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The EMR Twitter Roundup

Posted on October 26, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Lots of really interesting discussions happening on Twitter about the EMR. Some are around really exciting developments. Others provide great insights. Others are complaining about how far we still have to go. Enjoy these EMR insights and perspectives as we head into the weekend.


I saw KLAS present this information at the MEDITECH MD and CIO Forum last week. The data is pretty compelling when it comes to EMR Training and Education and it’s tie to satisfaction.


The answer to this question is that this caluclation is really hard and the rules around it are really complicated and distributed across a large number of organizations. If we could solve this problem, it would be a great thing for patients. However, in our current system, it is a really hard problem to solve.


It’s great to see well done policies facilitated by technology. This is a great example of where that’s possible. However, this next tweet explains why we have to be careful about it too.


I hope he’s wrong about it being immortalized. Hopefully it’s just a step forward and that we’ll continue to see workflows adapted and changed. My guess is that he thinks they need to be scrapped completely and start over. Well, when has that ever happened in healthcare? Not very often. So, we have to stick to incremental improvement.

Hospitals Taking Next-Gen EHR Development Seriously

Posted on October 22, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Physicians have never been terribly happy with EHRs, most of which have done little to meet the lofty clinical goals set forth by healthcare leaders. Despite the fact that EHRs have been a fact of life in medicine for nearly a decade, health IT leaders don’t seem to have figured out how to build a significantly better one — or even what “better” means.

While there has been the occasional project leveraging big data from EHRs to improve care processes, little has been done that makes it simple for physicians to benefit from these insights on a day-to-day basis. Not only that, while EHRs may have become more usable over time, they still don’t present patient data in an intuitive manner.

However, hospital leaders have may be developing a more-focused idea of how a next-gen EHR should work, at least if recent efforts by Stanford Medicine and Penn Medicine are any indication.

For example, Stanford has developed a next-gen EHR model which it argues could be rolled out within the next 10 years. The idea behind the model would be that clinicians and other healthcare professions would simply take care of patients, with information flowing automatically to all relevant parties, including payers, hospitals, physicians and patients. Its vision seems far less superficial than much of the EHR innovation happy talk we’ve seen in the past.

For example, in this model, an automated physician’s assistant would “listen” to interactions between doctors and patients and analyze what was said. The assistant would then record all relevant information in the physical exam section of the chart, sorting it based on what was said in the room and what verbal cues clinicians provided.

Another initiative comes from Penn Medicine, where leaders are working to transform EHRs into more streamlined, interactive tools which make clinical work easier and drive best outcomes. Again, while many hospitals and health centers have talked a good game on this front, Penn seems to be particularly serious about making EHRs valuable. “We are approaching this endeavor as if it were building a new clinical facility, laboratory or training program,” said University of Pennsylvania Health System CEO Ralph Muller in a prepared statement.

Penn hasn’t gone into many specifics as to what its next-gen EHR would look like, but in its recent statement, it provided a few hints. These included the suggestion that they should allow doctors to “subscribe” to patients’ clinical information to get real-time updates when action is required, something along the lines of what social media networks already do with feeds and notifications.

Of course, there’s a huge gap between visions and practical EHR limitations. And there’s obviously a lot of ways in which the same general goals can be met. For example, another way to talk about the same issues comes from HIT superstar Dr. John Halamka, chief information officer of the Beth Israel Deaconess Medical Center and CIO and dean for technology at Harvard Medical School.

In a blog post looking at the shift to EHR 2.0, Halamka argues for the development of a new Care Management Medical Record which enrolls patients in protocols based on conditions then ensures that they get recommended services. He also argues that EHRs should be seen as flexible platforms upon which entrepreneurs can create add-on functionality, something like apps that rest on top of mobile operating systems.

My gut feeling is that all told, we are seeing from real progress here, and that particularly given the emergence of more mature AI tools, a more-flexible EHR demanding far less physician involvement will come together. However, it’s worth noting that the Stanford researchers are looking at a 10-year timeline.  To me, it seems unlikely that things will move along any faster than that.

EMR Usability A Pressing Issue

Posted on January 29, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A few months ago, in a move that hasn’t gotten a lot of attention, the AMA and MedStar Health made an interesting play. The physicians’ group and the health system released a joint framework designed to rank EMR usability, as well as using the framework to rank the usability of a number of widely-implemented systems.

What makes these scores interesting is not that they’re just another set of rankings — those are pretty much everywhere — but that the researchers focused on EMR usability. As any clinician will tell you (and many have told me) despite years of evolution, EMRs are still a pain in the butt to use. And clearly, market forces are doing little to change this. Looking at where widely-used systems rate on usability is a refreshing look at a neglected issue.

To score the EMRs, researchers dug into EMR vendor testing reports from ONC. This makes sense. After all, though the agency doesn’t use this data for certification, the ONC does require EMR vendors to report on user-centered design processes they used for eight capabilities.

And while the ONC doesn’t base EMR certifications on usability, my gut feeling is that the data source is pretty reliable. I would tend to believe that given they’re talking to a certifying authority, vendors are less like to fudge these reports than any they’d prepare for potential customers.

According to the partners, Allscripts and McKesson were the highest-scoring EMR vendors, gaining 15 out of 15 points. eClinicalWorks was the lowest-scoring EMR, getting only 5 of 15 possible points. In-betweeners included Cerner and MEDITECH, which got 13 points each, and Epic, which got 9 points.

And here’s the criteria for the rankings:

  • User Centered Design Process:  EMRs were rated on whether they had a user-centered design process, how many participants took part (15+ was best) and whether test participants had a clinical background.
  • Summative Testing Methodology: These ratings focused on how detailed the use cases relied upon by the testing were and whether usability measures focused on appropriate factors (effectiveness, efficiency and satisfaction).
  • Summative Testing Results:  These measures focused on whether success rates for first-time users were 80% or more, and on how substantive descriptions of areas for improvement were.

Given the spotty results across the population of EMRs tested, it seems clear that usability hasn’t been a core concern of most vendors. (Yes, I know, some of you are saying, “Boy howdy, we knew that already!”)

Perhaps more importantly, though, it can be inferred that usability hasn’t been a priority for the health systems and practices investing in these products. After all, some of the so-so ratings, such as that for the Epic product, come from companies that have been in the market forever and have had the time to iterate a mature, usable product. If health systems were demanding that EMRs be easy to use, the scores would probably be higher.

Frankly, I can’t for the life of me understand why an organization would invest hundreds of millions of dollars (or even a billion) dollars in an EMR without being sure that clinicians can actually use it. After all, a good EMR experience can be very attractive to potential recruits as well as current clinicians. In fact, a study from early last year found that 79% of RNs see the hospital’s EMR as a one of the top 3 considerations in choosing where to work.

Maybe it’s an artifact of a prior era. In the past, perhaps the health systems investing in less-usable EMRs were just making the best of a shoddy situation. But I don’t think that excuse plays anymore. I believe more providers need to adopt frameworks like this one, and apply them rigorously.

Look, I know that EMR investment is a complex dance. And obviously, notions of usability will continue to evolve as EMRs involve — so perhaps it can’t be the top priority for every buyer. But it’s more than time for health organizations to take usability seriously.

Building Usable EMRs: What About The Patient?

Posted on November 12, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I think most of us reading HealthcareScene.com blogs like this one would agree that for EMRs to become more usable, the process of developing them will have to change.  Specifically, everyone seems to agree that if vendors and physicians don’t work together on usability, we’ll end up with with system after system that nobody wants.

But what about patients? Do they have a role in making sure EMRs are usable?  According to Jon Mertz, the answer is a definite yes.  As Mertz sees it, it’s not good enough for vendors and physicians to talk shop to one another — patients will have to be part of the conversation.  I think he makes a lot of sense.

Talking with EMR vendors is a good way for physicians to get more of what they want, but it’s not enough, Mertz argues, I think quite persuasively. It’s also important for physicians to ask patients want to see in an EMR, especially so given that patients will eventually have access to all of that information. “Patients add an essential perspective to how an [EMR] should be used,” Mertz writes. “It is a system to serve them and their care.”

Vendors should also be talking to patients as well as physicians, Mertz suggests. “Even though physicians, clinicians, and administrative personnel are the primary users of an EHR, their solutions benefit patients, too. Information in an EHR will be viewed and carried forward by patients, so they can provide a valuable perspective on usability.”

The final step in this cycle is to develop a patient base which actively uses EMR data and is quite willing to offer feedback on how the process is working. Specifically, they need to be capable of letting hospitals, physicians and other providers know how their access to data is working, especially if the form they’re getting in doesn’t serve their needs.

I really appreciated Mertz’s take on getting patients involved in the EMR usability process. It’s a point that doesn’t get made often enough — and will definitely need to be talked up more in the future. After all, without patients feeling comfortable with their data, the ultimate goals of Meaningful Use aren’t attainable.

37 Seconds To Chart Encounter on Peds EMR

Posted on September 11, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If you’re like me, you’ll probably be a bit surprised (pleasantly) by the following video, which can be found embedded in an equally interesting blog post on EMR feature-creep or “featuritis” by Dr. Charles Webster.  (I would have shared the video here but it’s only available on Dr. Webster’s site.)

In it, the ever-insightful Dr. Webster details how a peds practice has gotten to the point where a routine encounter takes 37 seconds to chart using the practice’s pediatrics-specialized EMR, as follows:

1:08 I open the chart
1:13 Chart my physical exam, my pharyngitis exam
1:19 Chose my diagnosis of strep pharyngitis
1:25 Make my treatment duracef and follow up in 3 days
1:31 Write my prescription
1:33 Edit my follow up if necessary
1:37 Have created a beautiful chart
1:42 Check my billing
1:44 And I’m finished

That may sound extreme, but it’s not, he says. “I’ve looked at timed studies of our current physicians’ charting at  pediatrics or family practice, and the average chart for a sick visit is 28 seconds,” he notes.

As if that wasn’t sensational enough for an audience expecting EMRs to make everything tougher, he had more to share.
“In reality, with a finger or a stylus you can do this in about a third the time,” Dr. Webster told them.  In this case, that would mean 17 clicks in 12 seconds, but people can generally tap their finger at that pace with little trouble, he says. Not such a big deal.

That being said, it seems likely that going forward, doctors will need to better develop the cognitive motor skills of musicians — the ability to step up eye-hand coordination to be sure —  if they want the best results out of their systems.  Dr. Webster says he’s planning a future post which critiques EMR data and order entry from the point of view of psychological models of musical cognition, learning, and motor skill. I think I’ll want to catch that one!