What is an electronic health record (EHR)? A magic pill? Not necessarily. In the era of digitalization in the healthcare industry, electronic health records have been meant to improve healthcare processes and serve patients. So why do clinicians give this technology an “F” rating for usability in a 2019 study by Yale University? For context, look at how participants in other studies rank different programs and devices in terms of usability:
A — Google search engine
B — Microwave ovens, ATMs, and Amazon
C — Microsoft Word, DVRs, and GPS devices
F — Microsoft Excel (due to its steep learning curve)
In the study conducted by Yale, healthcare professionals gave EHR systems a usability score of 45, which is even less than Excel’s 57. The same Yale-led study discovered that EHRs are also contributing to doctors’ burnout. What’s the reason for these deadly results?
The US HITECH Act of 2009 was well-intentioned, but it pushed healthcare providers to adopt unknown and complicated technology as quickly as possible. As a result, the healthcare industry, trying to become digitized, is increasingly experiencing security and workflow issues, leading to frustrated clinicians and dissatisfied patients.
But giving up on ineffective, buggy, and clumsy software you’ve almost gotten used to means having to walk the road of complex new implementations once again. And while this does require an investment of time and money, it doesn’t guarantee a positive outcome. This is why C-level managers of healthcare enterprises hesitate to change their EHR systems but still are interested in how to build an EHR system.
If you realize that your current EHR is blocking your practice from growing and prospering, this article will show you how you can break the vicious cycle and implement an effective EHR system.
What irritates clinicians about their EHR systems
A study by the University of New Mexico found that the design of clinical processes and the clinical culture — both of which are directly related to the use of EHRs — contribute to nearly 40 percent of the total stress experienced by healthcare specialists. Let’s check out what EHR complexities lead to clinician burnout.
The University of New Mexico study points out that doctors spend one to two hours on EHRs and other deskwork for every hour spent with patients and spend an extra one to two hours of personal time on EHR-related operations on a daily basis. No wonder they do, as scheduling a computed tomography scan through an EHR might take 45 minutes.
Moreover, EHRs — often even those provided by the same vendor — are not interoperable between different facilities. Consequently, a patient’s tests may be repeated as many times as a patient goes to a different facility.
EHRs are prone to errors
The problem of patient misidentification is increasingly evident. Take for example an incident last year at Virtua Our Lady of Lourdes Hospital in New Jersey when a patient received a kidney transplant that was destined for another patient of the same name and age. Luckily, the intended recipient obtained a transplant a few days later and both patients are okay, but many similar incidents have been caused by the use of EHRs.
EHRs are difficult to use
EHRs are complicated and feature-packed. Customizing an EHR requires lots of manual work and may not be fully successful due to the systems’ rigidity. The need for being tech-savvy and ready to deal with puzzling interfaces is driving some clinicians right out of the profession, as a mistake might cost a life. Additionally, EHRs keep requiring excessive mouse clicks and pagination to insert information during appointments, deflecting attention from patients.
Let’s see how these issues manifest themselves in the most used and seemingly reliable EHR software.
What’s wrong with the leading EHR software systems?
Cerner and Epic are undisputed leaders in the US EHR market. According to a report by KLAS, they hold 54 percent of the US acute care hospital market, with Epic having 28 percent and Cerner 26 percent of the market share.
These vendors provide comprehensive and expensive systems, multi-year contracts for which usually cost millions or even billions of dollars to install an EHR. Adopting Cerner or Epic software might take from six months to more than a year, not counting the time needed by employees to adapt to the new system. When choosing either of these products, healthcare organizations fairly expect state-of-the-art software and service. But along with sophisticated functionality and extensive software integration capabilities, you may encounter the following issues.
Barriers to caring for and serving patients
Here are examples of how EHR systems might cause harm to patients’ health and hospital operations, leading to significant financial and reputational damage.
Epic. In 2015, suspecting that a patient was suffering from meningitis, a physician at the Saint John’s Health Center in Los Angeles carried out a spinal tap. Next, an infectious disease specialist ordered a critical lab test in the Epic EHR. The order was placed successfully according to the user interface, but as it turned out later, it wasn’t forwarded to the lab. The patient’s test results were delayed a few days as a result, resulting in irrevocable brain damage from herpes encephalitis. The error might have been caused by the Epic EHR not completely “interfacing” with the lab’s system. Epic claimed it was the hospital specialist’s fault, as they allegedly used the wrong button and it was the hospital who had configured the interface with the lab. But three years later, Epic paid $1 million to settle the suit. The medical facility and its two healthcare specialists paid a total of $7.5 million, and one case against a third specialist is pending trial.
Cerner. In 2017, the Glen Falls Hospital in New York experienced constant issues with their billing system. This resulted in $54 million in uncollected bills. Of these uncollected bills, $38 million were directly related to the Cerner EHR system used by the hospital. Hospital staff said that bills weren’t sent out of the facility for several months due to issues with the Cerner EHR system. Other hospitals, like the Western Missouri Medical Center, have also experienced serious financial losses caused by the Cerner EHR billing system.
Cerner provides an aesthetical graphical user interface, but it isn’t easy to navigate. Lots of users complain about long and repetitive workflows to perform even simple tasks. Employees will require comprehensive training before they feel comfortable using the Cerner system.
When it comes to Epic, many doctors have written about its overwhelming complexity: the dashboard is overloaded with buttons, switches, lights, and levers. According to a post for The New York Times written by Emily Silverman, M.D., the Epic EHR makes sudden and premature requests, mid-documentation, to “assign” patients diagnoses from a list of extremely specific options.
Considering clinicians as task performers rather than humans
In the same post by Emily Silverman, you can read impressions of using the Epic EHR system. Dr. Silverman recognizes the lack of supportive components in the system, saying that staff receive ruthless daily reminders about tasks they haven’t performed yet with no praise for what has been accomplished. This makes physicians feel constantly deficient.
Besides Epic and Cerner, there are countless other ready-made EHR solutions out there. But they receive even more user complaints. It’s no wonder the level of EHR dissatisfaction among clinicians is so high. So what’s the way out?
Build a custom EHR system that will incorporate all the best practices you appreciate in leading off-the-shelf software and will be tailored to the specific needs of your practice.
Why develop a custom EHR?
Check out the most obvious reasons for custom EHR development.
Implement all the features you need — and nothing you don’t
A modern EHR might contain features for chronic disease management, behavioral health support, e-prescribing, and surgery preparation. It might even provide drug diversion tools to ensure proper prescribing methods.
Developing a custom EHR empowers you to pick the features needed by your practice. At the same time, you don’t have to implement unnecessary functionality that will confuse your employees and cause them to get lost in a mindblowing assortment of options.
Implement only the integrations you need
Let’s say you currently have two different EHRs: one for your hospital and the other for your private practice. You have two interfaces, but in addition, there are 40 different programs that must exchange data with these systems and communicate with each other. A software development partner can help you implement a single EHR that incorporates all your practice and hospital processes into a single interface.
While working on Healthfully, an enterprise eHealth system, we ensured integrations with EHR, HL7, telemedicine, payment, and WebRTC solutions. Some of the solutions we needed to integrate with were poorly documented legacy systems, but we ensured system integrity despite the variety of tech stacks we used.
Timely improvements and quick support
According to some users’ complaints, Epic customer support is not very responsive to improvement requests regarding simple tasks that could be performed easier by adding a button or checkbox in specific areas. Downtime for the service might also be problematic if maintenance needs to be done during work hours.
When developing a customizable software solution with a development partner, you can expect thorough initial research and testing of features by end users along with the collection, analysis, and implementation of improvement requests.
When building Healthfully, we established a process for collecting feedback regarding features under test and providing prompt fixes, as the functionality we were developing was urgent for our client.
Training end users
Your EHR software development partner can also offer to train your staff and ensure further support and maintenance. And in case you have requirements for urgent new functionality, your partner will be there for you.
Due to the COVID-19 outbreak, Healthfully needed back-to-work, back-to-school, and telehealth functionality. We implemented all these features within two weeks.
Now let’s explore how to build an EHR system.
EHR system development: where to start?
These three steps will help you overcome your most burning healthcare business challenges with an EHR app.
Step 1: Define your strategic goal. For example, if your goal is to reduce patient turnaround times, you might consider integrating an appointment scheduling feature, video chat, etc.
Step 2: Talk to your users about their needs. Your clinical staff, patients, and even insurance providers can provide you with valuable insights into how to refine your software and make it more patient- and hospital-oriented.
Step 3: Document your requirements. Once you’ve defined your strategic goals and your users’ needs, you can transform them into business requirements, based on which you can prepare a functional specification. Your technology partner can help you with this.
Read also: The Role of a Business Analyst at Yalantis
Let’s see what needs and objectives your EHR app should cover.
Minimizing paperwork and optimizing data entry
While doctors can obtain some information directly from different sources, they still have to enter or upload data to an EHR. That’s where human errors might occur. Sometimes, EHRs even contribute to the appearance of errors.
For example, some EHR systems remove the decimal point when a provider types in a medication dose. If a doctor were to type in an order for 2.5 milligrams of medication in such a system, this would actually be processed by the EHR as 25 milligrams. This error could lead to an overdose. So developers must avoid such inconsistencies.
Here’s how an EHR can minimize the possibility of errors:
There might be cases when a patient is weighed in pounds but the patient data has to be inserted into the EHR system in kilograms. To ensure accuracy, units must be clear in the interface. The general principle of the data entry process is simplicity and data consistency.
Copying and pasting is an important functionality that cuts time and cognitive burden for healthcare specialists. However, poorly implemented copy-paste functionality can pose risks to patients. Users might fail to check and edit data, as an EHR doesn’t help them do that. To enable users to spot inaccurate information, an EHR might ensure:
Automatic data updates. An EHR may automatically update notes with current vital signs and test results. Displaying the name of the author on all notes can help doctors see whether or not a recent note has been updated from a previous version. The author’s name can remain the same if the note is copied with no revisions but change if another doctor reviews and edits it.
Сentralized data matching system. A centralized data matching system automates record de-duplication and data integrity. An efficient enterprise master patient index (EMPI) is essential in providing a smooth data flow from provider to provider. EMPIs that use location intelligence and geocoding to check addresses help healthcare providers standardize and authenticate addresses in real time. This helps to avoid risks related to duplicate records and detect fraud.
Read also: Our Healthcare Software Development Services
Searchability, advanced decision support, and reporting
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, giving information in an easy-to-understand format. This way, you’ll make it easier for doctors to make informed decisions about a patient’s diagnosis, current health condition, and treatment plan.
Your product should be equipped with a powerful analytics and reporting framework capable of generating all types of medical reports to help you meet your business goals and provide the best service. Bear in mind that the types of reports your system needs to generate will depend on your requirements.
Improving customer engagement and providing transparency
When wisely implemented, patient engagement features benefit patients by putting them in control of their health and benefit clinicians by giving them more time to focus on patient care. A patient portal can lead to a high level of patient engagement. Let’s see what a helpful patient portal should include to improve the user experience and increase patient loyalty.
Online appointment scheduling not only greatly increases patient satisfaction but also saves time for your staff, letting them spend less time 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.
Health risk assessment (HRA) tool
Preventing illness is better than curing it. Allow your patients to enter data about their state of health using questionnaires or the chatbot function. The HRA tool allows your patients to prevent severe consequences of their lifestyle, reduce genetic predisposition to certain diseases, and minimize the possibility of contracting infections. Using HRA functionality, doctors can detect potential symptoms and take appropriate measures to prevent serious illnesses. To learn more about how to integrate your software with the health risk assessment module read this article.
Access to lab results and medication records
Your lab integration module should automatically upload lab results to the system and make them available to both doctors and patients. What’s more, it should show explanatory notes next to each result. This will help doctors and patients quickly understand which results are within and outside the norm.
Enabling adequate data protection
The HIPAA Security Rule requires all healthcare providers to take physical, administrative, and technological measures to protect private information. For EHR systems, this means providing access controls, data encryption, audit controls, activity logs, etc. Check the details of these security measures in our guide to how to become HIPAA-compliant.
While working on Healthfully, we ensured its HIPAA compliance. We also ensured that users only had access to appropriate data layers in the app as part of the app’s compliance with FDA requirements for medical app data security.
In addition, we made sure the app’s control system allows users to access their information both on the web and in the mobile app via a secure HTTPS connection. To ensure the smooth operation of the access control system, we created a separate module based on the open source CanCan component. Other modules request data from this module to understand what level of access users have.
There are two keys to effective interoperability between healthcare providers:
- Creating and promoting an open application programming interface (API) that will allow for the sharing of unified medical records. Ideally, this API should be easy for medical workers to set up and configure.
- Following a unified standard for exchanging information between healthcare providers. By following established standards such as fast healthcare interoperability resources (FHIR), developers help healthcare organizations speed up the adoption of app-based solutions that support data interoperability.
A couple more tips for creating an EHR system
Here are some tips on how you can guarantee the highest level of usability for your medical personnel and patients.
Minimize the number of clicks required. Unfortunately, most EHRs require users to make excessive clicks. Read how developers were able to use the SMART on FHIR to reduce keystrokes for chronic disease management in one EHR workflow from 18 to 6.
Consider doctors as humans. Try to find a human tone of voice. If there’s no real emergency, make the interface colors and symbols neutral, even calm. Notifications regarding a patient’s death should provide empathy. What Epic calls “deficiencies” and “delinquencies” might be named “incomplete tasks.” Periodic encouragement with messages like “thank you for all your hard work” will inspire and support users.
Consider integration with wearables. To monitor patients’ vitals, manage chronic diseases, and support post-surgical observations, you can parse data directly from wearable devices or health applications such as Google Fit and Apple Health through these medical software platforms’ native APIs.
Now you know how to create an Electronic Health Record. As you can see, a custom EHR can bring a lot of benefits to your healthcare business: fewer disparities and errors in medical records, better engagement with patients and their families, improved decision-making and care coordination, and increased security for your patients’ data. But before deciding on a software development partner, make sure they’re highly experienced in building complex high-quality projects, creating service-oriented architectures, implementing electronic medical record systems, and providing cost-efficient services.
Want to build EHR software? Yalantis, which has been ranked one of the top three software outsourcing companies in Ukraine by Clutch, would be a great choice. Tell us about your most burning pain related to your EMR/EHR software solutions and we’ll help you treat it with a custom web or mobile medical app.