Customizable EMRs Are Long Overdue

EMRs can be customized to some extent today, but not that much. Providers can create interfaces between their EMR and other platforms, such as PACS or laboratory information systems, but you can’t really take the guts of the thing apart. The reality is that the EMR vendor’s configuration shapes how providers do business, not the other way around.

This has been the state of affairs for so long that you don’t hear too much complaining about it, but health IT execs should really be raising a ruckus. While some hospitals might prefer to have all of their EMR’s major functions locked down before it gets integrated with other systems, others would surely prefer to build out their own EMR from widgetized components on a generic platform.

Actually, a friend recently introduced me to a company which is taking just this approach. Ocean Informatics, which has built an eHealth base on the openEHR platform, offers end users the chance to build not only an EMR application, but also use clinical modules including infection control, care support, decision support and advanced care management, and a mobile platform. It also offers compatible knowledge-based management modules, including clinical modeling tools and a clinical modeling manager.

It’s telling that the New South Wales, Australia-based open source vendor sells directly to governments, including Brazil, Norway and Slovenia. True, U.S. government is obviously responsible for VistA, the VA’s universally beloved open source EMR, but the Department of Defense is currently in the process of picking between Epic and Cerner to implement its $11B EMR update. Even VistA’s backers have thrown it under the bus, in other words.

Given the long-established propensity of commercial vendors to sell a hard-welded product, it seems unlikely that they’re going to switch to a modular design anytime soon.  Epic and Cerner largely sell completely-built cars with a few expensive options. Open source offers a chassis, doors, wheels, a custom interior you can style with alligator skin if you’d like, and plenty of free options, at a price you more or less choose. But it would apparently be too sensible to expect EMR vendors to provide the flexible, affordable option.

That being said, as health systems are increasingly forced to be all things to all people — managers of population health, risk-bearing ACOs, trackers of mobile health data, providers of virtual medicine and more — they’ll be forced to throw their weight behind a more flexible architecture. Buying an EMR “out of the box” simply won’t make sense.

When commercial vendors finally concede to the inevitable and turn out modular eHealth data tools, providers will finally be in a position to handle their new roles efficiently. It’s about time Epic and Cerner vendors got it done!

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I’ve been in one form of IT or another for the past 35 years. Buying “out of the box” is done for one of two reasons: Either the user org does not have the budget for something bigger or the user org does not have the brains to think of something better.

  • You are kidding, right, re

    ” ..providers will finally be in a position to handle their new roles efficiently”?

    All of my clients use customizable EHRs – no two installs are identical, and, for the most, part, super end users, with help from IT for more complex tasks like workflow rule sets and interconnectivity, build, own and manage their EHRs.

    The thing is they have been building, owning and managing their workflows since 1995.

    It good to hear “It’s about time Epic and Cerner vendors got it done!

    Better 20 years late than never.

    Of course, Epic and Cerner will come to realize that their consulting revenue will decrease dramatically once they let customers build, own and manage their own workflows.

    Guess what they will do to compensate for that?

    I find it very amusing when people ask us if we are ‘ready’ for ICD-10.

    I have here in front of me version 1 of “The ICD-10 Classification of Mental and Behavioral Disorders published by the WHO (our1st product was a behavioral healthcare EHR). The date of publication is 1992 and we introduced in into our product in 1995.

  • Anne’s point is well taken. There’s a need for EHR’s that can mix and match components.

    I’d add that EHRs should allow users to customize screens, etc. For example, if a practice is doing research on an issue, it should be able to easily modify their system to use it in their research.

Click here to post a comment