What are the benefits of custom EHR over the standard?

woman working on an EHR in a hospital
© Maocheng

In over a decade, electronic health records (EHR) solutions have become an indispensable tool for the healthcare industry players

The American Healthcare Association Annual survey 2008-2021 showed that 96% of non-federal acute care hospitals adopted a certified EHR. At the same time, a 2022 KLAS report on EHR satisfaction by organizations found that the highest satisfaction score is 40%. In community hospitals, the rate hasn’t reached 20%. 

Providers usually try to optimize their EHR solutions or implement a new system to improve the situation.

Unfortunately, optimizing the EHR doesn’t always work, as quality optimization requires steady cooperation among all team members. As for new system deployment, providers often wonder which option brings more benefits, another off-the-shelf solution or a custom EHR system. We’ll look into the pros and cons of both solutions and help you make a grounded decision.

An off-the-shelf EHR solution

Off-the-shelf electronic healthcare records are designed to streamline various hospital processes. They usually fit large hospitals, which offer acute care for multiple injuries and illnesses in any medical field. Off-the-shelf EHR systems offer rich functionality that can be activated rapidly and at available cost. It helps providers ensure timely treatment of those acute cases. Besides, some large-scale EHR vendors even offer fixed-price EHRs, eliminating the risk of significant solution price increases over time.

That is the case with MEDITECH, a cloud EHR provider. Their EHR solutions can power critical care hospitals (CAHs) and serve as a viable option for streamlining care at remote and rural locations.

Off-the-shelf EHR example: rural care solution

A critical care hospital (CAH) is a healthcare facility located in a remote or rural area. To be certified as a CAH, a hospital needs to comply with specific conditions:

  • Location no less than 35 miles away from another hospital
  • Success in meeting unique community needs
  • Small size (max. 25 acute care beds)
  • Round-the-clock emergency care provision

If a hospital obtains the CAH status, it can get cost-based reimbursement for Medicare services, flexible service offers, staffing policies, and access to grants and other resources.

Moreover, CAH and rural hospitals can further reduce their EHR costs. For example, in June 2020, Cerner set up CommunityWorks and CommunityWorks Foundations, their cloud-based EHR solutions. The tools follow a fixed-fee payment model with no hefty up-front investments from CAH and rural clinics. As a result, 70% of participating hospitals beat baseline accounts receivable in three months, achieving a 5.5% performance improvement.

Still, out-of-the-box systems also have a range of downsides that may block their adoption.

Off-the-shelf EHR: pros and cons

Benefits Downsides
  • Affordable cost
  • Fast deployment
  • Rich training materials and a large user community
  • Many unnecessary features
  • Maintenance costs
  • Insufficient integrations across health IT tools
  • An Inflexible system with a cumbersome interface and a lack of workflow support

A custom EHR system

Unlike a ready-made EHR, a custom solution provides all the necessary functionality to help a provider meet the specific needs of hospitals and their patients. As a result, it is a go-to solution for particular medical facilities – pediatric hospitals, ophthalmology centres, and mental care practices. For such hospitals, some features not available in off-the-shelf EHRs come under the spotlight.

For pediatric hospitals, for example, such a feature is child development screening. For Intermountain Healthcare from Utah, the process involved parents’ questionnaires on child development, demographic information, and the key social determinants of health. Filling out the paper questionnaire was time-consuming for parents, so the provider decided to digitize it. The digital patient intake tool Intermountain Health saved parents and clinicians 15 minutes and reduced the level of stress during the visit. After completion, the screening data is added to the EHR.

Custom EHR example: pediatric hospital EHR

General EHR solutions don’t always fit the narrow focus of speciality practices. For example, there are six critical features a pediatric hospital EHR needs to offer:

  1. Vaccine management

    • Children’s vaccination comprises a large set of vaccines to be administered on a complex schedule. The system sends doctors notifications on planned vaccinations daily.
  2. Routine health care management (RHCM)

    • This section is built on Bright Futures guidelines. This document explains the content of the 21 primary care visits recommended for children from birth to age 21.
  3. Family dynamics

    • Though in adult care, family specifics belong to social determinants not always included in the EHR, in child care, it’s a rightful part of the system. The conditions in which a child lives and grows are critical for the doctor to understand the scope of influences on a child’s health. It helps clinicians deliver the most appropriate personalized care.
  4. Medication management

    • With weight- and age-based dosing to reduce safety risks for children. The medications section should also include relevant dosing references for different age groups, how long it takes for a medication to take effect, and potential side effects.
  5. Pediatric norms and growth charts

    • With references to reputable sources and abnormality signaling notification for typically and atypically developing children.
  6. Customizable privacy setting

    • While sharing their health information with parents is standard practice for children, adolescents may prefer to keep some data to themselves. If adolescents’ care lacks confidentiality, they are likely to ignore their visits, especially for reproductive health, mental health, or substance abuse.

Creating a quality pediatric EHR requires custom development. Out-of-the-box EHRs can’t ensure such precision. Nevertheless, custom EHRs also present a set of cons to mind.

Custom EHR system: pros and cons

Benefits Downsides
  • Laser-targeted focus on your speciality
  • Personalized, user-friendly interface
  • Integration with the necessary third-party apps and devices
  • Swifter upgrades
  • High cost
  • Prolonged implementation
  • Personalized training materials or sessions, smaller user community
  • Complex data transition processes between custom and commercial EHRs 

Making a wise choice

Both out-of-the-box and custom EHR solutions are useful healthcare industry tools. They help providers ensure quality care provision without delay, thus improving patient outcomes and experience. However, implementing an off-the-shelf solution or a custom EHR system depends on your practice requirements. 

If your healthcare organization is a general hospital or a critical access hospital in a rural location, you can go for an off-the-shelf solution. Those tools offer a whole set of features needed for urgent care delivery for various diseases and injuries in critical situations.

A custom EHR could better fit a medical organization that offers care in particular fields. Such solutions provide a specific set of EHR features a speciality practice needs. Custom EHR, built in cooperation with the organization’s clinicians, offers tailor-made solutions with industry-specific features. 


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