Planet Jeffro

This is a classic issue with EMR implementation.  EMRs are generally designed by engineers and are geared up for aggressive billing.  They are generally not optimized for speed on the part of the physicians or staff who actually have to use the systems.

My father’s hospital has just brought on a major EHR and because it is so poorly designed (every simple request requires 150 clicks in a maze of menus and dropdowns and what not), the “highly paid data entry specialists” cannot process cases as quickly as before.

As Dr. Marshall of Georgetown points out, the EMR is meant to improve efficiency, not add friction and grind things to a halt.  But that’s what has happened in a lot of cases.

My father’s “EMR” since 1999 has simply been Microsoft word (enhanced with templates and ‘text expander’ shortcuts) for consults and Adobe Acrobat for incoming documents.  Amazingly, his rudimentary system wouldn’t qualify at all for the $44k yet enables him to literally fly through notes in a fraction of the time that the more robust EMRs would take.

My sense is that EMR design is about where web design was in the 90s.  EMRs seem woefully disconnected from the user experience and more importantly, the user’s context.  It’s like the designers either didn’t walk through the steps of how a physician would interact with their system, or simply didn’t value the end user’s time.

More likely, though, they designed it for billing optimization.

I think once EMRs become a fundamental part of the healthcare landscape then we’ll really start to see the feedback loop and improvements made the UI/UX.  At least that’s my hope.  If hospitals, for example, will be penalized for poor performance, then they will immediately jump on the fact that entering certain data into the chart by an ER doctor that normally takes an average of 8 minutes due to poor design, could be cut to 2 if the design were modified in these ways.

In building Patient Communicator, my father and I made 10,000 little decisions on how to optimize the system for speed so a physician, not staff, could actually handle all the incoming patient requests of the day while seeing a full day of patients.  Just like the original Palm mantra - everything must be accessible within 3 clicks - we made it so virtually all requests and actions could be executed in just 1 or 2 steps.  After all, when a physician only gets paid on office visits, time is quite literally money.

I hope the bigger companies look towards optimizing workflow and minimizing click fatigue in their systems.  It’ll go a long way in improving healthcare.