How To Build an EHR System: A 10-Step Guide

Posted in EHR

Executive Summary

EHR software is the new norm in the healthcare industry. It is lauded for benefits like improving decision-making, streamlining workflow, and reducing human errors, and it is currently helping 91% of organizations in the United States manage their systems. Building an effective Electronic Health Record (EHR) system is essential for improving healthcare delivery, yet many existing systems still have design flaws and usability issues. To address these roadblocks and understand how to build an EHR system, vendors should involve healthcare professionals during the process.

Their insights can be valuable in designing and making intuitive interfaces to ensure interoperability with other applications. Regular updates, comprehensive training, robust data security, and mechanisms for ongoing user feedback are important aspects of continuous improvement. By focusing on these areas, software development companies can build EHR solutions that enhance patient care, minimize clinician burnout, and ultimately lead to better health outcomes. 

What is EHR implementation?

An EHR implementation is the process that includes planning and carrying out the integration of EHR software in a healthcare organization. The term implementation refers to integrating a software-based service or component into the workflow of an organization or an individual user. An EHR system implementation is an organization-wide effort, the impacts of which will be felt by everyone from physicians and administrative staff to patients.

What Is An EHR Implementation Plan?

To successfully implement an EHR system, planning a thorough outline and setting clear goals is non-negotiable. Dedicate a team and highlight the areas you need to work on so that they can select the required features. Provide a well-defined budget and timeline for carefully selecting the right EHR system.

Make sure the plan covers information about factors like:

• Software and hardware updates
• The chosen method of adoption and training
• Tentative time frame
• Cost estimates
• Distribution of labor and responsibilities
• Workflow changes

The most effective way to create an EHR implementation plan is to take sufficient time and collaborate with your team to achieve long-term goals.

3 Tips for Building a Successful EHR System

How to Initiate an EHR Implementation Plan?

An EHR implementation plan begins with extensive market research, keeping the budget in mind. Organizations that begin without processing the costs of implementing considering their budget. Hence, they fail to provide adequate resources for successful implementation. Clearly articulate the goals and objectives so that proper features can be selected while considering cost. 

Best Practices For a Successful EHR System Implementation

1. Tailor EHR To Fit Within Your Workflow

Off-the-rack EHR software does not guarantee 100% results. Before planning to implement EHR software, evaluate different aspects of the systems that facilitate your organizational needs. 

To make sure that the new EHR system fits everyone’s requirements, plan a survey form to get their opinions and recommendations. This will help you learn what your staff needs and how you can tailor the EHR to fit their expectations.

2. Identify Potential Failures In EHR Implementation

Conducting thorough research on the pros and cons of EHR implementation can help you address potential issues and identify the reasons for failures. Gather input from stakeholders to identify concerns and insights, then engage with your vendor to discuss these barriers. 

3. Proper Training After Implementation 

Do not hurry. Give your team sufficient time to train for every step of the process. Start with the basics and then move on. Arrange several short training sessions to help your staff learn about the new system and its benefits to increase their willingness to use it.

4. Eliminate Duplication

The new system will serve your needs only if you input accurate and relevant data. Eliminate repeated information from your paper records before transitioning to the new system. If there are multiple paper charts for a single patient, enter the data only once to prevent duplicate entries and maintain the integrity of your new system.

How to Build an EHR System?

Here is the 10-step guide to build an EHR system:

1.How to Set a Clear Roadmap

The building block of the EHR development plan is setting goals after understanding the organization’s needs. To build an effective EHR system, start by identifying flaws in your current workflows and systems. Next, outline the tasks that consume the most time and energy. The EHR system can be tailored to address these issues and improve outcomes. 

The main step in this process is to define clear goals for the EHR implementation after a comprehensive assessment of your practice and consultation with your staff. Gather feedback tasks that are most time-consuming for physicians. This collaborative approach will align your EHR system with the practice’s real needs, improving efficiency and patient care. Automating administrative tasks like appointment scheduling or billing through an EHR system can drive it toward efficiency with greater functionality.

Involve high-level executives to get valuable insights into the current state of medical practices and identify essential features needed for your EHR system. Once they review and approve the list of functions, make a detailed outline to help you prioritize the necessary features and serve as a benchmark for assessing the system’s success after completion of implementation.

2. Defining Budget Limits and Projections

Common downfalls in EHR implementation occur when healthcare organizations invest more but get less ROI. Your primary aim with EHR should be to lower patients’ costs while improving the quality of healthcare services. Establish a well-defined budget to protect against loss to reach this goal.

Beyond the initial costs of building the system, approximately $1,200 per user annually is spent. These additional costs are often overlooked. By understanding these financial edges upfront, you can get a successful EHR implementation that delivers proper returns.

Create a realistic budget that includes:

• Customization consultancy and consultancy costs
• Training fees
• System upgrades
• Cloud migration costs, along with backup and storage

3. Preparing the Infrastructure

Another critical step of EHR development is preparing the architecture. If the basic infrastructure of the system does not accommodate good practices across the board and has a poor UX design for healthcare providers, there is a problem. This affects your practice efficiency. The architecture includes interoperability, messaging standards, security, registries, safety, and privacy. To make sure your system security meets privacy laws, our experts build EHRs in compliance with HIPAA standards. 

Beyond software, the infrastructure encompasses your hardware needs, with new devices during this process step. Preparing hardware entails installing printers in each physician’s room and supplying other staff members with appropriate technology tools.

4. Transferring Data

Once the infrastructure is prepared, patient data from the legacy system is transferred to the newly built electronic health record system. Analyzing the best approach for your practice and patients creates a seamless data migration mechanism that reduces your staff’s frustration.

To make the transfer process as easy as possible, we take care of a few aspects, such as:

• Define migration parameters, such as what data needs to be entered into the EHR and how large the backup needs to be.
• Create a workflow to make data entry as clear as possible to avoid inaccuracies.
• Arrange training for data entry staff.
• Double-check to ensure all information is added correctly.
• Store paper charts safely.

5. Conducting EHR Training Sessions

Paper charts were the norm, with reluctance to adopt new ways of handling patient records. Focus on training your staff on EHR implementation to encourage participation and use. Therefore, experts at folio3 design engaging training programs that help your staff learn quickly to meet your organization’s implementation goals. Our EHR training is comprehensive and customized for each practice. It highlights the significant benefits of implementing EHRs and how to do it successfully.

The session is meant for everyone: medical and dental assistants, patient service coordinators, medical office computer specialists, medical records clerks, etc. 

We help with: 

• Providing a highly skilled team of trainers for on-site or remote training
• Selecting super users from your practice as the points of contact with our teams
• Setting clear training goals and a timeline to finish the training on time
• Modifying training to fit the current skill level of your staff

6. Optimizing EHR Software For Mobile Phones

Making health records accessible via mobile devices simplifies patient access to their information. Our experience with healthcare clients has given us insights into the features that attract patients. We also assist in marketing your new EHR implementation to encourage patients to utilize this technology effectively in your practice.

7. Getting EHR System Certifications

A certified EHR saves you from legal allegations and transforms how your practice runs. We seek to comply with all certification requirements established by ONC (Office of the National Coordinator for Health Information Technology), an HHS (Department of Health and Human Services) supported organization in the US.

The ONC certifies all healthcare IT standardized according to the technology capability, security, and functionality requirements adopted by HHS. Certified EHR systems undergo pre-testing and post-certification requirements to ensure adherence to technical standards.

After considering certification requirements, we develop our EHR product and conform to certification criteria.

8. Managing Standards and Protocols Compliance

In addition to being aware of EHRs’ technical capabilities, we pay special attention to changing regulations that could hinder their full utilization. We will provide you with essential information on regulations and meaningful use that may impact your new EHR to maximize your use of the EHR system.

Like any other technology dealing with PHI (protected health information), EHR software must comply with HIPAA law. Among other security needs, our EHR software strictly controls the privacy of patient data by restricting access based on user roles. For example, while sensitive patient data is only accessible to the provider and patient, billing and payment-related information can be maintained by administrative staff.

Our EHR software can also run automated logs to record every action on the system, which you can use for audit purposes.

9. Get Ready for Go-Live

The system must be fully developed and tested before launch to avoid glitches. In some cases, testing goes hand in hand with development. We test your new EHR in a production environment to comply with regulations. Our developers add automatic tests to the code. Then, a QA (quality assurance) engineer considers all possible scenarios and views the system from all angles.

By this time, your staff will be well-versed in the system’s functionality and how to use it to its fullest potential. Still, if there are areas where the system lacks, we will find and address them to tackle as many issues as possible before jumping to the actual launch day.

At some point, when the system meets set criteria and new content, features, or modules are in place, we launch it in your practice. You can inform patients about the new EHR software and enlighten them about its benefits.

10. Post-Launch Reflection by Tracking the Performance of your Custom EHR Software

The EHR development process is not over with going live; the launch of your new EHR is just the beginning. The development process of your custom EHR software is ceaseless and iterative and often requires ongoing training to keep your staff well-accustomed to system changes.

Post-launch reflection on your EHR involves fixing some lingering (minor) issues and keeping your system up to date. Of course, this step is far less intensive than initial development. Still, our teams consider it critical and thus make sure to fix the bugs.

After we have launched the system, we get a deeper insight into areas, including:

• Patient satisfaction to reduce frustrations.
• Productivity levels to keep staff motivated by setting reasonable expectations.
• ROI by performing calculations and comparing progress against goal metrics.
• Data errors to determine where additional training is required.
• Billing, reporting, and data collection to make adjustments (if and as needed) and improve operations.

What Is The Role of CDS Hooks in EHR?

Clinical Decision Support Hooks, or CDS Hooks, provide a seamless way to incorporate reminders, messages, and relevant links into Electronic Health Record (EHR) systems. These tools offer quick decision support to healthcare professionals as they attend to patients. 

The term “hooks” aptly describes how these tools integrate with EHR systems, allowing essential messages to fit in seamlessly and providing timely assistance to healthcare workers in their daily tasks.

Types of CDS Hooks

CDS Hooks in Electronic Health Records (EHRs) present information through what is known as a “card.” There are three types of cards:

• Informational: These cards simply provide information to the clinician.
• Suggestion: These cards offer suggestions that the clinician can choose to accept or reject.
• Link: These cards contain links to reference materials or apps that the clinician can access. CDS Hooks can also include links to SMART on the FHIR apps, allowing clinicians to launch them directly from the card without logging in separately.

Most EHRs display these cards in different colors to indicate their importance. For instance, a blue card signifies informational content, an orange denotes a warning, and a red indicates critical information.

4 Benefits of CDS Hooks Integration

The benefits of integrating CDS hooks include:

Improved Clinical Decision Support

Incorporating CDS Hooks, particularly integrated with Fast Healthcare Interoperability Resources (CDS Hooks FHIR), into Electronic Health Record (EHR) systems provides clinicians with timely and contextually relevant decision support during patient care. This enables healthcare professionals to make informed decisions that align with evidence-based practices, ultimately leading to enhanced patient outcomes.

Interoperability and Scalability

CDS Hooks’ standardized approach promotes interoperability among diverse healthcare systems, facilitating smooth integration with various external decision-support services. This scalability ensures that healthcare institutions can adopt the latest advancements in clinical decision support without being tied down by proprietary solutions.

Workflow Efficiency

Incorporating CDS Hooks streamlines clinical workflows by providing decision-support interventions directly within the EHR interface. This enables clinicians to access relevant insights seamlessly without disrupting their workflow, enhancing efficiency and productivity.

Continuous Improvement

Through CDS Hooks integration, healthcare organizations can continuously refine their decision-support capabilities. By leveraging external CDS healthcare services and staying updated with the latest clinical guidelines and best practices, institutions can consistently elevate the quality of care delivered to patients.

Frequently Asked Questions 

What Are The CMS Requirements for EHR?

CMS (Centers for Medicare & Medicaid Services) requires eligible providers and hospitals to adopt meaningful use of a certified EHR. 

1. Certified EHR Technology (CEHRT): Providers must use CEHRT to qualify for CMS incentive programs.
2. Structured Data Storage: EHRs must store data in a structured format for efficient retrieval and sharing.
3. Reporting Period: In 2023, the reporting period is a minimum of 90 days; this increases to 180 days in 2024.
4. Electronic Clinical Quality Measures (eCQMs): Providers must report on at least six relevant eCQMs during the reporting period.
5. Certification Criteria: EHRs must meet 2015 Edition criteria, operational from the start of the reporting period, and certified by the end.
6. Privacy and Security: EHR systems must comply with strict privacy and security standards.
7. Interoperability: EHR technology must support secure electronic health information exchange.
8. Attestation: Providers must attest that they have not restricted CEHRT interoperability.

What are the best EHR technology platforms in 2024?

Here’s a list of the best electronic health record (EHR) platforms in 2024:

DrChrono

From medical records to practice management to billing systems, DrChrono EHR software handles all. It prioritizes reasonable efforts to be fully compliant with all HIPAA requirements.

Epic

Epic EHR software is aimed at helping people get well, stay well, and live healthier lives in the future. It is a cloud-based software with the functionality to handle the daily operations of hospitals, including their EHRs.

Carecloud

Carecloud provides an integrated electronic health record platform known as Charts that offers collective benefits of EHR, medical billing service, and practice management software.

Kareo

Kareo is an integrated technology platform, the electronic medical record solution for outpatient settings used by practitioners across the US. It is qualified to help eligible practitioners obtain meaningful use attestation.

Cerner

The Cerner EHR platform Millennium® supports an integrated view of patient care in outpatient and inpatient settings. It helps providers make data-driven decisions to provide better care.

Allscripts

Allscripts EHR software is developed by one of the top healthcare software companies in the USA. It is a clinical and operational solution for small and mid-sized practitioners to help them run operations well and improve revenue cycle management.

How to Implement a Patient Portal?

You can implement a patient portal technology in your practice by following the steps outlined below:

1. Research and learn about different patient portal technologies and vendors
2. Based on your goals, look for the features and benefits that are most important for your practice
3. Keep all stakeholders on the same page and get their approval before communicating to vendors
4. Evaluate existing workflows and make adjustments
5. Select a partner for consultation and onboarding support
6. Get a custom portal built by the vendor, or choose a pre-made one
7. Prepare your portal to go live

How to Create EMR Software?

Creating an EHR software includes the following steps:

1. Discovery Stage: The developmental process starts with defining the project goals, identifying core functions, and understanding user needs to direct the EHR system.
2. Development Stage: The actual coding occurs when developers create the user interface and implement the essential features of the EHR software.
3. Testing and Compliance: The focus is on rigorous software testing to check its functionality and security while ensuring compliance with healthcare regulations like HIPAA.
4. Implementation Stage: During implementation, the EHR software is deployed in a clinical setting, including data migration and integration with existing systems.
5. Evaluation Stage: Assessment of the EHR system’s performance and gathering feedback for continuous improvement. 

What is a Laboratory Data Management System in Healthcare?

A laboratory data management system is software used for importing, organizing, and storing laboratory test results and reporting on sample data and test results. Some hospitals and practices (with the help of top medical device integration companies) integrate their EHRs with laboratory management systems to automate the data exchange process. LIMS can keep the EHRs updated with the latest patient data in real-time.

Name 2 Top Medical Device Integration Companies in the EHR Market

Two top software companies in the EHR market are Cerner and Epic. They offer integration solutions for organizations to connect their EHRs with medical devices.

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