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Positive Patient Experience with an EHR is Possible

Posted on August 30, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had a rare healthcare experience – something that I had only read about in blogs and on Twitter – a physician showed me what he was entering into him EHR while I sat beside him in the exam room! I’m not ashamed to admit that my first thought was “I can’t believe this is really happening”.

The doctor must have noticed how I quickly moved my seat closer to the large monitors because he chuckled and asked me: “How long have you been in healthcare?”. After sharing a laugh he went on to say “It’s rare that patients take a keen interest in what I’m keying into the system. It’s usually other healthcare people that want to see what’s going on. Are you a nurse or a physician?”

When I told him I was in Healthcare IT field he smiled and said “Ah that would have been my third guess.”

For the next 20 min he would type a line of notes, point to the screen and then share his reasoning with me. I asked him questions on clinical terms that I did not understand, at which point he would bring up a resource that had a definition. If he didn’t have a ready resource, he explained it as best he could and then encouraged me to look it up on a trusted site like Mayo Clinic’s.

Near the end of the appointment, the doctor asked me if I was involved with EHRs. When I asked him why, he said the most intriguing thing – “because it’s clear to me that the people who design EHRs (a) have never actually seen a patient in an exam room – it’s ridiculous how awful the screens are and (b) never thought that one day doctors would sit beside patients to let them see what they are entering.”

The latter statement has been churning through my mind ever since.

There is little doubt that the majority of EHRs are less-than-well-designed. Physicians everywhere complain about the amount of clicking required to navigate their EHRs and the number of fields they have to enter. The prevailing opinion is to improve EHRs by getting closer to physicians and actually studying how they really conduct a patient visit. This will certainly yield positive results.

But what if we designed an EHR that was meant to be displayed on a big screen? One that had screens that the patients would see as the doctor entered his or her notes? I believe that designing for this type of usage would result in a more significant improvement in usability and have a more positive impact on patient experience than building EHRs based on better observation of physician workflow.

Consider the phenomenon of open kitchens in the restaurant industry. For diners, being able to watch the kitchen staff prepare meals helps to pass the time while waiting for your order. It also allows the diner to see how talented the chefs are – because they can see them working. For staff, an open kitchen often means that the restaurant has put a lot of thought into optimizing food prep workflow. After all, no one would choose a layout that had staff constantly bumping into each other in full view of diners.

If a company designed an EHR that could be shared with patients, they would not only improve the interface for physicians, but they would also provide a means for that physician to improve the overall patient experience.

I hope that more physicians adopt the practice of sharing their EHR screens with patients during a visit. Doing so will immediately improve patient experience and will push vendors to improve their solutions at a far greater pace.

Usability Principles for Health IT Tools

Posted on October 22, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A recent article of mine celebrated a clever educational service offered on the Web by the US Department of Health and Human Services. I ended with a list of three lessons for the health care field regarding usability of health IT Tools, which deserve further explanation.

Respecting contemporary Web practices

Communications can be improved by using the advanced features provided by the Web and mobile devices. In the HHS case, developers went to great lengths to provide a comfortable, pleasant experience to anyone who viewed their content, even if the viewers were visiting a different web site and the HHS content was merely embedded there.

This commitment to modern expectations is rare in the health care field. Web sites and electronic records are famously stuck in the 1990s. Doctors have been warned that they can’t use unencrypted email or text messages to communicate sensitive information to patients, so they use patient portals that are self-contained and hard to access. The tools on my family practice’s portal, provided by eClinicalWorks, don’t even come up to the standards of email systems developed in the 1980s. They lack such fundamental features as viewing messages by sender or viewing threads of multiple messages.

Worse happens if a clinician needs to perform complex tasks in an EHR or to work in multiple windows at once. There are whole areas of health IT (such as the notions of health information exchanges and patient portals) that reflect its primitiveness. Access to data should be fundamental to health IT products.

Why? EHR vendors are focused on HL7 standards, clinical decision support, and other nuts and bolts of data-crunching. They don’t possess the most advanced design and Web coding teams. Given their small market size–compared to social networks or e-commerce sites–one shouldn’t be surprised that health sites and EHRs don’t invest in cutting-edge Web technology. It’s no surprise, for instance, that when athenahealth (the most forward-looking proprietary EHR vendor, in my personal view) decided to reach out to the mobile world, they purchased an existing mobile app development company.

Another barrier may be the old software and hardware used at many health care sites, as described in item 6 of an Open mHealth round-up.

The problem is that health care applications and web sites need to make things easy for the user–at least as easy as retailers do. Both clinicians and patients tend to visit such sites when the are feeling pressured, tense, and depressed about what they’re dealing with. Mistakes have serious negative consequences. So interfaces should be as usable as possible. It also helps if their interactive elements behave like others that the users have encountered in other apps and web sites; hence the value of keeping up with current user interface practices.

Consider the people at the other end

I’ve already explained how the mood and mindset of the app user or web visitor has a critical effect on user interface design. Designers never know in advance–even when they think they do–what the users are asking for. And users vary widely as well. Therefore, sites must be prepared to evolve continuously with input and feedback from users. This requirement leads directly to the next suggestion.

Open source meets more needs

Most health care developers (and app buyers) assume that software must be kept closed to establish viable businesses. In other industries, large institutions are thriving on Linux, open source Java technologies, free databases such as MySQL and various NoSQL options, and endless free libraries for software development. Yet proprietary software still rules in electronic health records, medical devices, consumer products, and mobile apps.

Releasing source code in the open seems counter-intuitive, but it can lead to greater business success by promoting a richer ecosystem of tools. The vendors of health apps and software still haven’t realized–or at least, haven’t really pursued to its logical conclusion–the truth that health prospers only when many different parts of the health care system work together. Under the shepherdship of the Department of Health and Human Services, doctors are groping their way toward working with other doctors, with nursing homes and rehab facilities, with behavioral health clinics, and with patients themselves. Technology has to keep up, and that means eliminating barriers to interoperability.

APIs are a fine way to allow data sharing, but they don’t open up the tools behind the APIs. Creating a computing environment for health that ties together different systems requires free and open source software. It enables deep hooks between different parts of the system. Open source EHRs, open source device software, and open source research tools can be integrated to make larger systems that offer opportunities to all players.

Platforms for innovation

Instead of picking off bits of the existing health care infrastructure to serve, developers and vendors should be making platforms with vast new horizons and new opportunities for business. Platforms that encourage outsiders to build new functions are the concept that ties together the three observations in this article. These platforms can be presented to users in different ways by leading Web developers, can incorporate enhancements suggested by users, and can rely on open source to make adaptation easy.

Two platforms I have discussed in previous articles include SMART and Shimmer. SMART is an API that provides a standard to app developers working with patient data. Shimmer is a new tool for processing data from fitness devices. Each is starting to make a mark in the health care field, and illustrate what the field can achieve when parties work together and share results.

A Great EMR Survey from AAFP

Posted on August 11, 2009 I Written By

Some of the best and most objective information about EMRs comes from the Center for Health IT at the American Academy of Family Practice. Real doctors who have purchased EMRs rate their EMR in 5 different categories: Quality, Value, Usability, Productivity and Support.

This report is ONLY available to members of the AAFP. I think if the AAFP really wanted to do all of us a big favor, they would release this report to anyone who is interested in seeing it. I don’t understand why they are keeping it secret.

It is going to be very difficult for doctors to find a good EMR because there are so many EMRs and so many “bad” EMRs (hard to use, reduce productivity, expensive). Starting with this survey can help doctors start their EMR search on the right foot.

Contact the AAFP and ask them if you can get a copy of their report.

Center for Health IT

Hopefully they will have our great Healthcare System’s best interest at heart. By making this report available to all doctors, they can help us all get “good” EMRs that are usable and high in quality.

If you are a doctor looking for an EMR, start your search with a few EMRs that get good ratings in this survey.