Healthcare software development: An industry overview

The term “software” is quite broad and can encapsulate many different digital tools and systems to support patients, clinicians, and business leaders. Healthcare companies can implement new healthcare software using custom medical software development or with the help of an evolving field of software-as-a-service (SaaS) solutions.

Since the acceleration of telehealth adoption during the COVID-19 pandemic, reports indicate that patients expect and may even prefer virtual health care services in 2023 and future, especially because virtual care opens up another channel for patients to connect with their health care provider, which can improve continuity of care if in-person visits are more time-consuming and inconvenient to schedule.

Companies with a virtual-first model typically offer a telemedicine software platform including custom healthcare software features like patient intake, synchronous and asynchronous care team communication, symptom tracking, digital care planning, e-prescribing, educational information, and payment.

There are countless examples of virtual-first care platforms that specialize in specific care categories and patient populations including Maven, One Medical, Tia Clinic, hims & hers, Included Health, Neura Health, and Pip Care.

These tools can measure a patient’s activity, including sleep cycles, physical activity, heart rate, and even electrocardiograms, and can then send real-time patient data to their healthcare provider. In this way, both patients and providers alike can get a more longitudinal view of a patient’s health and create opportunities for patient-provider interaction outside the rigid boundaries of the hospital. Many wearables fit more squarely into the wellness category such as the Apple Watch and health app, Oura Ring, and Fitbit. Others have a particular medical focus such as Dexcom and Senseonics and may fall into the category of Software as Medical Device (SaMD) described below.

The incentive behind these tools is to help patients navigate the complicated healthcare system. In practice, this can look like assistance with untangling reimbursement and coverage details, decoding clinical jargon, understanding diagnosis and treatment methods, and improving the care experience through patient advocacy and care coordination. Some examples include Eden Health and Castlight.

For legacy healthcare players, transitioning to a multi-channel offering has been a slower process. Many traditional brick and mortar healthcare providers offer patient portals or “digital front doors” to improve the administrative efficiency surrounding patient care.

Patient portals softwares typically allow them to view doctor’s visit notes, ask follow-up questions to their care team, view laboratory results, schedule appointments, and access immunization records. Most major EMR systems such as Epic, Cerner, and Athenahealth have their own patient portal used by large hospitals and health systems.

An emerging class of purely digital therapeutic interventions have emerged in recent years, some with FDA clearance that allows doctors to prescribe a software application like they would an in-person therapy or medication. Pear Therapeutics released some of the FDA cleared digital therapeutics focused on substance use disorders and insomnia.

By nature of their responsibilities, healthcare organizations benefit from software that enhances their ability to provide care for patients, in terms of streamlining administrative tasks, improving workflow, and complementing human care with analytical functions.

The same systems described in the patient-facing section above also have a clinician-facing experience which allows doctors and nurses to conduct telehealth appointments, review patient records and self-reported symptoms, answer questions, send reminders, and manage their schedule. These software systems typically include a number of clinical and administrative tools including clinical decision support, task management, and EHRs described below.

These tools offer clinical support and guidance to clinicians as they are providing care. CDS for healthcare offer timely information, reminders, or recommendations to help inform care decisions. These features are typically built into the Electronic Health Record software.

There are also software tools such as Dock Health designed specifically to help doctors and nurses manage clinical workflows and ensure that appropriate tasks are completed for each patient. These systems may also improve communication across disparate care team members to ensure continuity of care for patients.

The Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 mandated the use of electronic systems to manage patient records. The most prominent are examples of EHR software development as they are used by clinical teams in nearly all care delivery settings.

Electronic health records (EHRs) are updated by the provider at each visit, and they contain all relevant information for that patient’s care, including demographics, visit notes, diagnosis, and treatment, medical history, laboratory results, medications, allergies, and immunization records. The complexity of sharing data between EHR vendors and other software systems has given way to an entirely new field of healthcare interoperability solutions.

An emerging field of SaMD supports hardware devices through both clinician and patient-facing interfaces. Nearly all next-generation medical devices such as Butterfly include a software component to help visualize and analyze results, train users on device best practices, and provide accompanying virtual care connected to condition management. SaMD applications serve a medical function and are therefore more heavily regulated by the FDA than broader digital health applications.

There is a growing category of infrastructure software tools that offer point solutions to support specific areas of care delivery and practice management. Many healthcare SaaS (software as a service) solutions are built into broader patient and provider-facing systems like those described above. Elion, a new marketplace for healthcare SaaS, breaks these tools into the following categories:

• Clinical solutions: such as care team management, clinical workflow management, staffing, patient messaging, e-prescriptions, and referral management.
• Healthcare administrative solutions: including patient intake and scheduling, prior authorization, patient billing, and administrative task management.
• Data and analytics tools: This category includes interoperability tools targeting claims and clinical data, patient and practice insights, and provider data quality metrics.

Other hospital management software may include features used to manage environmental health and safety (EHS) or systems for storing and accessing clinical guidelines.

Given the incredibly broad definition of healthcare software, designing and building these systems can look quite different depending on type of problem, scope of solution, and other project factors such as budget and timeline.

At HTD, we work with teams to identify the proper software solution for their specific set of needs: Sometimes this involves designing and developing medical software from scratch while other times it means wiring together and customizing existing SaaS infrastructure tools.

Before beginning any software implementation, HTD typically starts with a discovery phase to better understand the product area and align with stakeholders on the best path forward.

Discovery is meant to bridge the distance between idea and the healthcare software development stage. In discovery engagements, teams seek to align on the following:

• What are the problems this digital product is meant to solve?
• Who is the audience for this product (who are the “users”)?
• What competitors or other solutions in the market target a similar set of problems?
• What is the unique value that this product will deliver?
• What set of features are required to deliver the value described above?
• What technology architecture best supports the contemplated features?
• What implementation strategy makes the most sense given budget and timeline constraints?

Many key players are involved in this phase, including Tech Leads, UX Designers, and Product Owners. The healthcare industry also requires unique industry knowledge, so in-house digital health consultants commonly advise during the strategy-defining stage.

At HTD, we offer two types of discovery engagements:

1. Business and technology strategy discovery: This initial discovery phase focuses on answering large questions about product-market fit. It typically involves deep user research (including patient and clinician interviews), design thinking workshops, and technology needs assessments to align on a high-level product vision.
2. Product scoping discovery: With a defined vision from the phase above, product scoping focuses more tactically on determining the scope of an initial MVP (minimum viable product) and the best path to implement the scope with respect to technology choices, third-party SaaS integrations, team, timeline, and cost.

With a clear product vision in place, user experience designers take on the task of designing what the product will look like in practice. Typically software design starts with low-fidelity wireframes meant to demonstrate and test core product flows before investing time in full interface design. Usability testing can take place at the wireframe stage to verify and validate a product concept with real users.

Once validated, high-fidelity screen-by-screen designs and a UI component library are assembled to pass off to developers for implementation. Screen designs can also be compiled into a pre-development clickable prototype in order to test or demonstrate core flows to internal and external stakeholders.

UX/UI design requires deep understanding of user needs and behaviors, typically drawn from user research. In many healthcare software applications, patient engagement and positive behavior change are key to success. Leveraging fundamentals from behavioral psychology can be helpful to design a product that resonates and leads to long-term patient outcomes.

Throughout the healthcare software development phase, engineers translate product designs into code in order to create “live” functioning programs. Engineers specializing in specific frameworks and languages build both system back-end (application structure, data, and logic) and front-end (user interface that people interact with).

There are many different frameworks that teams use when developing healthcare softwares. Agile approach has become an increasingly popular method for healthcare app development. This is an iterative approach that brings the internal team members and the customer into constant collaborative loops of planning, executing, and evaluating.

Each iteration brings in small improvements, so this is a fast-paced methodology. The flexibility of this approach makes it a good fit for building an MVP (minimum viable product) with input from many stakeholders and users. Teams using an agile development approach typically use the scrum methodology to manage work.

Before the rise of agile processes, many teams instead used a waterfall approach. Instead of working in iterative loops or “sprints” to build products piece-by-piece, waterfall involved clearly defining requirements and designs up front before implementing exactly as planned. This approach is less flexible and can cause issues when new needs or ideas arise throughout the project. However, in some cases, this approach can be helpful. For instance, when designing and developing FDA regulated software like SaMD and digital therapeutics, a waterfall approach may be a better fit for creating documentation for FDA submission.

The QA stage of development for healthcare digital solutions is crucial to ensure that the product functions without errors. Testing starts first on the developer level with unit testing, which is performed on isolated sets of code, then moves into integration testing, in which multiple units of code are tested as one entity, and finally into system testing, in which the entire product is tested. In addition, usability and performance tests are geared toward ensuring positive user handling and experience. The nature of highly sensitive patient data in healthcare also creates regulatory and security standards that software in the healthcare industry must abide by.

The HIPAA (Health Insurance Portability and Accountability Act) framework for health compliance lists a set of minimum rules that healthcare software must satisfy. The industry standard for electronic health data is set by HL7 (Health Level 7), and the standard for interoperability in medical imaging is set by DICOM (Digital Imaging and Communication in Medicine). Health software must also comply with broader software standards such as those set by the ADA (Americans with Disabilities Act).

Once a new medical software application has been designed and coded in a development environment, it is tested in a staging environment—a test space that is not accessible to users but mirrors the “real” production environment. Before final launch, the team creates a release checklist to ensure that all necessary steps are taken. Once complete, the application can be deployed to the production environment where it is ready for use.

In the case of native mobile applications, deployment typically involves submitting for acceptance to the Apple App Store and Google Play Store.

Healthcare software needs to be maintained to keep up with changing regulations, software updates, and evolving patient demands. Developers are the main players in this phase, but the degree to which software evolves over time depends on a company’s priorities and resources.

There is no shortage of challenges in the US healthcare system. Healthcare software has the potential to strategically improve the delivery and management of care by simplifying workflows, making information more accessible, reducing the cognitive burden on providers, and empowering patients to take control of their own health.

HTD works with teams to plan, design, and build healthcare software across a wide range of use cases. Our team provides healthcare software development services to help guide clients from idea to implementation. Reach out to info@htdhealth.com for a free consultation about how to digitally transform your organization.