EHR Vendors: Step Up Your Game - InformationWeek

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EHR Vendors: Step Up Your Game
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User Rank: Apprentice
7/31/2014 | 10:56:53 PM
Unfortunately, EHR innovation will be painfully slow the way things are going...
I appreciate your enthusiasm and optimisim regarding EHR innovation.  I wish the same, but as a physician as well as an open source software coder (or hacker) who developed his own homegrown EHR (NOSH ChartingSystem), I have serious concerns about the trajectory of the EHR and Health IT market.  You correctly asked and answered the question of why physicians are not adopting EHRs and yes, it is all about usability.  I wrote a blog post ( about this and I feel that most EHR vendors would care less about physician's idea of workflow and usability because most EHR's are designed from a framework based on billing and administrative workflows rather than patient care, espeically in the outpatient realm (which is quite different from a hospital or academic medical center).  To most physicians, even those like me who are tech savvy, this is a difficult concept to reconcile and is quite disruptive.  Until an EHR adequately addresses clinical workflow usability (which I don't think any really do), physician adoption and participation will be suboptimal.  Unfortunately (this is where I am pessimistic), those who have the financial means to purchase or develop an EHR (ie adminstrators) are those that don't have the clinical expertise to understand these usability, user-interface issues, and subsequently enough agitation to innovate there. 
On top of that, the Meaninful Use initiatives have significantly altered the EHR market where, intentionally or not, we are starting to see EHR market consolidation with only a few major player.  This will have negative effect on physician's voices being heard to address usability issues and innovation will likely be stiffled since there is no incentive to these big EHR vendors to change their tune or innovate for innovation's sake.
That's why I developed my EHR, first as an open source licensed web-based project, to hopefully educate and encourage physican input in continuously improve it, to see what would happen if an EHR was built from a clinician's point of view...already, I believe it's quite different than the traditional systems.  It's also open in the sense it adopts open standards (like Blue Button Plus for C-CDA generation and parsing) and in the future, clearly documented API's will be developed so that data can be shared securely between other systems if one so chooses.  I also deliberatly chose to avoid certification for MU for the reasons that the certification requirements are antithetical to clinician usability.  Yes, it's a huge undertaking and goes pretty much against where things are going in the EHR and Health IT realm, but I believe clinicians absoultely need to be involved in the process, otherwise, it's not much of a "health" record with meaningful data for the clinician.  But who knows?
User Rank: Ninja
7/28/2014 | 5:18:06 PM
A pleasant fiction

>>Imagine the possibilities if EHR vendors transform their closed and proprietary systems into open platforms<<


I'm sure this sentence alone is making EHR vendor CEO heads explode.  CEOs aren't exactly the sharpest tool in the shed - many of them can barely use email.  Suggesting that their proprietary systems (which = cha ching in their minds) is tantamount to giving away the system for FREE.  Sorry.  Ain't gonna happen.  The entire industry would have to undergo a profound paradigm shift and I don't see that happening anytime soon.  It's a pleasant fiction, however.
User Rank: Apprentice
7/28/2014 | 4:40:29 PM
Re: Want to change the game? Rethink who's eligible to play.
Thank you for your response. 

Having been a hiring manager for most of my career I recommend that all candidates ignore the past healthcare experience requirements for most applications. I myself got into healthcare straight out of college without any healthcare IT experience. Most skilled managers will look beyond the healthcare requirements if there are other solid skills listed in the CV. I have hired many candidates that had no healthcare experience but I sensed a willingness to learn and that the individual would be a good team player. The trend is definitely changing and it is opening up and hiring the best people in healthcare IT! This is good new indeed for the industry and for the new talent.

Warm Regards.

Jeff Jerome
Jeff Jerome,
User Rank: Ninja
7/25/2014 | 10:58:28 AM
Re: Usability of EHRs And if you don't someone else will
@ Henrisha - Your comment about customer loyalty is very true for EHR and frankly and software of professional services provider.  Customer service is not a department it is a company philosophy.  And for a healthcare provider to jump ship there has to be a very compelling reason.  With that said I am going to ask my customer what drove them to take on that change from one provider to another.  It took them over two years and untold millions of dollars to achieve this goal.  So there was something big that made that happen.
User Rank: Strategist
7/25/2014 | 1:26:55 AM
Re: Usability of EHRs And if you don't someone else will
EHR vendors, and all other vendors for that matter, shouldn't bank on customer loyalty. First and foremost, what matters is the service and support customers get. If you fail on any point, they will switch to another who can give them what they need.
Jeff Jerome
Jeff Jerome,
User Rank: Ninja
7/24/2014 | 10:50:40 PM
Re: Usability of EHRs And if you don't someone else will
Personally I have seen companies switch EHR vendors and that is no small commitment.  And from usability point of view if the vendor does not make the application easy to use then customers will find alternatives.  And for traditional software companies who get usability they will find a way to make the interface more attractive.  Plus there are new vendors coming on line that offer EHR as a Service, practice Fusion for one.  The typically cater to smaller practitioners but this too could change.
User Rank: Apprentice
7/24/2014 | 2:18:48 PM
Want to change the game? Rethink who's eligible to play.
The minimal requirements for every health IT job listing I've read during the last 18 months contain an item that automatically disqualifies the vast majority of tech developers and interface designers:
X years [or months] experience in healthcare [sometimes adding or related industry]

No doubt, healthcare is different. Many industries demand a focus on safety with respect to potential biological, chemical, physical, or radiologcal hazards or an awareness of laws related to use of chemicals, information privacy, or professional malpractice. Healthcare demands all of these simultaneously, often with lives at stake.

In light of such demands, wouldn't it be more sensible to hire the best IT professionals regardless of past employment setting—to prefer, but not require, healthcare experience?

Mr. Weschler speaks of his optimisim that healthcare IT ...can begin to learn and take advantage of the progress made in other industries. Organizations seeking to do this—and to do it efficiently—will need to welcome IT professionals from outside healthcare sector.
User Rank: Apprentice
7/24/2014 | 9:41:05 AM
Usability of EHRs
Thanks so much for posting this article!!

We totally agree with the majority of the points that you make and would like to add the following:

Adopting User-Centered Design (UCD) methodologies saves money (10-100x ROI)

Adopting User-Centered Design methodogies in Healthcare can save lives - see

The ONC Meaningful Use stage two certification required that EHR vendors describe their UCD practices and provide a summative usability test as part of their submission.  A large number of these vendors have provided filler text (copied and pasted from NIST documentation) and less than what should be acceptable studies (We've seen vendors report on summative studies with a single participant, and that participant was an employee of the EHR vendor!)

The HealthIT market is about 10 years behind the enterprise software market, which is about 5 years behind the consumer market.  Given the amount of money that is involved in healthcare, and the potiential for this technology to extend and improve the quality of life for so many, it is a shame that the industry is so far behind.

We are doing all that we can to help, by conducting summative studies, helping EHR vendors with design issues, presenting papers on usability at conferences, engaging on social media,etc.  We all need to work together to solve this.  Join us after all, Usability starts with YOU.

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