About me
As the CTO of Elmeas, I bring over 20 years of experience across fintech, banking, and medical platforms. In the mid-2000s, I led a Hospital Information System (HIS) rollout and managed the data centre for a 2,500-bed hospital. Currently, I’m spearheading a cutting-edge HIS software project. I’ve worked with both startups and large enterprises, and I’m passionate about leading creative, collaborative teams to drive healthcare innovation.
Laying the Foundation: Building the EHR Cityscape
Electronic Health Record (EHR) platforms, often referred to as Hospital Information Systems (HIS), have become the backbone of healthcare infrastructure. These systems aim to enable healthcare providers to manage patient data, coordinate workflows, and streamline daily operations, ultimately improving efficiency and patient outcomes. It may seem simple, but despite AI and machine learning advancements that have attracted market and investors, a significant gap remains between the actual needs of clinical staff and the solutions offered by software companies. Many hospital staff continue to face fundamental challenges and this disconnect is significant.
At Elmeas, we aim to bridge this gap by developing a system that is not only fast and user-friendly but also perfectly aligned with the real demands of clinical staff. In implementing our EHR platform, we aimed to address not only critical aspects like security, system integration, billing, and budget management but also to develop a solution that is both simple and fast, fully tailored to the specific needs of our clients.
In this article, I’ve presented an overview of the Elmeas EHR platform, illustrating how its various subsections function like distinct neighbourhoods within a bustling mega-city, each contributing to the larger system. In the upcoming articles, I will dive deeper into the technical aspects, offering a behind-the-scenes look at each section and how they operate in detail.
EHR Platforms: A City of Diverse Neighbourhoods
An EHR platform can be compared to a city with various neighbourhoods, each representing different departments within a healthcare system. While the clinical workflow serves as the backbone of the platform, each connected department—ranging from patient management to clinical data repositories—has its own unique needs and must remain decoupled to function efficiently. For example, “bed management” requires real-time tracking of patient availability, while “billing management” deals with financial data and insurance processing. Each of these areas operates under different sets of requirements, and integrating them while maintaining their distinct workflows can be a complex balancing act. The challenge lies in ensuring that all these systems work together seamlessly, without compromising flexibility or functionality in any one area.
Zoning the City: Tailoring EHR Systems to Diverse Healthcare Needs
Implementing a flexible EHR platform presents numerous challenges, primarily due to the need for customization, scalability, and user-friendliness. Each healthcare organisation operates with unique workflows and requirements, making it difficult to create a one-size-fits-all system without making it overly complex or cumbersome for users. Scalability is another significant hurdle, as an adaptable EHR must function smoothly in both small clinics and large hospitals alike. Moreover, frequent updates and new features require continuous learning, complicating training and adoption for staff. For smaller healthcare providers, the cost of developing a flexible, compliant system adds yet another layer of difficulty. These factors highlight the complex nature of creating an effective EHR platform that can cater to the diverse needs of the healthcare landscape.
Mapping the Streets: Mastering Clinical Workflows in EHR Development
The first and most critical step in developing an EHR platform is integrating the clinical workflow. Every hospital operates with its own workflow system, developed over years to ensure efficiency and deliver the best possible patient care. These workflows are highly structured and tailored to the specific needs of each healthcare setting, making their implementation a particularly challenging task.
What complicates the process further is the lack of standardisation across the industry. Each healthcare institution follows its own internal processes, making it difficult for software vendors to offer solutions that seamlessly fit into these established workflows. This challenge is one of the main reasons why there are relatively few strong competitors in the EHR market. Traditional workflow management systems often fall short of meeting the unique needs of clinical environments, where processes such as outpatient and inpatient care, visits, episodes of care, and services need to be precisely defined and integrated.
At Elmeas, we realised early on that mastering these workflows is essential before any other aspect of the EHR system can be successfully implemented. To achieve this, we dedicate significant time and effort to understanding and customising workflows for each healthcare organisation. Our approach ensures that the platform is not only flexible but also perfectly aligned with the complex, highly structured workflows of modern healthcare.
We accomplished this by spending substantial time with clinical staff. Our design team even spent months in remote hospitals to fully grasp the intricacies of their workflows, ensuring the system remains simple and quick to use, meeting the essential needs of the healthcare staff.
Powering the Grid: Designing Essential EHR Services for Efficient Healthcare
After implementing the clinical workflow, the next essential step in building an EHR platform is designing the services. These services form the backbone of the EHR, covering both clinical operations and the data they generate. Generally, they are divided into two categories: administrative (non-clinical) services and clinical services.
Administrative services handle the non-medical aspects of healthcare, such as scheduling, billing, patient registration, and resource management. They ensure that a hospital's day-to-day operations run efficiently by gathering essential data, including appointment logs, financial records, and staff assignments. If you've ever been frustrated by repeatedly providing the same information or overwhelmed by the amount of paperwork in a hospital, this is where the problem lies—a lack of flexible and integrated administrative digital services.
On the other hand, clinical services are at the core of patient care. They manage the collection of medical data, including diagnostic tests, treatment plans, patient histories, and clinical outcomes. This data is crucial for making informed decisions and delivering personalised, effective treatment. Therefore, it's vital to have a highly adaptable pipeline that supports fast and accurate clinical form creation. The clinical services section must be meticulously designed to not only capture the necessary data but also seamlessly integrate with other systems, such as lab results and pharmacy databases, ensuring a complete and accurate view of the patient’s medical history. Collecting and delivering clinical data effectively is critical because a thorough understanding of a patient's medical background is key to determining the next steps in their treatment. However, achieving this level of integration and flexibility is extremely difficult. In the next section, I will dive deeper into the complexity involved in this process.
Connecting the Dots: Overcoming the Challenges of Clinical Data Collection and Integration
As previously mentioned, one of the most challenging aspects of implementing an EHR platform is the collection of clinical data. Healthcare environments generate massive amounts of data from multiple sources—patient records, lab results, radiology reports, and more. Ensuring this data is accurately gathered, properly structured, and easily accessible is vital for both patient care and clinical decision-making. However, the diversity in data formats and structures poses a significant challenge to standardisation and integration. For example, medication orders can vary significantly based on the prescribing system, dosage instructions, and pharmacy databases, making it difficult to align these into a unified system.
Another major challenge is integrating the EHR platform with other external software and hardware systems. EHRs need to interact with various systems within a hospital, such as laboratory information systems, radiology software, and even financial and billing platforms. These systems often function independently, making seamless integration difficult. Without effective integration, data silos can emerge—for instance, labs and imaging departments might store their data separately—leading to inefficiencies in workflow and increased potential for errors in patient care. Although recent technological advancements have led many modern EHR platforms to adopt advanced APIs and middleware solutions to bridge these gaps, significant challenges still persist.
Building the Blueprint: Utilising OpenEHR for Unified Clinical Data Management
To tackle the inherent complexity of managing clinical data, we adopted OpenEHR, a well-established open standard specifically designed for handling, storing, and exchanging electronic health records. Created in the 1990s to address the need for standardised healthcare information systems, OpenEHR ensures that clinical data remains interoperable across different platforms, enabling long-term preservation and meaningful exchange of health records in a structured format.
Although OpenEHR offers tremendous flexibility and is supported by an active community, full-scale adoption comes with its own set of challenges. The complexity of the data model requires significant time and expertise to fully grasp and implement, and the lack of comprehensive documentation often complicates the integration process. For us, as a small startup with limited resources, adopting OpenEHR into our workflow system proved to be a major challenge. While we initially looked to open-source projects like EHRbase to speed up development and keep costs down, we quickly learned that relying too much on open-source solutions carries risks, especially for a small team of engineers.
One of the main issues we faced was balancing the use of open-source tools with the need to manage and customise them effectively. While open-source projects offer powerful solutions, they often lack the detailed documentation and immediate support needed for rapid troubleshooting. Aware of these risks, we decided to scale back our reliance on multiple open-source projects in our software ecosystem. Instead, we focused on deepening our expertise in the ones we retained. For instance, we spent several weeks analysing the EHRbase to fully understand its inner workings. This allowed us to customise key features to fit our needs, making the integration smoother and more aligned with our system.
Despite these hurdles, OpenEHR remains a highly promising standard, with ongoing community efforts focused on improving its usability and simplifying the adoption process.
Completing the City: Expanding and Securing the Future of Our EHR Platform
Our next stop on this journey was addressing the implementation and adoption of other key "neighbourhoods" to make our mega-city fully functional. This included developing a highly scalable storage system for managing and retrieving binary files like medical images, integrating a comprehensive medical terminology service to handle coding systems such as ICD, OPS, and SNOMED, and establishing seamless connections with other EHR platforms—our neighbouring "cities"—via the HL7 pipeline. We also strengthened service and security layers to ensure stability and protection. Key steps included using high-availability solutions and implementing essential security measures to boost system reliability.
Though we’ve already deployed our application in several medical clinics and continue to expand its functionality, our core mission remains the same: to keep the system Simple and Quick.
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