Why One EHR Doesn’t Fit All: What I’ve Learned Designing for 20+ Specialties

For years, the healthcare technology market has tried to fit all practices into one EHR mold. As a Product Owner and Privacy Officer, I’ve had the privilege to work closely with clinicians across more than 20 medical specialties.

From the high-acuity demands of cardiology to the deeply personal and lifecycle-focused care in OBGYN, I’ve witnessed firsthand how vastly different their workflows, documentation styles, compliance requirements, and patient engagement models can be.

This blog is a reflection of those years of learning. I’ll walk you through the core reasons why one-size-fits-all EHRs fall short, share real stories from the field, and explain what we did differently to design systems that not only work but accelerate care, improve outcomes, and support the financial health of the practice.

The Myth of the Universal EHR

The promise of a universal EHR was attractive for vendors: build once, sell everywhere. And for clinics, it sounded efficient. But what looks like efficiency on paper often translates to frustration at the point of care.

Universal EHRs tend to:

• Force rigid documentation templates that don’t match specialty-specific thinking
• Add unnecessary clicks and workflows for specialties with different care models
• Underestimate compliance variations between fields (e.g., psychiatry vs. cardiology)
• Deliver generic reports that don’t capture KPIs meaningful to that specialty

One behavioral health provider told us: “I spend more time fighting the EHR than focusing on the patient.” That’s not a software problem; that’s a design philosophy problem.

Real-World Examples: How Specialties Differ

Let’s explore how needs diverge across specialties and how our software adapted to meet them.

1. Cardiology

Cardiology workflows rely heavily on diagnostic integrations (e.g., EKG, echocardiograms), procedure tracking, and longitudinal care plans. 

They need:

• Flawless imaging/report integration
• Chronological patient tracking across visits
• Stress test and echocardiogram documentation modules

We built cardiology-specific dashboards showing ejection fraction trends, stent history, and the last three lipid panels right on the chart screen.

2. OBGYN

OBGYNs need structured OB history, prenatal flowsheets, fetal growth tracking, and seamless handoffs between nurse practitioners and physicians. 

We:

• Designed prenatal summary views with standard ACOG forms
• Built GTPAL documentation with auto-updating EDD calculations
• Integrated lab result timelines specific to prenatal needs
  
  

3. Behavioral Health

This specialty is narrative-heavy. SOAP notes are long-form. Compliance includes outcome tracking and detailed treatment plans. 

We:

• Enabled rich-text, voice-to-text support in progress notes
• Embedded PHQ-9/GAD-7 scoring tools
• Automated treatment plan reviews with goal progression tracking
  
  

4. Podiatry

Highly procedure-driven, podiatrists require:

• CPT code suggestions aligned with visit types
• Image annotation for wound care
• DME (Durable Medical Equipment) ordering workflows

We provided templated surgical reports for common foot/ankle procedures and auto-linked them to billing codes.

5. Urgent Care

Here, speed is everything. These clinics need:

• One-click problem lists
• Built-in triage protocols
• Rapid discharge instructions

We built a custom mode where clinicians could complete charting in under 3 seconds using AI.

Compliance: A Moving Target Across Specialties

Another reason one-size-fits-all fails is the complex world of compliance. Behavioral health must meet different audit standards than internal medicine. Pain management must tightly document controlled substances. OBGYN practices need prenatal documentation that aligns with payers.

Over the years, we built rules engines that adapt per specialty. If you’re a psychiatrist, you’ll be prompted for suicide risk assessments. If you’re a surgeon, pre-op clearance checks appear. All without overloading the screen.

Billing and RCM: One More Layer of Complexity

Billing is a key user of the EHR, and not just a back-office function. Coding, documentation linkage, charge capture, and pre-authorization vary widely.

For example:

• In dermatology, image-backed lesion mapping is crucial for accurate CPT coding.
• In internal medicine, chronic condition management and accurate problem list maintenance are critical.
• In primary care, preventive screenings impact MIPS metrics.

Generic EHRs often miss these nuances, causing underbilling or compliance risk. Our design process includes RCM advisors and specialty-specific coders to tailor billing flows that match real-world encounters.

Reporting That Matters

Practice managers often ask us: “Can I see how our diabetic patients are trending?” Or, “How many prenatal patients are due for labs?”

Generic reporting tools offer canned reports. But a GI practice doesn’t care about OB metrics. A behavioral health clinic doesn’t track LDLs.

We implemented:

• Specialty-aware reporting templates
• Role-based dashboards (providers see trends; managers see productivity)
• Custom KPIs that match board-certification or payer-incentive requirements
  
  

What We Did Differently

Here’s what we changed in our product strategy after working with real users for years.

1. Built Configurable Templates

Every specialty has its own templates. We avoided bloated one-template-fits-all models.

2. Created Workflow Modes

Urgent care mode. OB flow mode. Behavioral therapy mode. Each with shortcuts, layout, and alerts customized to speed and clinical logic.

3. Included Clinical SMEs in Design

Every design sprint included real providers in that specialty. We reviewed mockups with them. They signed off on workflows.

4. Designed for the Entire Team

We didn’t just build for providers. Nurses, front desk, billers, and compliance officers each had their user needs addressed.

5. Ensured Configurable Compliance Prompts

Our alert system wasn’t hardcoded. It adjusted based on specialty and local/state rules.

6. Tied Documentation to Billing Natively

Our EHR ensured that documentation naturally triggered appropriate coding options, preventing revenue leakage.

What This Means for Your Clinic

If you’re evaluating EHRs, here’s the bottom line: if the system you’re considering doesn’t ask what specialty you are and doesn’t change meaningfully based on that answer, you’re going to spend more time customizing, patching, and explaining why things don’t work the way your clinic does.

And that’s costly, not in dollars, but in provider burnout, lost productivity, and missed revenue.

Closing Thoughts

Healthcare is not monolithic. Every specialty brings its own nuance, rhythm, and clinical logic. After designing systems across 20+ specialties, I can confidently say: the best EHR isn’t the one with the most features. It’s the one that understands you.

If your software feels like it was built for someone else, maybe it was.

It’s time for software that doesn’t just meet the baseline but elevates the care you deliver. And that starts by building for the specialty you practice.

Want to see how our specialty-aware EHR can work for your practice?

Schedule a personalized demo and experience software that fits your way of practicing medicine.