Custom Workflows: Your Practice, Your Way. No Epic Customization Bills.

The Problem: Epic Customization Is Insanely Expensive

Epic charges $85,000-$150,000 to build custom templates. You wait 4-8 weeks for each template. Your practice manager can’t modify them—any change requires IT involvement and additional fees.

Your dermatology clinic needs Mohs surgery-specific templates. Your psychiatry practice needs PHQ-9 to BHI workflow integration. Your FQHC needs UDS reporting fields. Epic’s answer: $50K-$200K per specialty, 6-12 months of implementation, and permanent IT dependency.

The Better Path: Practice-Managed Templates

OrbDoc: Your practice manager builds templates in 3-5 days. Changes them in 30 seconds. No vendor dependency. No additional fees.

Multi-specialty group? Each specialty builds its own templates. Solo practice? Customize for your unique workflow. The templates belong to you—not Epic, not a vendor, not an IT consultant billing $250/hour.

The Enterprise Customization Trap

Epic and Cerner built excellent systems for large health systems with dedicated IT departments, substantial budgets, and standardized workflows across hundreds of providers. For those organizations, expensive customization makes sense. Spread $200,000 across 500 providers, and the per-physician cost becomes manageable.

But independent practices operate in a different economic reality.

Why Enterprise Customization Costs $50K-$200K

The Technical Reality:

Enterprise EHR customization requires vendor-certified analysts who understand both clinical workflows and proprietary system architectures. These specialists don’t come cheap. Typical customization projects involve:

• Clinical workflow analysis: 40-80 hours at $150-$250/hour
• Template design and development: 60-120 hours of analyst time
• Testing and validation: 40-60 hours
• Training and deployment: 20-40 hours per template set
• Ongoing maintenance and updates: Annual fees 15-20% of initial cost

A moderate complexity customization (specialty-specific templates for a 5-provider practice) easily reaches $75,000-$125,000. Complex workflows with conditional logic, specialty calculations, and integration requirements approach $200,000.

The Ongoing Dependency Problem

The customization cost is just the beginning. Enterprise systems create permanent IT dependency:

Want to Add a New Template? Call your vendor, submit a change request, wait 3-6 months, pay consulting fees.

Need to Modify an Existing Workflow? Same process. Your practice manager can’t make changes. Your physicians can’t adjust templates. You’re dependent on vendor resources and timelines.

Clinic Workflows Evolve? Too bad. Either live with outdated templates or budget for another round of expensive customization.

This dependency model works fine for hospitals with IT departments. For independent practices, it’s a straitjacket.

The “One Size Fits All” Alternative

Most small practices can’t afford custom workflows, so enterprise vendors offer standardized templates. These generic solutions force your dermatology practice to use the same skin exam template as every other specialty, your psychiatry practice to wedge PHQ-9 screening into generic intake forms, your rural FQHC to manually track social determinants of health in free-text fields.

The result: documentation that doesn’t match your clinical thinking, templates that don’t capture your specialty’s nuances, workflows that slow you down instead of supporting your practice.

The Independent Practice Solution: Practice-Configurable Templates

OrbDoc takes a fundamentally different approach. Instead of expensive vendor-driven customization or rigid one-size-fits-all templates, practices get flexible template builders that adapt to their needs without IT departments.

No-Code Template Customization

Practice managers and clinical leads can build and modify templates directly, without programming expertise or vendor dependency.

Visual Template Builder:

Drag-and-drop interface for creating custom forms. Add fields, set up conditional logic, configure workflow branching, and adjust templates based on specialty needs. Changes take effect immediately without waiting for vendor consultants.

Example: Dermatology Practice Custom Workflow

A three-provider dermatology practice needs Mohs surgery-specific templates:

Traditional Path (Epic/Cerner):

• Request customization quote: $85,000
• 9-month implementation timeline
• Requires certified analyst
• Future changes cost $5,000-$15,000 each
• Annual maintenance: $12,000

OrbDoc Path:

• Practice manager opens template builder
• Selects dermatology template library as starting point
• Customizes Mohs-specific fields (layers, margins, pathology tracking)
• Adds anatomical diagrams specific to practice preferences
• Configures workflow: Initial excision → Pathology review → Re-excision if needed → Reconstruction
• Tests with physicians, refines based on feedback
• Deploys to practice in 3-5 days
• Total cost: $0 (included in platform)
• Future modifications: Practice manager makes changes in minutes

Specialty-Specific Template Libraries

Rather than starting from scratch, practices access pre-built template libraries covering 30+ specialties. These templates incorporate specialty society guidelines, current documentation best practices, and common workflow patterns.

Specialty Libraries Include:

Primary Care: AWV templates, chronic disease management (diabetes, HTN, CHF), acute illness evaluation, preventive care protocols

Cardiology: Stress testing, echocardiography, cardiac cath documentation, device implantation, EP studies

Dermatology: Full-body skin exams with anatomical mapping, biopsy tracking, cosmetic procedures, dermoscopy documentation

Psychiatry: Intake assessments, PHQ-9/GAD-7 integration, BHI documentation, medication management, therapy notes

Orthopedics: Joint-specific examinations, pre-op planning, operative notes, post-op protocols

Hospital Medicine: Daily progress notes, discharge summaries, handoff documentation, care transition coordination

Templates aren’t rigid. Every pre-built template serves as a customizable starting point. Add practice-specific fields, remove elements you don’t use, adjust workflows to match your clinical approach.

Workflow Branching and Conditional Logic

Complex clinical scenarios require templates that adapt based on patient responses and clinical findings.

Example: Psychiatry PHQ-9 to BHI Workflow

Patient completes PHQ-9 screening. Based on score, the template automatically branches:

Score 0-4 (Minimal): Standard visit documentation continues Score 5-9 (Mild): Prompts provider to discuss symptoms, offers BHI coding guidance Score 10-14 (Moderate): Automatically opens BHI documentation template, suggests follow-up timeline Score 15+ (Severe): Triggers safety assessment, suicide screening, immediate intervention documentation

This conditional logic happens automatically. The template adapts to clinical findings without the provider clicking through multiple screens or remembering to open additional forms.

Implementation:

• Enterprise system: $15,000-$25,000 customization fee
• OrbDoc: Practice manager configures in template builder, no cost

Practice-Specific Macros and Shortcuts

Providers develop personal documentation patterns. Support those patterns with custom macros and shortcuts.

Common Use Cases:

Standard Phrases: “Patient tolerating medications without side effects, plan to continue current regimen”

Exam Normals: One-click documentation of normal cardiovascular exam, normal neurological exam, etc.

Specialty-Specific Language: Dermatology lesion descriptors, cardiology hemodynamic terminology, psychiatry mental status exam normals

Procedure Steps: Standard operative note sequences for common procedures

These shortcuts aren’t system-wide mandates. Each provider customizes their own macros to match personal documentation style while maintaining structured data capture for billing and quality reporting.

Real-World Implementation: Multi-Specialty Group Practice

Organization: 15-provider independent multi-specialty group (5 primary care, 3 cardiology, 2 dermatology, 2 psychiatry, 3 hospital medicine)

Challenge: Previous EHR offered only generic templates. Each specialty struggled with documentation that didn’t match their clinical workflows. Physicians spent excessive time on documentation, quality metric capture was incomplete, and billing optimization suffered due to inadequate template support.

Epic Customization Quote: $175,000 for specialty-specific templates across all five specialties, 12-month implementation, ongoing $26,000 annual maintenance

OrbDoc Implementation:

Week 1-2: Practice administrator trained on template builder Week 3-4: Templates customized per specialty using library starting points Week 5-6: Physician testing and refinement Week 7: Deployment across practice Total cost: $0 additional (included in platform)

Results After 6 Months:

Documentation Efficiency:

• Primary care: 18 minutes → 12 minutes per visit (33% reduction)
• Cardiology: Procedure notes 35 minutes → 14 minutes (60% reduction)
• Psychiatry: BHI documentation time reduced 45%

Quality Metrics:

• AWV completion rates: 62% → 89%
• Diabetes quality measures: 71% → 93%
• Depression screening documentation: 68% → 96%

Revenue Impact:

• Better template-guided billing: $145,000 additional annual revenue
• Saved customization cost: $175,000
• Total first-year value: $320,000

Ongoing Flexibility:

• Practice makes template adjustments monthly based on feedback
• New providers get customized templates matching their workflow preferences
• Specialty protocols updated immediately when guidelines change
• No vendor dependency, no consulting fees

Use Cases: When Practice Flexibility Matters

Use Case 1: FQHC with UDS Reporting Requirements

Scenario: Federally Qualified Health Center needs integrated UDS (Uniform Data System) reporting fields in routine documentation. Standard EHR templates don’t include social determinants of health screening, substance use tracking, or housing stability documentation required for federal reporting.

Enterprise Approach: Custom forms development, $35,000-$55,000, requires annual updates when UDS requirements change

OrbDoc Approach: Practice builds custom intake templates with SDOH fields, substance use screening integrated into visit documentation, housing stability tracking linked to care coordination workflows. Updates for new UDS requirements implemented by practice manager in hours.

Impact: 100% UDS data capture, eliminates manual chart abstraction saving 40 hours monthly, federal reporting compliance without ongoing customization costs.

Use Case 2: Rural Multi-Site Clinic with Variable Internet

Scenario: Three clinic locations in rural areas with unreliable internet. Need offline-capable templates that sync when connectivity returns. Different sites have different patient populations requiring site-specific template variations.

Enterprise Challenge: Most enterprise systems require constant connectivity. Custom offline capabilities (if available) cost $50,000+. Site-specific templates multiply customization costs.

OrbDoc Solution: Offline-first architecture works without internet. Each site customizes templates for their patient population (Site A: agricultural worker health focus, Site B: geriatric emphasis, Site C: pediatric orientation). Templates sync automatically when connectivity returns.

Impact: Documentation continues during internet outages, site-specific templates match local population needs, zero additional customization cost.

Use Case 3: Hospital Medicine Group with Rotating Coverage

Scenario: Eight hospitalists share patient panel on 7-on/7-off schedule. Need standardized templates for consistency but flexibility for individual documentation preferences.

OrbDoc Implementation: Base hospitalist templates provide structure for daily progress notes, discharge summaries, and handoff documentation. Individual hospitalists customize within that framework (different normal exam phrasing, personal macros, preferred assessment organization). Team maintains consistency while supporting individual styles.

Impact: New hospitalists onboard quickly with standard templates, experienced physicians maintain efficiency with personal customizations, handoff quality improves through template standardization, patient continuity benefits from consistent documentation structure.

When Enterprise vs Independent Approach Makes Sense

Epic/Enterprise Systems Are Right For:

Large health systems with 200+ providers where $200,000 customization cost spreads across many users ($1,000 per provider becomes reasonable)

Organizations with dedicated IT departments that can maintain complex customization over time

Practices requiring deep integration with hospital systems, research databases, and complex institutional workflows

Standardization priorities where enforcing uniform workflows across hundreds of providers outweighs flexibility

Practice-Configurable Templates Are Right For:

Independent practices (2-20 providers) where $50,000-$200,000 customization cost per provider is prohibitive

Practices without IT departments that need clinical staff to manage template evolution

Multi-specialty groups where each specialty needs different workflows without multiplying customization costs

Practices that evolve rapidly and need to adjust templates frequently without vendor dependency

Rural and underserved settings where offline capability, flexibility, and cost-efficiency all matter

The question isn’t which system is better in abstract terms. The question is which economic model and flexibility approach matches your practice reality.

Getting Started: Template Customization for Your Practice

Assessment Phase

Identify Documentation Pain Points:

• Which templates don’t match your workflows?
• What fields do you wish you had?
• What repetitive documentation wastes time?
• What quality metrics are you missing?

Prioritize Customization Opportunities:

• High-volume templates (used daily): First priority
• Specialty-specific needs: Second priority
• Nice-to-have refinements: Future optimization

Implementation Phase

Week 1-2: Training

• Practice manager learns template builder
• Review specialty template libraries
• Identify starting points for customization

Week 3-4: Build and Test

• Customize templates based on practice needs
• Test with 1-2 physician champions
• Gather feedback and refine

Week 5-6: Deployment

• Roll out to full practice
• Provide physician training
• Collect ongoing feedback for optimization

Ongoing: Iterate

• Monthly template review
• Adjust based on provider feedback
• Update when clinical guidelines change
• No vendor dependency, no consulting fees

ROI Calculation

Avoided Customization Cost: $50,000-$200,000 (one-time) Avoided Annual Maintenance: $7,500-$30,000 (recurring) Documentation Time Savings: 15-30% efficiency gain Quality Metric Improvement: Better template guidance improves measure capture Billing Optimization: Template-supported code selection reduces undercoding

For a 5-provider practice, first-year value typically exceeds $100,000 (avoided customization cost + efficiency gains + quality improvement).

The Flexibility Advantage

Enterprise systems excel at standardization. Independent practices need flexibility. The right template system adapts to your practice instead of forcing your practice to adapt to rigid workflows.

OrbDoc’s approach: Give practices the tools to customize their own templates, provide specialty-specific starting points to accelerate implementation, eliminate vendor dependency for ongoing changes, and support practice evolution without consulting fees.

The result is documentation that matches your clinical thinking, templates that support your specialty’s needs, and workflows that evolve as your practice grows. All without six-figure customization costs or IT department dependency.

Your practice is unique. Your documentation should be too.

See Practice-Configurable Templates in Action

Schedule a demo to see how your practice can customize templates without vendor dependency or enterprise costs.

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