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

Customisations also lead to differences in database structure (schema - in technical terms). Non-uniformity of database schema across user sites mean that for data to be interoperable a middleware will be required whenever collating data from different client sites. Sometimes, due to differences in schema and semantic non-uniformity (as often exists in medical terminologies) data becomes completely non-interoperable.

There are more issues