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An analysis of EMR & HIMS projects and products in use reveal certain 'deficiencies'. Most developers either try to sell their processes to the client ignoring the latter's legitimate requirements or customise their products to fit the client's requirements.

In the first case, steam-rolling a client's legitimate business requirements and forcing down 'best practices' in the industry may be disruptive for doctors and support staff and may degrade the quality of care.

In the second case, excessive customisation leads to differences in database structures and a different code base in different installations (for the unintiated, this means slightly different shades of the application is lodged at different client sites). When upgrades are attempted these code differences have to be kept in mind as upgrades may break the applications at some sites. Also, this scenario is unacceptable if multiple clients use the same application hosted as a 'software as a service'.

Customisations have other issues as well - they cost money. See the 'Vicious cycle of EMR products'