Health organisations love to customise their IT platforms. Every practice thinks its workflows are unique. Every PHO wants reports shaped exactly the way their board expects. Every district wants its referral forms to look different. Twenty years of watching this play out has taught me one thing: every customisation you make today is a cost you'll pay later.
The pattern is so consistent it should be a law of health IT. An organisation buys a platform. The platform doesn't perfectly match their workflow. So they customise it. Custom fields, custom forms, custom reports, custom integrations. Each one is small. Each one is justified. And collectively, they create a system that no longer resembles the vendor's standard product.
40%
average increase in migration costs for health IT systems with significant customisation versus standard configurations
Source: Gartner, Healthcare IT Migration Analysis, 2023
Then the vendor releases a major upgrade. The standard customers upgrade smoothly. The customised customers discover that their modifications break under the new version. The upgrade becomes a project. The project takes months. During those months, the organisation is running an outdated system while everyone else moves forward.
Or worse, the organisation decides to change vendors. The data in their standard fields exports cleanly. The data in their custom fields doesn't. The custom reports don't translate. The custom integrations need rebuilding. A migration that should take six months takes two years.
I've seen this happen at every scale. Small practices that customised their patient management system and then couldn't upgrade for three years. PHOs that built custom reporting layers and then spent more on maintaining them than on the underlying platform. Organisations that were effectively trapped in a vendor relationship because the cost of leaving was prohibitive due to customisation.
3-5x
longer average time to complete vendor migrations for heavily customised health IT systems
Source: KLAS Research, Health IT Migration Survey, 2023
The temptation is understandable. When a clinician says, "I need a field for X," and the standard system doesn't have it, the easy answer is to add one. When the board wants a report in a specific format, the easy answer is to build it. When a workflow doesn't quite fit, the easy answer is to modify the system.
The discipline is harder. Ask whether the standard approach works well enough. Challenge whether the custom field is really needed or whether existing fields can serve the purpose. Build reports using the vendor's standard reporting tools rather than custom layers. Accept that the platform won't perfectly match every workflow, and adapt the workflow where the cost is lower than adapting the system.
The question isn't whether the customisation solves today's problem. It always does. The question is whether you'll still be paying for it in five years. You usually will.
Rikimata Massey
Health CIO Advisory
None of this means zero customisation. There are legitimate cases where the standard product genuinely can't support a critical clinical or operational requirement. But those cases should be the exception, documented, justified, and accepted with full awareness of the long-term cost. What I see instead is customisation as the default response to any gap between the system and the workflow.
The organisations that move fastest in health IT are the ones that stay closest to standard. They upgrade on schedule. They migrate when better options emerge. They integrate new tools without rebuilding their foundations. And they spend their IT budget on improving patient care rather than maintaining custom code.
Every customisation is a bet that the future will look exactly like today. In health IT, that bet almost never pays off.