice or hospital, you can consider integrating your EHR with practice management software that will allow for a more coordinated workflow for your staff, with to-do lists and reminders.
An effective EHR system can bring a lot of benefits to your healthcare business: reduce health disparities and errors, better engage patients and their families, improve decision-making and care coordination, and maintain security for your patients’ data. Still, developers need to work further on the user-friendliness and interoperability of EHR systems. Despite many commonalities, every healthcare business has its own challenges. If you’ve already defined these challenges and are looking for a pair of hands to help you solve them, we’re here to help.