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Don’t Blame Providers For Variations In EMR Use

Posted on June 20, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

A new study published in the Journal of the American Medical Informatics Association has documented what we all already know  — that providers have idiosyncracies in how they use EMRs. The question that remains unanswered is whether this is a bad thing.

According to iHealthBeat, researchers dug into a massive amount of data which painted a picture of how 112 physicians and nurse practitioners working in federally qualified health care centers in New York City used their EMRs. To conduct the study, the researchers looked at 430,803 visits by 99,649 patients who came to the centers.

After analyzing the data, the study found that providers varied in several key habits when using their EMRs, including how often the updated patient problem lists, when they would respond to clinical decision support alerts, whether the appointment was with a new patient or an established one, and the use of the meaningful use objective metrics, iHealthBeat reported.

Why were providers vary so widely and how they conducted these tasks? Researchers said that there are several reasons for this variation, including the providers overall familiarity with the EMR system, the familiarity with the patient’s medical problems, and workflow differences due to staffing differences at the health centers.

According to the researchers, significant variance among providers’ EMR use suggests that it’s a good idea to measure individual level measures of usage, as such studies might improve research on quality and cost outcomes of EMR use. In other words, the study suggests that variance in EMR usage might lead to positive or negative outcomes, and that standardization — once best practices are determined — might improve outcomes.

The problem with this logic, though it sounds  good on the surface, is that providers are struggling hard enough already to develop routines which make EMRs work for them. And as with any other technology, those workarounds are going to vary depending on who you’re talking about and what they’re trying to accomplish.

I’d argue that while tracking sources of variance in EMR use might have some value in improving outcomes, it’s no excuse to force standardization in professionals’ EMR habits, as long as their overall outcomes are appropriate. What’s more, a push to standardize how providers use EMRs puts the struggle to make them workable on providers, not the vendors whose product quirks are almost certainly responsible for this dilemma.

The bottom line, as I see it, is that while this research is useful, it should raise a red flag on vendors, whose usability levels are still far from where they should be. When you give providers a highly usable, well-thought-out interface to use which suits their daily routines, then it might be time to streamline their work habits. Until then, give  them a break if you don’t want to spark a revolution.

P.S. If you’re curious about what the best thinking on EMR usability is out there, check out this list.

Defining EHR Usability Isn’t for the Timid

Posted on December 30, 2013 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Editor’s Note: A big welcome to Carl as a writer on EMR and EHR. He’s been writing guest posts across the Healthcare Scene network for many years, but we’re happy to have him now writing formally on EMR and EHR. You’ll be able to read all of Carl’s past and present posts on EMR and EHR here.

Sometimes it seems that EHRs and usability are like Earth and Mars. Their orbits get relatively close, but they’re never going to occupy the same place and time.

Of course, the two we’re occupied with aren’t cosmic equals. EHRs are specific systems, while usability is, at best, a concept with various definitions. In fact, the closer you get to a definition of usability the less focused it becomes. My late brother used to call things like that, “Far aways.” “The farther away you get the better they look.”

Indeed, most definitions of usability say it’s something that’s useful. Ugh. So, is there any way to bring some clarity to its definition, so it has greater precision?

Doing so, I think, requires not only defining what usability is, but also tackling when it’s not present what’s wrong.

Usability: A Different Definition Approach

Most definitions of usability I’ve seen push the issue off onto use or useful. That is, usability is defined as something that is useable. This isn’t far from using a word to define itself, which was a grammar school no no. It also fails to involve the user’s expectation. I would define it this way:

Usability is the ability of a system to supply a desired result with the minimum necessary information, conditions or steps.

This definition hinges on a user getting what they want expeditiously. Simply put, usability means no unneeded fuss or feathers. As I look at it, usability is to systems what parsimony is to logic. In logic, the simplest explanation that explains the occurrence is the best. Similarly, the most usable system is the one that requires the least effort to supply the correct response.

User Hostile Systems

If I left matters at this juncture, however, I wouldn’t have addressed a major related issue. When a system is user hostile, just where has it gone wrong. Each of us has experienced or heard these tales. You make a simple request and wind up in wilderness of documentation or your options are have everything but what you want.

These are negative examples of usability. It is, however, not enough to just stamp them as such and move on. It’s also important to say exactly where usability fails. To get a handle on these issues, I divide them into three classes:

Class One: Bug. Generally, a computer or software bug is anything that caused a wrong or unexpected response. I take a narrower view. To me, a bug represents a properly designed system that’s incorrectly implemented. That is, the program code fails to carry out the system designer’s intent. For example, you click Print and the system emails your Aunt Edna.

Class Two: Design Failure. In these, the code is OK, but the requirements failed. The classic refrain for these is, “ Yes, that‘s what I asked for, but it isn’t what I wanted.” Fixing these, unlike bugs, requires correcting the requirements and conforming the code.

Class Three: Missing Requirement. Sherlock Holmes in the Silver Blaze mystery had this to say about EHR usability:

“Is there any point to which you would wish to draw my attention?”
“To the curious incident of the dog in the night-time.”
“The dog did nothing in the night-time.”
“That was the curious incident,” remarked Sherlock Holmes.

Nothing is less usable than something that doesn’t exist. It’s not a matter of getting wrong. It’s a matter of not getting it at all.

What makes this a difficult category to apply is the issue of user need. What some users think is fundamental, others may regard as a frill or not necessary at all. Usability, therefore, hinges on neither design nor programming but on policy. However, if policy deems the function important, then its omission is far more serious than the other two categories.

An example. I use a large practice associated with a local medical school. It uses Jardogs’ Followmyhealth (FMH) web portal. It conveniently combines PHR, email and scheduling. I especially like being able to email my PCP. Recently, however, I ran into a class three problem.

FMH lists my PCP and any other of my providers. My PCP suggested I see a specialist for a problem. I went to FMH to find a list of specialists and phone numbers. I got nowhere. I could remove a provider, but not find a new one. I searched FMH’s knowledge base for provider and got 40 hits, but nothing on finding one. I then went through the FMH Patient Guide again without luck. Frustrated, I left the system and went to the practice’s public web site. It had the list. I found the department and number I wanted. Once I got set up, the new provider appeared in FMH.

Wondering if I had missed something, I called support with the problem. The support rep spent several minutes, came back, and confirmed that it could not be done, which surprised him. He agreed they should at least have a link in FMH to search for providers. Whether FMH adds it, of course, is a policy question.

EHR Usability: Is There a Right Path?

Posted on December 9, 2013 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The following is a guest post by Carl Bergman from EHR Selector.

Earlier this fall, the AMA sponsored a Rand Corporation study on physician’s professional satisfaction. Based on interviews with physicians in 30 practices, the study covers a variety of topics from workplace setting to quality of care, EHRs and health reform, etc. At the time, the report generated discussion about dissatisfaction in general with EHRs and MU in particular.

Usability, Part of MU?
Overlooked in the discussion was a new and important recommendation on usability. Here’s what is says:

Physicians look forward to future EHRs that will solve current problems of data entry, difficult user interfaces, and information overload. Specific steps to hasten these technological advances are beyond the scope of this report. However, as a general principle, our findings suggest including improved EHR usability as a precondition for federal EHR certification. (Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, p.142) Emphasis added.

It would be overkill to say that this represents adopted AMA policy, however, it’s not overkill to say that the recommendation is part of a project that the AMA initiated and supports. As such, it is most significant that it recognizes the need to bring some coherence to EHR usability and that the MU system is the logical place to put it.

Changing the Vendor – User Relationship
One commentator who did notice the recommendation was EHR Intelligence’s Robert Green. In his review, Green took a different tack. While agreeing that usability needs improvement, he saw a different way to get change:

Usability remains an enigma in many clinic-EHR vendor relationships because it hasn’t been nearly as important in the recent years’ dialogue as “meaningful use.” But among the competing priorities, usability among physicians and their EHR vendor is a real opportunity to develop shared expectations for a new user experience.

As a patient, I would rather not see the delegation of the “usability” dialogue of EHR to those in the roles of meaningful use certification. Instead, physicians who have spent many years of their lives learning how to “take care of patients” could seize the moment to define their own expectations with their EHR vendor of choice within and beyond their practice. (How connected is EHR user satisfaction to vendor choice?) Emphasis added.

I think these two different paths put the question squarely. They agree that usability needs increased action. Users have gotten their message across with alacrity: all systems fail users in some aspect. Some fail catastrophically. Though some vendors take usability to heart, the industry’s response has been uneven and sporadic.

Where these two approaches differ is tactics. Rand looks at usability, and sees an analog to MU functions. It opts for adding usability to MU’s tests. Green sees it as part of the dialogue between user and vendor.

As a project manager and analyst, my heart is with Green. Indeed, helping users find a system that’s a best fit is why we started the Selector.

Marketplace Practicalities
Nevertheless, relying on a physician – vendor dialogue is, at best, limited and at worst unworkable. It won’t work for several reasons:

  • Nature of the Market. There’s not just one EHR market place where vendors contend for user dollars, there are several. The basic divide is between ambulatory and in patient types. In each of these there are many subdivisions depending on practice size and specialty. Though a vendor may place the same product name on its offerings in these areas, their structure, features and target groups differ greatly. What this means is that practices find themselves in small sellers’ markets and that they have little leverage for requesting mods.
  • Resources. Neither vendors nor practices have the resources needed to tailor each installation’s interface and workflow. Asking a vendor, under the best of circumstances, to change their product to suit a particular practice’s interface approach not only would be expensive, but also would create a support nightmare.
  • Cloud Computing. For vendors, putting their product in the cloud has the major advantage of supporting only one, live application. Supporting a variety of versions is something vendors want to avoid. Similarly, users don’t want to hear that a feature is available, but not to them.
  • More Chaos. Having each practice define usability could lead to no agreement on any basics leaving users even worse off. It’s bad enough now. For example as Ross Koppel points out, EHRs record blood pressure in dozens of different ways. Letting a thousand EHRs blossom, as it were, would make matters worse.

ONC as Facilitator Not Developer
If the vendor – buyer relationship won’t work, here’s a way the MU process could work. ONC would use an existing usability protocol and report on compliance.

Reluctance to put ONC in charge of usability standards is understandable. It’s no secret that the MU standards aren’t a hands down hit. All three MU stages have spawned much criticism. The criticism, however, is not that there are standards so much as individual ONC’s standards are too arcane, vague or difficult to meet. ONC doesn’t need to develop what already exists. The National Institutes of Standards and Technology usability protocols were openly developed, drawing from many sources. They are respected and are not seen as captured by any one faction. (See NISTIR 7804. And see EMRandEHR.com, June 14, 2012.)

As I’ve written elsewhere, NIST’s protocols aren’t perfect, but they give vendors and users a solid standard for measuring EHR usability. Using them, ONC could require that each vendor run a series of tests and compare the results to the NIST protocols. The tool to do this, TURF, already exists.

Rather than rate each product’s on a pass – fail basis, ONC would publish each product’s test results. Buyers could rate product against their needs. Vendors whose products tested poorly would have a strong incentive to change.

EHRs make sense in theory. They also need to work in practice, but don’t. The AMA –Rand study is a call for ONC to step up and takes a usability leadership role. Practice needs to match promise.

Healthcare vs Sickcare, MU Undermines EHR Usability, and Kaiser Monkey Game

Posted on July 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This might seem a little self serving since I sent this tweet in reply to Georg Margelis’ comment. It’s a really good question though and one I’ve been starting to think about recently. I’ve often heard that the really sick people are the ones that cost healthcare so much money. My question is whether keeping them healthy just delays the costs or whether keeping them healthy actually costs less money long term.


This is such an important topic. I’ve been commenting more and more on this subject. I’ve wondered if a usable EHR can be created that satisfies MU. I imagine it depends on how you define usable.


This is a pretty cool Monkey game from Kaiser. Although, the real value in this article is better understanding some of the approaches that Kaiser is taking to healthcare. So many people salivate over working with Kaiser. It’s good to understand what they are and aren’t looking for if you’re looking for that relationship.

EMR Usability Point Difference, Us vs Them in EHR Adoption, and EMR Companies Don’t Care About Usability

Posted on July 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


I can’t believe there’s a 30 point difference in usability. Really? No, I’m not talking about the difference. I’m talking about trying to put a number on EMR usability. Think how ridiculous that idea really is. An EMR is made up of 100s of functions and you’re going to take an EMR vendor’s usability and try and quantify it to a number. That’s just insane.


This is an awesome point that really highlights a bunch of the key challenges that happen in EMR implementations. There’s definitely a lot of blame and finger pointing that can happen. You have to battle against this for it not to happen.


This is a great article that can be summed up with: because they don’t have to care. That’s right. EHR sales are doing just fine, so they don’t have to worry about usability. Healthcare really has reached a point of acceptance of crappy technology. This will change one day, but I don’t see it changing at least until after meaningful use.

User Experience is Hot HIT Topic with Good Reason

Posted on April 18, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

User experience in the world of healthcare IT has never been a hotter topic. It seems not a day goes by that I don’t come across an article, blog, tweet, or outright rant regarding the state of user friendliness, especially with regard to EMRs. (Who can forget the American Medical Association’s note earlier this year to Farzad Mostashari, peppered with complaints about physician usability of EMRs?) I see plenty of negative coverage around the topic – plenty of folks like to have a soapbox to stand on, after all.

I don’t, however, see enough coverage devoted to businesses and providers working to make the backlash better. Surely there are unsung heroes out there in the world of HIT UX that are at their drawing boards right now, attempting to take the sting out of those extra clicks, and listening with bated breath to providers’ complaints and praises.

I came across one such story in New Orleans a few months ago, where, like many of you, I tried to successfully drink from the fire hose (bottled water, actually) that was HIMSS13. I was able to sate my thirst for good UX news at the PointClear Innovation Awards breakfast, which honored a select group of the company’s clients for their work in the realm of user experience.

McKesson took home top honors this year, and while I had some knowledge of their work in the area, I didn’t realize how great of an emphasis they have placed on making sure their healthcare IT solutions are used in the most optimal way for the best possible patient outcomes.

“The big dynamic we are trying to tackle is around critical decision makers,” explains Bobby Middleton, Executive Director, Enterprise Intelligence Product Management at McKesson. “Through experience with our customers and continued research, it is becoming very obvious that our healthcare leaders are often put in a position to make critical decisions without pertinent, relevant and timely information.

“Our Enterprise Intelligence solutions are all geared around providing the right information to the right person at the right time,” he adds. “Our User Experience research is being used to make sure the targeted offering we are delivering via these solutions help a specific set of critical decision makers make the right decision. It is going great so far, and really allowing our technology teams to connect with their end consumers.”

I wonder if we’ll start to see more positive publicity of efforts like McKesson’s, especially as Stage 2 draws closer, more and more providers consider switching to more mature EMRs, and next year’s predicted influx of the newly insured start to clamor for greater digital engagement options and price transparency. One less click or toggle may just make all the difference when it comes to quality patient care.

One Doctor’s EMR Usability Wish List

Posted on March 18, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

In this space, we talk a lot in the abstract about how physicians feel about EMR usability. Today, though, I wanted to share with you some great observations from a KevinMD.com piece by an angry anesthesiologist who lays out her own usability wishlist for EMRs and health IT generally.

In the piece, Dr. Shirie Leng fumes over the sheer work it takes for her to negotiate the systems she uses at her hospital. She notes that over the course of doing eight cases during a day, she’ll a) sign something electronically 32 times, b) type her user name and password into three different systems a total of 24 times and c) generate about 50 pages of paper given that the the computer record must be printed out twice.

To Dr. Leng, there’s ten steps institutions can take to eliminate much of the hassle and waste:

1. Eliminate user names and passwords:   She suggests using biometric sign-in technology.

2. Eliminate the paper:  Why print data that’s already entered into the system, she asks?

3. Make data systems compatible and 4. Make everyone statewide use the same system:  Dr. Leng says it’s crazy that we don’t have interoperability within hospitals or between different institutions.

5. Don’t make her turn the page:  “All the important information about a patient should be on the first page you open when you look at a patient,” she says. “I shouldn’t have to click six different tabs.”

6. Don’t make her repeat herself: If she does several cases the same way, with the same documentation each case, don’t make her re-enter it every single time.

7. Invest in voice-recognition software:  During patient interviews, Dr. Leng notes, she wants to look at patients and talk, not hunt and peck at the keyboard or worse, spend hours later typing in data or clicking checkboxes.

8. Go completely wireless:  Not an EMR point, but a good one nonetheless: why make doctors untangle cords and monitoring wires?

9. Hire a typist if you need one:  Don’t turn nurses into data entry clerks, she argues. Right now they have massive amounts of data entry piled onto their plate.

10. Triple back-up the system:  Paper doesn’t crash but computers do, she notes.

So there you have it, a list of EMR and health IT concerns straight from a practicing physician. I think all her points deserve attention.

Do EMRs Force Doctors To Draw Conclusions?

Posted on February 4, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Today I was reading a column by the inimitable Mr. HISTalk in which he argued that EMRs really can do a major disservice to patients.  One way in which they do so, he suggests, is inherent in their design:

“EMRs try to turn freeform and sometimes tentative thoughts into dropdowns and template-driven generic verbiage that may destroy their original context (that’s what programmers do: impose order and create retrievable database information, so it’s not really their fault).”

I found this to be pretty interesting, because it highlighted a problem not discussed a lot in this space. To wit, it points out that dropdowns, templates and the like aren’t just frustrating — they’re actually forcing doctors to document care in pre-prescribed ways which may or may not suit the physician’s line of thought.  After all, in a template-and-dropdown environment, there’s little room for thinking out loud, suggesting theories or making unorthodox observations.

Ideally, the notes physicians enter or dictate should represent the best of their judgment, but also their intuition. Not only is intuition necessary to determine the best course of care for patients, it’s a critical tool for divining when something is out of order, be it a test result, the patient’s current diagnosis or something in the history that doesn’t fit.

And here you have the essential conflict between EMR-driven medicine and “old fashioned” methods.  As Mr. HISTalk points out, it’s the job of the EMR makers to normalize data such that it can be abstracted, shared and studied.  But it’s the job of the doctor to solve the problem that shows up in front of them, whether it can be described easily using a template or not.

Now, I’m not suggesting, as many have, that EMRs can’t be evolved into tools which are flexible enough to both support physicians’ process.  But I do think it’s important to focus in on issues like these, as they’re still very much in play.

When The EMR *Is* The Problem

Posted on January 25, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

The other day, I sat in an office while a nurse practitioner entered data into an EMR.  The visit was a follow-up, so there wasn’t a lot to record, but somehow, it took a good 45 minutes nonetheless.  While the nurse’s long stenciled fingernails couldn’t have helped her typing speed much, the real problem seemed to be the EMR, which kept locking up and seemed to be harboring someone else’s data. (It had my weight at 50 plus pounds more than I am, a data problem to be avoided if you’re hoping to track patients for health risks.)

Now, I do think some of the responsibility for the crazy quilt of mistakes and processing problems can be laid at the feet of the nurse, who didn’t seem particularly well oriented to the system and as noted, clearly couldn’t have passed a high school typing test. I also doubt she had to mispronounce my name three times as she moved from one screen to another.  Clearly, she wasn’t big on bedside (office-side?) manner.

The thing is, I think she wanted to be helpful, wanted to be personal and most importantly, wanted to be careful with the interview and med prescriptions. The problem was, she was so embedded in the process of using the EMR that the higher purpose of having it there in the first place was all but lost. Though she seemed bright enough, the nurse had trouble compensating for the demands of the system.

The bottom line, as I see it, is that even if the nurse will never win any IT prizes, the situation was not her fault.  It was that the EMR absorbed all of the nurse’s attention and concentration, leaving me feeling somewhat peripheral to the situation at best. Yes, she could probably make some improvements in how she interacts with patients, but if taking her eyes off the screen means she forgets critical details, that’s not going to happen.

This experience left me wondering: How often are good clinicians being turned into distant, vexed and struggling professionals who barely acknowledge that the patient is there twiddling their thumbs?  And how can the health system afford this kind of timewaste and error-prone user patterns?  I don’t know the answer to either question but I think we should find out.

Some Interesting EMR Usability Ideas

Posted on December 20, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Not long ago, I wrote a piece slamming the lack of EMR usability standards out there today, arguing that the industry was pretty much going to stay in a rut until we got some.  One of our readers, Prasad Patankar, posted a very thoughtful response which I felt deserved more exposure and discussion.

Here’s his ideas, in italics, with my comments interspersed:

* EMR systems should have a consistent hierarchy for navigation so
  that it is easy for users to locate information.

This is hard to argue. Unfortunately, given the vendor turf wars going on out there, I think we’re going to be stuck with proprietary systems and proprietary hierarchies for some time to come.  But what Prasad suggests here is just common sense, not that we can expect to see a lot of that on display.

* Error messages should be clear. They should explain why the error
  occurred and explain what the users should do next. Definitely not
  any programming language errors.

Again, I agree with Prasad here. This kind of consistency would do much to orient users. The problem is, these systems are still driven largely by developers, who best understand the nasty programming language error codes.  Expecting them to make their EMR products speak plain English is a bit of a stretch, sadly.

* For screens that contain too much information, there should be an
  option available for the users either to see the summary or a
  detailed drill-down capability. Some EMR vendors have started
  incorporating this functionality into their reporting modules.

Beautiful — a function vendors already understand. That’s enough to sell me on the notion that it can be more widely implemented, and soon. In this case, there’s no excuse for vendors to obfuscate;  just go ahead and make the data easier to read already!

* Consistency should be followed in displaying allergies and current
  medications in one single location. Users should not have to click
  multiple windows to get to this. This also applies to past
  encounters(progress notes) which have been migrated prior to
  implementation of the new EMR system.

This is a very good idea. When Your Editor recently read up on research into errors made using EMRs, medication slip-ups were by far the most common event. (And the only event that created serious harm was administration of a drug to which the patient was allergic.  Past notes might not be as urgent, but useful, definitely.

* It would also be interesting to see if EMR vendors could incorporate
  the cultural context and meaning of a color in that context before
  they use the entire color palette in their software.

This is an intruiging idea, though I can’t imagine the big enterprise vendors giving it much thought.  Perhaps if Apple designed their interface… But that’s a tale for another day.