EHR customization vs. configuration: What to consider

EHR customization vs. configuration: How to evaluate healthcare software for long-term adaptability

Healthcare organizations have good reason to look for technology that fits the way they work. Clinical and administrative workflows can be complex, and during an EHR evaluation, the ability to tailor a system to an organization’s specific needs can be an appealing sign of flexibility.

But evaluating flexibility means looking beyond how well a system can accommodate today’s requirements.

What happens when those workflows change after go-live? When the platform is upgraded? When the organization needs a new integration? Or when it wants to take advantage of emerging interoperability, automation, analytics, or AI capabilities?

These questions are increasingly important when evaluating healthcare technology for the long term. A system designed around an organization’s requirements before implementation may provide a close initial fit, while a platform designed to support ongoing adaptation offers a different model for evolving as needs change. Neither approach is inherently right for every organization or every requirement.

The more useful question isn’t simply what a vendor calls its approach to flexibility. It’s how that flexibility works and what it means for your organization after go-live.

Understanding this distinction can help healthcare leaders evaluate not just how well technology fits today, but how readily it can adapt to future needs.

EHR customization vs. configuration: Look beyond the terminology

“Customization” and “configuration” can mean different things from one healthcare technology conversation to the next. Vendors and customers may use the terms differently or even interchangeably. Rather than focusing on the labels, it can be more useful to understand how a system can be tailored and when that tailoring happens — during implementation or after go-live.

For this discussion, we’ll use the terms this way:

• Customization refers to tailoring that typically happens before or during implementation, when software is changed or built around to meet an organization’s specific requirements. This approach can help optimize a system for workflows and needs at the time it is implemented.
• Configuration refers to adjustments an organization can make within the platform as it uses the technology. Depending on the system, that might include supported settings, rules, roles, or workflows that allow organizations to adapt how the technology works without changing the underlying platform.

Focusing on when and how tailoring occurs shifts attention to the life of the technology. Workflows change, organizational priorities shift, new partners and data sources need to be connected, and new capabilities become available. Technology decisions made during implementation can influence how straightforward or complex it is to respond later.

The more useful comparison, then, is not customization versus configuration, but initial fit versus ongoing adaptability. A tailored implementation may be appropriate when an organization has specialized requirements. Evaluators should also understand what those choices mean for maintaining, upgrading, integrating, and adapting the technology in the future.

Consider what you’ll need to manage after implementation

Tailoring technology to meet specific requirements can solve important problems during implementation. But the work involved in supporting those choices can extend beyond go-live.

For each organization-specific change, healthcare leaders should identify what their teams will need to do to maintain it. Consider:

• Platform updates: Will the change continue to work when the vendor updates the platform?
• Workflow changes: Can your organization adjust the workflow itself, or will you need help from the vendor or a developer?
• New integrations: Could existing modifications affect how easily you connect another system to the EHR? 

Organization-specific changes can have implications for data, too. Depending on how those changes are implemented, they may affect how consistently information is captured, exchanged, and used for reporting. These considerations become more important as organizations share information with outside partners and bring together data from multiple sources.

Certain workflows may justify a specialized solution and the additional work that comes with it. Understanding those responsibilities upfront helps organizations weigh that effort against the value the customization provides.

Looking beyond implementation gives buyers a fuller picture of flexibility: whether a system can accommodate a requirement and how much effort it may take to support that requirement.

Look at how the platform supports what comes next

Evaluating long-term adaptability also means looking beneath individual features and workflows to the platform that supports them. As healthcare organizations adopt new ways to exchange data, automate work, and use AI, the underlying technology can influence how those capabilities become available to users.

A shared, cloud-based platform offers one approach. The vendor can introduce new capabilities through the platform while organizations continue to adjust supported settings and workflows to their needs.

athenaOne® offers an example of this model. Its cloud-native architecture allows athenahealth to introduce AI capabilities into existing athenaOne workflows without requiring customers to migrate to a new offering or complete a new implementation. Organizations can gain access to new capabilities within the platform they already use rather than treating every major advance as a separate technology transition.

The benefits can extend to connectivity. Mountain Laurel Medical Center, for example, had previously found that building an interface with a state registry could take months. After moving to athenaOne, CEO Jessie Storey described connecting to a registry as more like “a flip of a switch,” pointing to athenaOne’s network of existing, maintained connections as a key difference.*

That network operates at significant scale. athenaConnect™, the interoperability engine behind the athenaOne network, powers two-way data exchange across a network of more than 173,000 clinicians.¹ The network also connects to approximately 100 health information exchanges (HIEs) and accountable care organizations (ACOs) and more than 230 national registries. ^2-3

For healthcare technology buyers, these examples raise a broader evaluation question: Can the platform accommodate new capabilities and connections as they emerge, and what will your organization need to do to take advantage of them?

The answer can reveal more about long-term flexibility than the number of ways a system can be tailored on day one.

Decide when customization is worth the tradeoff

Some healthcare workflows and requirements are highly specialized, and supported configuration may not always provide what an organization needs. In those cases, custom development can be a reasonable choice.

Before making that choice, however, buyers may want to look beyond whether customization is possible and consider what the requirement demands. A few questions can help:

• Is the requirement unique? Determine whether the workflow reflects a specialized clinical, operational, or regulatory need or whether supported configuration could address it.
• What value will customization provide? Consider whether tailoring the technology will meaningfully improve the workflow, user experience, or another important outcome.
• Who will manage it over time? Understand who will make changes, provide support, and address issues as the organization and platform evolve.
• What could the choice affect later? Ask whether the customization could influence future updates, integrations, reporting, or access to new capabilities.

This kind of assessment helps organizations make customization a deliberate choice rather than a default response to every difference in workflow. Requirements that deliver meaningful value may justify additional development and ongoing support. Others may be better addressed through options the platform already supports.

Understanding those tradeoffs also gives buyers a better basis for comparing vendors by digging beyond customization to how they support change over time.

Questions to ask your healthcare technology vendor

Asking whether a platform is customizable may tell you that changes are possible. It doesn’t necessarily tell you how those changes happen, who is responsible for them, or what they could mean for the future.

During an EHR evaluation process, consider questions that reveal how flexibility works in practice:

How much can we manage ourselves?

• How can we adapt workflows after go-live as our needs change? 
• Which changes can our organization make on its own? 
• Which changes require vendor or developer involvement? 

What happens as the platform changes?

• What happens to organization-specific changes when the platform is updated?
• Who is responsible for maintaining any custom development or integrations?
• Could organization-specific changes affect our ability to adopt new features?

How does the platform support connectivity and data exchange?

• How does the platform maintain consistent data while accommodating organization-specific needs?
• How are new integrations or data connections added?
• Could changes we make affect our ability to exchange data with other organizations or systems? 

How will we adopt what comes next?

• What happens when we want to add a new AI, automation, analytics, or interoperability capability?
• Will adopting new capabilities require additional development, implementation, or migration?
• How does the vendor make new capabilities available across its platform?

The answers can help buyers understand what a system can do at the time of purchase as well as what it may take to change, connect, and expand the technology in the years ahead.

Choose technology with change in mind

An EHR is a long-term investment, and the needs that shape a technology decision today may evolve. The ability to accommodate change should be part of the evaluation from the start.

That means looking beyond whether a system can meet a particular requirement and understanding how it will support the organization as workflows, connections, and capabilities evolve. In some cases, customization may provide the right solution. In others, supported configuration may offer the flexibility an organization needs with less to manage over time.

The underlying platform is an important part of that equation. athenaOne brings EHR, revenue cycle management, and patient engagement together on a cloud-based, connected platform designed to support the introduction of new capabilities.

Choosing technology with that longer view can help organizations meet today’s requirements without losing sight of what they may need next.