Requirements of an Efficient EMR

While browsing a thread on my favorite EMR forum, I found this intrigueing post by Matt Chase (someone who I deeply respect and the MD behind Medtuity EMR).  Matt created an interesting list of requirements for building an efficient EMR.  He created this list to dispel the notion that the government could create an EMR software and offer it to doctors for free.  I’m sure this isn’t a complete list and I disagree with some of the finer points, but if every EMR was able to do the things on this list, those using EMR would be much happier.  Take a look at the list of EMR requirements:

  • The record must be totally collaborative to allow anyone in the office to open and chart without regard to others having the chart open.
  • There must be security. An audit trail.
  • It must be very customizable for the practice. No EMR company in the world has all the medical expertise to have the latest and greatest templates for every specialty.  Customizing must be simple and intuitive but a template which is customized now, cannot in any way harm the documentation done previously with that template.  Just think of the new procedures, treatments, lab tests, medications and more than arrive daily.
  • It must be capable of collecting that information, slicing and dicing it with great discrimination,  and conveying that information to other health systems software.
  • It must be capable of running client-server or self-contained on a laptop.
  • It must be affordable.  This $25,000 or more per user is ridiculous. A government funded EMR should be affordable out of cash flow– that is, no upfront purchase of the software, but rather, turnstile pricing.
  • It must be intuitive.
  • It must be “graded” in its operational capacity.  A new user can use obvious features but as they mature in their EMR awareness, more features can be accessed.  There is nothing like “need” to inspire to user to learn another step.  That is, filling out a lab form is too slow and so if the user wishes to switch to a bidirectional lab interface, it should be available.  If they don’t care, then at least give them the option of the software filling out the lab request form.
  • It must be easy to assist users who experience difficulty. This is one of the most important items by far. The ease of assisting a user will make or break many EMR installations.  My preference is to have the ability of the user, with a single click, to show their desktop to technical support, whether that technical support is in their large facility or in another prearranged site.
  • It must be easy to update, including all the SQL schema changes,  executable versioning, new clinical content, and so much more without the use of IT staff.  If for every update, someone in the practice must go from computer to computer to update it, updates will never get dispersed. Already the bar is too high.
  • It must be relatively simple to install, not requiring a dedicated IT professional.
  • It must be capable of allowing the practice to be paperless.  To design it short of that would ignore a significant percentage of the market.  That means document management in the many forms of documents– tif, jpg, doc, txt, pdf, Outllook emails, html, and even CCR.  Additionally, it should be capable of outputing all those scripts, excuses, referrals, letters, and more.  It should handle telephone triage (as it’s called in pediatrics) without generating a sticky note for the chart.  It must have a forms feature.
  • It should have alerts, messaging, and reminders for those who wish to use them.
  • It must be fast.  You want no one complaining of speed.
  • Anything else you think should be added to the list?  Anything you see that shouldn’t be on the list?

    About the author

    John Lynn

    John Lynn

    John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

    John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


    • Our office is looking into using an EMR system hopefully some time next year. We were wondering how long, per HIPPA, we would be required to store the hard copy of anything we do?

    • Hi Kim,
      If you’ve scanned the record, then you don’t usually have to retain the hard copy at all.

      The only caveat is that each state has different rules about this so it’s hard to give a hard and fast answer.

      If you decide not to scan the paper charts, then once again it depends on the state how long you have to retain the records. Usually it’s in the 6 year range (if I remember right), but you better check the local state laws to know for sure.

    • This is an excellent list, however, as of this moment there is nothing out there in regards to EMR that will hold true for this entire list.

      Right now a lot of IT people are going into programming because there is supposed to be a promising pay out from the government for these programs, or so people believe. With that said, people are not looking to make things affordable, but rather they are wanting them to be more expensive for more features.

      I think it will be a long time before any good company comes out with any sort of a reasonable price. It’s more likely someone will be upset with it, and will create their own open source version much like open EMR, but that has next to nothing on this list.

      Better tighten the belt and think thin! The more features we want, the more it will cost from the very get go. Up front license cost then a mandatory support you will probably NEVER use but have to pay it anyway. Better keep your case loads up.

    • Scott,
      I have to disagree with you. I think there’s a number of EMR out there that match this list. It’s just hard to know which ones since there are SOOOO many EMR out there.

    • The Veterans Administration has already developed this system at the National level. I don’t know why they don’t allow Physicians to “buy into” the software so they can use it too! They don’t have to link to the VA system. Not only that, when we reach the point where all doctors and hospitals are required to have the ability to communicate with one another directly…this is the system that could work for everyone! The VA medical system is connected across the country (maybe even throughout the world, don’t know)–all medical personnel and facilities have access but there are restrictions–so all places don’t have access to all patients, the access is restricted to direct patient care only.

    • KT,
      Actually, you can already implement the VA system anywhere you want since the software is open source. In fact, there are private companies using the open source VA software that are trying to do just that. Biggest problem is that the software might work great for hospitals and possibly even large group practices. However, the barrier to entry for a small practice is pretty near impossible to overcome.

      Then of course, you have the other people who say that Vista (that’s the name of the software) is built on the mumps platform and that it’s not a good long term alternative. Of course, the mumps fans will argue the opposite. In fact, if you want to start an exciting conversation on a blog, just write about one side or the other and you’ll get all sorts of comments both ways.

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