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EMR Workflow, AI, and Recognizing Innovation – Charles Webster, MD Edition


Uhh…I think it’s more than safe to say that Dr. Webster has a rep when it comes to EMR workflow. Consider this edition of tweets my ode to his passion.


I love that the idea of Smart EHR is spreading. I think it’s a really important one. I’m really intrigued by any new interfaces that incorporate AI. Thinking about the possibilities of what AI can do to a user interface is both scary and exciting. Although, I’m mostly excited.


Makes me wonder how a committee would do with EMR workflow. Innovation does rarely come from committees. This is a really interesting topic since most hospitals are dominated by committees. Are we missing out on a lot of innovation in our hospitals because of this?

August 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

International EMR Adoption Graphic, Reverb Chamber, and Workflow


This graphic seems to position the US in the lead position when it comes to EHR and HIE. Although, I’m not sure which countries they chose to include in the chart. As I recall countries like Norway and Denmark were way ahead of us and somehow they didn’t make it on the graphic. Plus, it looks like they used the very best numbers they could find for the US as opposed to realistic ones.


This tweet from Mandi reminded me that sometimes we live in a reverb chamber that the larger part of the healthcare community doesn’t hear. I think we’d all be amazed how many people in healthcare IT know very little about the workings of the healthcare IT market. They’re so focused on their jobs they see little outside of their healthcare organization. In fact, many are naive to even what’s happening within their own healthcare organization.

It’s still amazing to me how we have so many ways to connect and learn and yet many don’t seem to care.


If you’ve read this blog for any amount of time you’ll know the name Charles Webster, MD. He’s talking workflow everywhere he goes. What I haven’t figured out is if workflow is really the issue we’re not dealing with or if Dr. Webster just has workflow solutions and so everything he sees is a workflow problem. The proverbial “everything is a nail when you have a hammer.”

June 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Physician Guidance for EHR Success

I want to take a look at the complaint I hear over and over and over again when it comes to EHR software. I’ve heard this comment said about every single EHR vendor out there. I’ve also heard it from doctors in every specialty and from every size organization. It comes in a few different forms, but all communicates the same idea. This is the doctor complaint I’m talking about:

Did the EHR vendor even talk to a practicing doctor when they developed this EHR?

Yes, the complaint is usually voiced as a question, but the question is lathered up with an unbelievable shock that an EHR vendor could misunderstand a doctor’s workflow needs so terribly. Plus, it’s reinforced with the belief that if the EHR vendor had somehow just talked to a doctor, any doctor, that this wouldn’t be the result.

Of course, the situation is much more complicated than that statement supposes. In fact, there’s a great thread on the HIMSS LinkedIn group that has a bunch of deep discussion on how to create a healthy partnership between providers and EHR companies.

One key to understanding this relationship is first that every single EHR company has consulted doctors (usually many many doctors) in the development of their EHR software.

Many doctors will then wonder how they could have an experience like the one I described above if the EHR vendor consulted a practicing doctor (and I assure you many many doctors have had the experience above). The answer to that question has multiple layers. The first layer that most practicing doctors see is that “most doctors that consult EHR companies aren’t really practicing doctors.” In many cases, this is definitely the case. Many Chief Medical Officers at EHR companies have made EHR their full time job and no longer practice medicine. Many physician founded EHR companies have a physician leading the company that no longer practices medicine. Certainly some portion of the EHR workflow disconnect could be related to non-practicing providers driving the EHR development process, but that’s just one layer.

The second layer is that in every case I’ve seen there’s always been practicing providers involved in the EHR development process as well. They are active in user groups. They sit in focus groups. EHR vendors go to the practicing physician’s office to learn from them first hand. Most EHR companies really do make a sincere effort to understand the practicing physicians and not just try and guess at what the practicing physicians want.

Another layer to this problem is translating what the practicing physician requests into the EHR workflow. Now imagine that two practicing physicians request the polar opposite feature (yes, this happens a lot too). How then do you translate that feature into something that’s going to satisfy both physicians. That’s not an easy thing to accomplish.

The next challenge to consider is that many physicians aren’t technically astute enough to know what they want. When this is the case, they don’t know what they should even be asking for. I’m sure many doctors will scoff at this idea, but it’s the same concept for programmers. Many programmers aren’t technically astute enough to understand the medical world well enough to develop what the doctor wants. It’s a two way street and is why it’s so important for EHR companies to create an amazing collaboration between the right doctors and the right programmers. That’s a special breed of person that is not easily found.

Of course, I haven’t even mentioned the specialty layer. A technically astute practicing physician in cardiology will likely do a terrible job designing an EHR workflow that works well for pediatrics, OB, and general medicine. If you thought it was hard creating an EHR workflow that works for all the doctors in one specialty, now try and do that across 40+ medical specialties.

If you remember back to the paper chart world (which many of you are still living in), how come we didn’t have a standard paper form that every doctor used to document the visit? In fact, it was pretty rare that any 2 non-affiliated clinics used the same form at all. Sure, some forms were exchanged at the medical societies, but in most cases each clinic wanted to modify the form to fit their own clinic’s needs and desires. This happens in the EMR world to some extent, but it takes more training and skill to modify an EHR workflow than the Word document you got from your colleague. Plus, many don’t want to invest the time to make those modifications.

I’m not trying to put the blame for this on anyone in particular. Plus, I don’t want to make this sound like an excuse for EHR vendors to be lazy in how they approach their EHR development. We can be sure that some of the issues I describe above aren’t because the doctors didn’t provide good requirements and not because the programmer didn’t know how to meet those requirements. Some of the problems we see have to do with a combination of rushed release times or lazy programming (which are related). When this is the case, EHR vendors should take it on the chin and deal with the issues rather than trying to blame someone else.

With that said, hopefully I’ve made clear that it’s not enough for an EHR vendor to just consult a practicing physician. If that was the case, then all 300+ EHR companies would have beautifully designed EHRs that physicians’ love. Instead, I think the fact that so many of the 300+ EHR vendors have this issue, it illustrates how hard it is to get a technically astute practicing physician that can get programmers to make a beautiful interface that applies across all specialties.

From now on, I hope to hear physicians who have this problem change their question to, “Did the EHR vendor even talk to a technically astute practicing doctor in my specialty that works the way I like to work and practices medicine the way I like to practice medicine and bills the way I bill and in the region I live when they developed this EHR?” Then, we’ll all be able to easily answer “No, it seems like not.

February 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

No EHR Training Needed

Anne Zieger over on EHR Outlook just posted an article talking about the need of training on an EHR. In the article, she quotes Dr. Bertman, CEO of EMR company Amazing Charts (Full Disclosure: They’re a sponsor of this site). Here’s one excerpt from the article:

According to Dr Jonathan Bertman, if you need extensive training to use an EHR, you shouldn’t buy it. “Doctors know how to be doctors,” he says. “They shouldn’t have to be trained to be software technicians – if they need training than it’s not a good thing.”

Here was my response in the comments of the article (and a little additional commentary for this post):
I have a feeling Dr. Bertman and I agree about training, but I think it’s over the top for him to say, “if they need training than it’s not a good thing.” Certainly many EHR software vendors require far too much training. I think that’s the point he’s trying to make and I agree 100%. However, the reality is that there are a whole lot of people that get training even on Office. In fact, there’s a whole entire industry around training on Office products. So, EHR is going to have training as well.

Another excerpt from the article:

“Compare them to Microsoft Office,” Dr. Bertman suggests. “It’s a powerful tool, but you usually don’t need special training to use it. An EHR is not more complicated than Office, and that’s how we should be looking at them.”

I’d generally disagree that an EHR is not more complicated than Office. The reality is that what you want to do in an EHR is more complicated than Office. Sure, if all I want to do is type a little bit and maybe click bold, then I’m fine. Most EHR you don’t need any training to login, browse their appointment grid, browse patients, and even create notes.

The reason for the EHR training that’s out there isn’t for these simple features. It’s for the more advanced features like is done in most Office trainings. I could be wrong, but I believe Dr. Bertman generally agrees with me on this, but it wasn’t expressed in a short quote from him.

One other interesting point is that I think a lot of people call it EHR training when in fact it’s about EHR workflow planning and training. You’re a brave person to implement an EHR without planning out your current workflows and how they’ll map to an EHR workflow. I often see this workflow planning and training covered under the broad definition of EHR training.

October 6, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Does an EMR Improve Patient Care?

Everyone probably realizes by now that I love to read first hand experiences with EMR and EHR. I guess I’ve always loved stories and I’ve always loved to tell stories, so maybe that’s where that comes from. I guess this is why I loved Katherine Rourke’s post called “Would An EMR Have Improved My Son’s ED Care?” on the Hospital EMR and EHR website. It’s a great read if you love first hand experiences with EMR as I do.

Katherine does raise a challenging question, “Does an EMR improve patient care?”

In past presentations, I’ve always put the idea of an EMR improving patient care under the “possible EHR benefits.” (See a full list of EMR and EHR Benefits) As many things in life there’s a big “Depends!” that is the b est answer to that question. The answer to this question depends on what kind of care you were offering previously, the type of care you offer, the EMR you chose, the features you chose to employ in that EMR, the match between your workflow and the EMR workflow, and I’m sure another dozen other depends as well.

What’s more important to point out is that an EMR can improve patient care. I certainly can’t guarantee that an EMR will improve patient care in your clinic, but I’ve seen many cases where it has improved patient care and so I know it’s possible. The biggest determining factor in whether an EMR will improve patient care in your clinic is your desire to have it do so.

Many times in life, you get what you want. Do you want an EMR to improve your patient care? Or were you too focused on wanting to get the EHR Incentive money? Not that these and other benefits are mutually exclusive, but the focus of your EHR implementation matters a lot. Make sure you’re focused on the right things and your EMR selection and implementation will go 100 times better. In fact, it will even improve patient care if you want it to.

September 16, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Listen to the Local Tribal Medicine of a Practice During an EMR Implementation

At the recent Health Tech Next Generation conference that I attended, I heard someone refer to the “local tribal medicine” practices that are found in a practice.

I found the description incredibly intriguing and descriptive. It’s an incredibly apt description of many of the practices and norms that exist in a medical practice. Each practice has created what becomes an almost tribal mentality when it comes to people’s passion for existing workflows and processes. [It's worth clarifying that it's tribal as far as people's passion for doing the workflow. Not because the practices and workflows themselves are tribal.]

I guess this is a natural thing that happens not only in medical practices, but throughout life. We grow accustom to certain processes and practices and so they start to feel really comfortable. Changing them can throw people for a loop even if you exhibit incredible care in the process.

I was recently asked by a reader whether I thought it was better for EHR vendors to look at changing the current operations to match the EHR workflow or whether it was better for EHR vendors to adapt to the current clinic workflow. Here was my response:

It’s an interesting dynamic. Part of it depends on the type of clinic that you’re dealing with. Sometimes a clinic has such terrible workflows that they need to be fixed before you apply an EMR. Otherwise, it will exacerbate the clinical workflow problems and cause some real pain.

However, I generally think it’s best to try and mimic the current process as much as possible when first implementing an EMR. Point being that you should cause as little disruption as possible. Although, it’s best when there’s some flexibility with this approach. Some things are possible in the electronic world that weren’t possible in the paper world and so there’s no reason to delay implementing those benefits when they’re pretty obvious.

Then, I suggest taking a look at the EHR system and how it’s working about a month (sometimes even a bit sooner) after implementation. At this point the clinic is proficient enough to talk about all the EMR features they were too overwhelmed to implement at the beginning.

Then, 9 months to a year out you can do another review to see what processes would be more efficient or could leverage technology better than you’re doing already. I’ve found that this review is when doctors really start to love their EHR and really start to see the value of using an EHR in their clinic.

In summary, I agree with modeling the current clinical workflow as much as possible to start, unless the practice is a mess. Then, I suggest evaluating those clinical workflows after the clinic has experience using it.

I’d love to hear your thoughts. How do you deal with the local tribal workflow of a practice? Do you want to change them during the EHR implementation or wait to make the changes?

August 16, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.