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Can We Talk? Challenges of SaaS Type EMR User Interfaces

Posted on August 20, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at

Forget about EMR interoperability between doctors’ offices and hospitals for a moment.

One of the recent developments in the ever-expanding SaaS (software as a service) world of electronic medical records must be the challenge of making all the individual software components talk together correctly.

There is (1) the EMR itself, (2) the programming platform/language, and the (3) internet browser.  Forgive the novice in me if I don’t get all my nomenclature correct.  I’m just a doctor.  If one component gets upgraded (and they always do), then the house of cards can come tumbling down in one fell swoop, at least temporarily.  We’ve experienced this recently at our office with our own EMR system and so I have a few thoughts on the matter.

In our office, first it was Firefox stopped working with the EMR.  Then we all switched over to Internet Explorer, which seemed to work for a time, but then that stopped working well and frequently froze up.  Chrome is working for now, but it seems to be only a ticking timebomb before this no longer works.

To make matters more complicated, different browsers have different ways of displaying information bars at the top, sides and bottom of the EMR window, and so some bars can get in the way of viewing different parts of the screen depending on which browser is used.  There are ways around this (conveniently called “workarounds”), but yet again, not so simple or straightforward and thus suboptimal.  I have to admit that it sort of feels like jiggling the handle on an old toilet to get it to stop running.  In other words, yes, you can do it, but, no, it doesn’t feel like it should work that way ideally.

We’ve been given the explanation that Adobe Flash is having problems interacting with the EMR system, or vice versa, since both the EMR and Flash have gone through successive, iterative upgrades to improve and add functionality to both services.  I can totally buy this explanation.  However, at what point will it just get too difficult to keep everything going?  Is it impossible?  Probably not.  But it’s a heck of a pain watching the EMR go through roadblocks as we forge into the future together, as vendor and provider.

This will undoubtedly affect any EMR system that is dependent upon other, third-party software.  It is a common situation that will change over time, and I’m almost certain that this is going to be a challenge, all around, for any EMR system on the market today.  As such is the case, I look forward to the day when it can be solved permanently by adopting a new standard for all platforms.

Electronic Medical Records Lost Using External Hard Drive

Posted on August 16, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at

I hate to call anyone stupid, but reading stories like Hospital Reports a Possible Data Loss really steams my Chinese dumplings.  According to the post, a doctor who works at two facilities, including the famous Harvard’s Brigham and Women’s hospital (of NOVA fame) walked out carrying a hard drive with over 600 patients’ personal, private medical records and then “lost” it on a trip to Mexico.  How could anyone commit or sanction such a risky action as walking out of a medical facility while hand-carrying an unprotected copy of so many people’s medical records in electronic form?!  And you gotta love that the records ended up in freakin’ Mexico of all places.  Whoever the legendary doctor was — who remains nameless — couldn’t have done a better job, short of sending the records to Al-Qaeda.  Can you imagine?!  Ugh…

You know what the answer to this is?  It’s quite simple — don’t store records on removable hardware. With the Cloud in place, I dream of the day when it’s mandated by law that health records cannot be stored on portable hardware.  We have so many brilliant companies using the latest SaaS technology that I really scratch my head wondering why this isn’t the default choice for all EMR and EHR systems.  There is little reason that the above disaster should still be allowed to happen in 2011.

Rather interestingly, and yet again, this is another example of data theft of patient records that was NOT electronic theft.  No usernames and passwords were hacked to get at the information.  It’s was just a plain, simple (at least as far as anyone knows) dumb-luck loss.  Another shining and yet pitiful  example of why I believe that records are far safer on the web and in the Cloud than in someone’s portable hard drive or laptop.  Do we really need to start anti-theft pad-locking and chaining hardware in place at medical facilities?

On another note, I’d love to have been the fly on the wall when the doctor was asked what happened that encouraged him or her to walk out with it.  Just how common is it?

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at

iPad Mania in Healthcare May Be Exaggerated

Posted on April 13, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In all my years writing about healthcare and technology, I’ve never seen such a storm of enthusiasm over a new medical device.  If the newspaper and blog coverage is any indication, we have no less than a moral duty to give an iPad to every practicing physician, stocked with a variety of the coolest medical apps.

In fact, Apple itself has jumped on the bandwagon, with its most recent iPad2 commercials displaying medical apps.

This, of course, has serious implications for EMR developers.  If the iPad is eclipsing even the desktop and smartphone as a primary means of accessing medical information, their focus will have to shift from a traditional client-server model — and perhaps even existing SaaS options — to one which is more modularized.  Their assumptions  about users’ interaction with their interface will need to be different as well.

The thing is, despite all of this discussion, I’ve seen no stats to back up the notion that even tech-friendly doctors see iPads as indispensable.

Where the iPhone (or at least smartphones generally) are concerned, sure, there seems to be plenty of research documenting that most physicians rely on them. But while there’s lots of anecdotes circulating about the iPad’s central future in medicine, none of the research firms covering the healthcare industry seem to have documented this trend.

What’s more, as a consumer whose family sees a lot of specialists — a few of us have chronic illnesses — I’ve never seen an iPad in anyone’s hands.  Walk into a coffee shop in the prosperous D.C. metro suburbs where I live, and sure, at least one consumer will have one.  But in DC medical offices, not so much.

Now, don’t get me wrong, if I were a product manager with an EMR vendor, I’d create an iPad interface and trumpet its existence to the world — it makes marketing sense if nothing else. One vendor which has already taken this tack is DrChrono, which prominently advertises the iPad version of its free EMR.

Regardless, I’m still waiting to see more evidence that the buzz around the medical iPad is more than just the expertly-crafted legends Apple creates around its products.  (Should we sense some Pixar magic here?) Anyway, just because everyone says something’s cool doesn’t mean it is.  I mean, we learned that in high school, didn’t we?