A&I Custom EHR for Orthopedics: Imaging & Surgical Planning
How A&I Solutions built a custom orthopedic EHR that integrated medical imaging, surgical planning, and implant tracking to streamline the complete surgical workflow.
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Connecting imaging, surgical planning, and clinical documentation
The client is an independent orthopedic surgical group operating three outpatient clinics and one ambulatory surgery center across the Southeast United States. The group includes four board-certified orthopedic surgeons and nine physician assistants, supported by a clinical and administrative team of 60 staff members and performing approximately 7,500 procedures annually.
The existing EHR was designed for general clinical documentation and did not support the imaging-intensive workflows required for orthopedic surgery. Surgeons reviewed radiographs, MRI studies, and CT scans through a separate PACS workstation, while surgical plans were documented using paper forms and implant information was manually recorded after procedures.
To address these limitations, the client partnered with A&I Solutions to develop custom EHR software built around orthopedic surgical workflows. The solution integrated imaging into the patient record, digitized pre-operative and operative documentation, and connected implant tracking with billing and compliance workflows.
Unifying orthopedic surgical workflows in one platform
The Challenge
- Diagnostic imaging was disconnected from the clinical record and required a separate PACS workstation.
- Pre-operative planning and operative documentation relied on paper forms, PDFs, and generic EHR templates.
- Implant tracking depended on handwritten records, creating documentation, billing, and compliance risks.
Our Solution
- Integrated DICOM-based imaging directly into the clinical workflow.
- Connected pre-operative plans, surgical documentation, and post-operative notes through a shared digital case record.
- Built digital implant tracking with billing, recall, and compliance reporting.
Cloud-based architecture for orthopedic surgical workflows
A&I Solutions developed the platform on AWS using DICOM, PACS integration, FHIR R4, HL7 v2.x, REST APIs, OAuth 2.0, RBAC, and SSO. The architecture connected referring facility imaging and the existing PACS environment to an in-EHR imaging viewer, which then fed into pre-operative planning, shared surgical case records, implant tracking, operative notes, and billing workflows.
Custom EHR software built for orthopedic surgery
A&I Solutions designed and delivered custom EHR software around the clinical and operational requirements of orthopedic surgical practice. The platform brought imaging review, pre-operative planning, operative documentation, and implant tracking into one connected workflow, reducing the need for paper records and separate systems. Through the A&I Solutions project delivery, the implementation demonstrates how a customizable EHR can be tailored to complex specialty and surgical workflows.
1. PACS-integrated imaging and surgical planning
A&I Solutions connected the client’s existing PACS environment directly with the EHR.
The platform included:
- DICOM-compliant retrieval of radiographs, MRI studies, and CT scans
- In-EHR image viewer with current and prior study comparison
- Image annotation within pre-operative planning
- HL7 v2.x ingestion from referring facilities
- FHIR R4-based structured report exchange
- Connected radiology reports and corresponding images
Surgeons could review and annotate imaging without leaving the clinical record, making imaging part of the surgical planning workflow.
2. Connected surgical and implant workflows
The platform created a shared digital workflow from pre-operative planning through billing and compliance.
Procedure-specific templates supported joint reconstruction, spine, and sports medicine cases, with surgical technique and implant selection tools built into the workflow.
Data from the pre-operative plan automatically populated relevant post-operative note fields, reducing duplicate documentation and supporting faster note completion.
A digital implant log captured manufacturer, catalog number, lot number, expiration date, and size during the procedure.
Verified implant information flowed into billing documentation, while recall search and automated implant reports supported compliance and payer requirements.
AWS, OAuth 2.0, RBAC, SSO, encrypted data storage and transmission, and HIPAA-compliant audit logging protected clinical and device information across the practice.