Dermatology practices need EMR functionality that generic ambulatory EMRs address unevenly. FHIR provides primitives for four specialty-specific patterns.
Pattern 1: Image-heavy chart integration. Clinical photography, dermoscopy images, teledermatology. Model as DocumentReference pointing to image storage. High-resolution images live in dedicated storage; DocumentReference tracks the metadata.
Pattern 2: Detailed procedure documentation. Excisions, biopsies, cosmetic procedures. Model as Procedure resource with dermatology-specific SNOMED CT codes. bodySite should be granular ("left forearm, dorsal, 3cm proximal to elbow").
Pattern 3: Pathology result integration. Skin biopsy results flow back from pathology lab. Model as DiagnosticReport linked to the source Procedure via basedOn.
Pattern 4: Patient-reported symptom tracking. SDC Questionnaire for symptom tracking (PsO PROMs, eczema severity indices). Longitudinal Observations feed dermatologist review.
Common dermatology EMR gaps
1. Generic image handling → dermatology workflows suffer. 2. Non-specific SNOMED codes → analytics can't distinguish conditions. 3. Manual pathology reconciliation → data silos. 4. No specialty PROM tooling → longitudinal tracking missing.
Dermatology-specific vendors
| Vendor | FHIR support | Dermatology depth |
|---|---|---|
| Modernizing Medicine EMA | Full | Full |
| Nextech Dermatology | Full | Full |
| PracticeStudio Dermatology | Partial | Full |
| Custom on Aidbox/Medplum | Full | Custom-built |
Integration considerations
1. Image storage capacity — dermatology generates 10-100x more images than general practice. 2. Terminology support — SNOMED CT dermatology sub-hierarchies. 3. PA support for biologics — Da Vinci PAS. 4. Teledermatology integration — SMART-launched apps.
Dermatology EMR is a subset of FHIR healthcare IT with specific patterns. Get the four right and specialty workflows fit.
