It’s true that many providers need a custom solution for their unique workflows, and the one-size-fits-all EHR is often a myth. The problem is that many EHRs try to solve this with customizations, which can be expensive and still feel like a compromise.

On the other hand, when a team tries to build their own tools, they quickly realize they have to build a ton of compliance and interop code they never wanted to touch in the first place. That’s why open source platforms that handle the core infrastructure, like Medplum, HAPI, or OpenEMR, can be such a good starting point. They get the team 90% of the way there, so they can focus on what really matters: building a great UI/UX for their users.

I don’t think providers truly want to go back to pen and paper, but they are looking for a better way. They can see the promise of what the solution could be, but they just haven't experienced it yet.

Disclaimer: I work for Medplum.

I had this thought recently: "different hospitals have different workflows, and they want to see different stuff in the UI. But obviously they all want domain objects like "a patient," "an appointment," etc. Some company should offer a standard backend, and a starting template for a frontend that each hospital can customize however they want."

It turns out that concept is called "Headless EHR," and it's pretty new.[0] Medplum (that the parent comment mentions) is one of the companies in this space.

[0]: https://healthapiguy.substack.com/p/to-ehr-or-not-to-ehr

The custom workflows are because each clinic system is trying to figure out the best way to make money, not the best way to treat patients or serve clinicians.

Disclaimer: I know a number of people who work for Epic. ;-)

Another issue with customizations is upgrades. Every upgrade you gotta validate all the customer-specific stuff.

And you may end up re-creating bad workflows instead of updating to better ones.