Not so long ago, patients’ medical information was in the form of paper records – handwritten, bound together, labeled, and filed away till the next visit. In fact, this is still how things are done in many countries.
In the mid 2000s, the mass adoption of information technologies encouraged many healthcare businesses to start integrating electronic medical record (EMR) systems into their business processes. 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, and more and more providers around the US started implementing EMR systems in their clinics. In turn, this caused the US government to recognize the necessity of enhancing communication between healthcare providers by making their medical software interoperable. That’s how electronic health record (EHR) systems were born.
Challenges for existing EHR solutions
Today, 87 percent of physicians use either an EMR or EHR system in their practice. That’s not surprising: according to the Centers for Medicare and Medicaid Services, 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.”
Still, 40 percent of doctors aren’t satisfied with the system they use according to the Physicians Foundation.
As the demand for healthcare software continues to grow, so do physicians’ expectations for these systems. According to Deloitte, many doctors expect improvements in documentation management, communication and care coordination, prescription management, interoperability, and user-friendliness of their EHR software. Moreover, many providers surveyed in the Deloitte study mentioned the high cost of maintaining their EHR solutions, while others complained about the complete inability to customize their systems without the vendor’s help.
Research conducted by JAMA in 2018 found that poor usability of EHR systems was partially responsible for more than 557 patient safety events in the period from 2013 to 2016. Additionally, industry experts believe that a poor user experience is partly to blame for physician burnout in recent years.
According to Boyd, much of the problem lies in the lack of specialty-specific EHR interfaces, which should be crafted based on the specific requirements of a healthcare facility.
This may encourage healthcare businesses to work with a medical app development partner and create their own medical platforms from scratch rather than use off-the-shelf solutions. Below, we share our insights on EHR app development to help you overcome your most burning healthcare business challenges.
EHR system development: where to start?
However obvious it may sound, first you need to figure out what you want from your EHR system. In other words, you should start with clearly defining your business requirements. And to do so, you need to be methodical:
Step 1: Define your strategic goals. For example, if your goal is to reduce patient turnaround times and increase revenue, you may consider integrating an appointment scheduling feature and video chat to avoid long wait times, reduce the number of no-shows and late arrivals, and speed up the process of gathering patient records.
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. Their responses can help you define the technological capabilities of your product.
Step 3: Document your requirements. Once you’ve defined your strategic goals and your users’ needs, you can transform these into business requirements, based on which a functional specification can be prepared. 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 may cover.
Minimizing paperwork and optimizing data entry
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’s quickly review how exactly an EHR system does that.
A medical records app should be able to store different types of information conveniently and securely. Data you might want to store in a medical logbook app includes:
General medical information about allergies, illnesses, and surgeries, immunization and vaccination history, and past and current diagnoses.
Treatment history, including the history of medications and notes from hospital stays and office visits. This information can help doctors decide on discharge instructions and follow-up care and can 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 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 data 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).
Notes from patient visits and hospital rounds, etc.
Some of this data can be manually entered, scanned, or uploaded to the app by a doctor, while other data can be received directly from other sources. Your EHR app may offer interoperability with pharmacies and laboratories – sometimes within your network, sometimes outside of it. Integration with labs and pharmacies allows physicians to send orders for lab work and prescriptions electronically, through an API. Once lab test results are in, they need to be uploaded to the system to be available for healthcare providers. We’ll talk about interoperability challenges a bit later.
Data entry was highlighted by the Pew Charitable Trust as one of the seven EHR usability challenges. Healthcare app developers should seek new ways to automate and ease data input for doctors. Here are a couple of advanced ways to do that:
For years, dictation was a common way for doctors 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; often you don’t have time. So in addition to voice dictation, you should think of implementing voice recognition technology. Vitaler and DrChrono have implemented speech-to-text features for doctors’ convenience.
Some technology providers like Vitaler, Flatiron, and Enlitic go further and use AI to ease data entry for doctors. For example, it’s now possible to review provider notes and extract structured data to auto-fill patients’ medical charts or capture notes with natural language processing. 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 contents of physicians’ notes by analyzing a patient’s medical records. Last year, Amazon announced an AI-powered tool that extracts the 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 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 advanced decision support
It’s important to let doctors conveniently navigate piles of digital healthcare data to access the information they need 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 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 clinical best practices to prevent chronic diseases.
Convenient reporting to comply with industry standards
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 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. 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)
Bear in mind that the types of reports your system needs to generate will depend on your requirements.
Improving customer engagement and providing transparency
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 positive effects on 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 helpful patient portal should include to improve the user experience and increase patient 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. That’s why you should include an appointment scheduling feature in your mobile and web apps. Not only does online appointment scheduling greatly increase patient satisfaction, it 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.
Access to lab results and medication records
Patients expect their lab results to be ready as quickly as possible. And it’s inconvenient for patients and staff alike 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 to both doctors and patients.
What’s more, your lab integration module should show all results with explanatory notes next to each type of data. This will help doctors and patients quickly understand which results are within and outside the norm.
When it comes to medication records, physicians can make use of e-prescribing to submit prescriptions directly to pharmacies so patients can easily pick up their orders.
An e-prescribing (or e-Rx) module allows physicians or nurse practitioners to electronically transmit prescriptions, which not only significantly reduces the turnaround time but also reduces the risk of miscommunication associated with handwritten prescriptions and phone calls.
Having full access to a patient’s medical records, an e-prescribing module can enhance the medication management process within your practice via a clinical decision support system: it can make checks against a patient’s current medications for drug–drug interactions, drug–allergy interactions, diagnoses, body weight, age, drug appropriateness, and correct dosing. Based on these algorithms, the system can alert doctors of possible contraindications, negative reactions, and duplicate medications, and can provide clear instructions for delivering more effective treatment.
Integration with wearables
To get a better picture of patients’ habits, general condition, and daily physical activity, you can parse data directly from wearable devices or health apps such as Google Fit and Apple Health through 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.
Sometimes, your patients need to get urgent advice or consultations without booking ahead and waiting in line. Enabling constant communication between doctors and patients is vital for providing quality care and winning customer loyalty. And it becomes possible thanks to real-time chat.
In-app chat is the primary feature of eCuris, a medical platform we developed for one of our clients to bridge the gap between patients and their relatives and healthcare providers.
However, it’s not only patient–doctor communication that needs to be improved. According to James Woodson, a medical doctor and the founder and CEO of Pulsara, 80 percent of medical errors (which cause up to 400,000 deaths per year) have their roots in miscommunication between caregivers during care transitions. Miscommunication can also result in a loss of about 2 percent of yearly revenue for hospitals, which equals about $12 billion per year in the US.
Rather than relying on fax machines and pagers, you can use real-time chat that provides instant and meaningful communication for 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.
Enabling adequate data protection
HIPAA’s Security Rule requires all healthcare providers to take physical, administrative, and technological measures to protect private information. What does that mean for EHR systems?
Access control. Aside from traditional password-based 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 ensured that users only had access to appropriate data layers in the app as part of our compliance with FDA requirements for medical app data security. We also made sure the app’s 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.
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 that may lead to patient harm.
To fight issues with interoperability, the US Office of the National Coordinator (ONC) for Health Information Technology has created a shared nationwide interoperability roadmap that describes a step-by-step strategy for achieving an interoperable healthcare IT infrastructure.
Within ten years, the ONC aims to create an infrastructure that allows healthcare providers and patients to easily access, send, and receive health-related data.
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.
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 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 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 not enough for providing interoperability – fruitful partnerships with pharmacies, laboratories, and other health establishments is a key.
Other industry certifications and security compliance
There is still a wealth of rules you should comply with to enable the healthy operation of your EHR application. But no one said that building a healthcare app would be a piece of cake.
In 2010, the Office of the National Coordinator for Health Information Technology introduced its Health IT Certification Program to set a consistent standard for implementing secure and reliable EHR products. Together with the National Institute of Standards and Technology (NIST), ONC has developed a set of functional and conformance testing requirements, test cases, and testing tools that underpin the program (among them are requirements to interoperability, data capture and exchange, and sensitive data segmentation).
To ensure patient safety and improve the overall usability of apps for both patients and clinicians, the program requires all healthcare software developers to engage end-users in EHR usability testing as part of its voluntary Health IT Certification Program. To prepare for the Health IT Certification, you can conduct usability testing based on test cases established by NIST or develop your own, which should address the most common usability challenges. After that, you have to submit your application for approval to the National Coordinator for Health Information Technology. Read this article by the Pew Charitable Trusts for more insights on EHR usability testing best practices.
Designed to promote and protect public health, the Food and Drug Administration is an agency of the United States Department of Health and Human Services. Recently, the FDA presented its new approach to digital health. The new Digital Innovation Action Plan includes goals like making changes to existing medical software policies and the pilot version of a new Pre-Cert Program.
HIPAA and GDPR
Most health apps gather and transmit sensitive patient information. To effectively protect user data, you should be aware of all applicable legal requirements and strictly follow regulations. These requirements may differ depending on your target market. A health app for the US market should comply with the Health Insurance Portability and Accountability Act (HIPAA); an app for the European market should follow the General Data Protection Regulation (GDPR).
General 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.
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. 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 of the necessity to invest in costly physical servers that fill space in your hospital. This option also provides better security and the ability to recover data in case of a server outage.
If you’re running a large practice or hospital, 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. You may also want to integrate your application with a medical billing system.
However intuitive your healthcare app may be, your staff must be effectively trained to fully unlock its potential. Make sure to develop an adequate training plan adjusted to each user’s computer skills.
An effective EHR system 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. Still, developers need to work on improving 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 overcome them, we’re here to help.