Dermatology practices have specific EHR needs that generic ambulatory EHRs don't fully address. FHIR provides the primitives; specialty EHRs on top add dermatology-specific capabilities.
Specialty-specific requirements
1. Image integration. High-resolution clinical photography, teledermatology videos. DocumentReference points to image storage. 2. Diagnosis specificity. Dermatology conditions have granular SNOMED CT codes. Terminology server must support this depth. 3. Procedure documentation. Excisions, biopsies with detailed Procedure resources. 4. Pathology integration. Skin biopsies feed pathology reports back into charts. DiagnosticReport with attached PDF or structured findings. 5. Patient-reported symptom tracking. Skin symptom Questionnaires via SDC.
FHIR-based specialty EHR patterns
1. Extend generic Patient/Encounter with dermatology-specific SDC forms. 2. Custom search parameters for dermatology conditions. 3. CDS Hooks for dermatology-specific rules (biologic drug requirements, phototherapy protocols). 4. Integration with dermatology-specific external services (pathology labs, teledermatology platforms).
Common dermatology EHR gaps
1. Generic EHRs don't handle high-volume image workflows well. 2. Terminology bindings often too broad (parent SNOMED codes instead of specific dermatology codes). 3. Patient reminders for skin cancer follow-up require custom automation. 4. Insurance authorization for biologics requires PA integration.
Vendor landscape (mid-2026)
| Vendor | FHIR support | Dermatology-specific |
|---|---|---|
| Modernizing Medicine EMA | Full | Full |
| Nextech | Full | Full |
| PracticeStudio Dermatology | Partial | Full |
| Custom on Aidbox/Medplum | Full | Custom-built |
Integration surface
Dermatology EHRs on FHIR expose SMART, CDS Hooks, Bulk Data — same as generic EHRs. Third-party specialty apps integrate through these interfaces.
Dermatology practice IT is a subset of general FHIR healthcare IT with specific needs. The FHIR primitives support the workflows; specialty EHRs layer specialty-specific UX on top.