Managing EMR Software Enhancement Requests

One of the huge challenges that an EMR software vendor has is the long lists of enhancement requests that they receive from end users. Managing these requests has got to be one of the most challenging jobs of any EMR vendor’s development and support teams.

An EMR vendor has so many often conflicting motivations related to which enhancement requests they add to their product. I won’t go into all the details of their job here, but let’s just say they’re walking a very small tight rope. On one side, they want to be able to create enhancements that will sale more product. On another they want to keep their current users satisfied. On the other, they don’t want to make their product to specific to one area, region, specialty (unless it’s specialty specific), insurance plan, provider type, etc etc etc. Another side wants to be able to keep innovating the product in ways that weren’t suggested by the end users. Then of course each EMR vendor wants to keep some of their enhancement plans private as part of their “competitive advantage.”

Honestly, none of this is new to software or EMR. We’ve been dealing with this for a long time. However, I don’t know of any EMR company that really manages this process well. That said, I’d love to hear about other EMR vendors approaches to collecting, managing and implementing software enhancement requests.

Here are just a few of the components that I think a good EMR software enhancement request system should have:

  • Simple, but complete method for requesting ehancements
  • Translation of the enhancement request into actionable enhancement (this is also important for helping to filter out repeats and other such noise)
  • Feedback to the end user of what was done with their request
  • System for users of the EMR to see all the enhancement requests
  • Method for users to be able to support enhancement requests that are already made (this helps an EMR vendor prioritize the requests)
  • Method for users to provide comments on already created enhancement requests (ie. refine and improve the existing requests)
  • Internal enhancement plans are part of the system
  • Completed enhancement requests are noted for those interested in following the progress

As I was listing these things I think that my view of enhancement request is partially clouded by open source projects (maybe there’s an open source EMR that does the above well?). However, I think that a number of open source projects do a really good job of managing enhancement requests. The non open source software world can learn a lot from open source software in this area.

I think one of the key things I’d love to see an EMR vendor do well is involving the “crowds” of EMR users (coined “crowdsourcing”) in the prioritizing and planning of future enhancements. Users of an EMR have a wealth of knowledge related to the product and I’ve yet to see an EMR vendor tap that knowledge really well.

I think doing the above would solve a common phrase I’ve heard after doing an EMR software update: “Why did they add that feature?” followed by the question “Why don’t they add this?”

About the author

John Lynn

John Lynn

John Lynn is the Founder of, 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.


  • Practice Fusion has a simple online ticket submission system for all our users. Our tech team includes user requested enhancements in their releases about twice a month.

    We actually just today released a new H1N1 Risk Report based on the suggestion of one of our doctors earlier in the week. (can read more about it on our blog) It was pretty cool to see it go from a suggestion to a live feature for all our physicians in just a couple days – with the involvement of technology, our CMO, support team, etc.

  • John,

    You are getting into now another area, but a good place to go.

    I believe MGMA just warned that providers need to be looking at not just the ability to meet 2011 guidelines, but a bunch to come. Like waves crashing on the shore. Can a system be upgraded at all, and within a vendor’s business model without “killing” the vendor? What about a large installed base? Keeping everyone in sync especially with a number of closely spaced updates and upgrades is tough.

    IMO, you need to start looking “under the hood” so to speak. HIT vendors have to “open up the kimono”.
    This a whole other area for consultants outside of features and UI.

    As one respected HIT interface vendor says, integrating EMRs is difficult enough just based on the “idiosyncrasies” of their respective HL7 data implementations. What did he mean? I asked him — he meant “a mess”.

    (1) multi-axial requirements
    (2) refactorabilty
    (3) database design and schemas
    (4) platforms
    (5) development tools and methodologies
    (6) object oriented code, or not really
    (7) quality of the source code
    (8) programming languages and tools
    (9) availability of IT talent for a vendors chosen platform and tool set
    (10) is the HIT vendor about to get the proverbial rug pulled out from underneath them by their tools and platform vendor(s)
    (11) will investors and the VCs finally “give up the ghost” and pull funding
    (12) etc., etc.

    One thing for sure, about to be a lot of sleepless nights in the HIT and provider community.

  • Emily,

    ASP/cloud model has advantages and dis-advantages. One obvious advantage is quick, simple and small updates and changes that everyone gets — boom.

    I get them all the time with my on-line financial services and shopping carts that I use.

    More sign and complex changes, like the ones coming down the road from ARRA/HITECH could be more problematic.

    Like waking-up one morning and my shopping cart is now using the metric system.

    The distributed computing model might actually be better for some providers in the more complex PM/EMR space.

    If an ASP/cloud vendor goes down for any reason including the wave of changes set to come, their entire user base could be down.

  • Emily,
    So the ticket request system possibly handles a couple of the items listed. However, do you allow/ask for feedback on your end user to rate/rank or otherwise identify which features should be developed? I’m not just talking about features they requested, but also letting users rate/rank all of the possible features that have been suggested both internally and externally? This is something I’d love to see done well in an EMR company.

  • Emily,

    As I have said, I remain platform/model agnostic to the extent possible and practical. I think you will agree that PM/EMR + ARRA/HITECH = potential problems for all involved. Maybe not rocket science, but this “ain’t gonna be easy”.

    From what I know of your organization, I have a lot of respect, but it also appears to me that many ASP/cloud vendors have chosen a “fork in the road”. The message (the veneer) of their Web sites for example is pretty clear. Correct me if I’m wrong.

    My point was sort of like the DOS to Windows transition. Many end-users did not want to transition and did not for some time.

    End-users are often happy and consider themselves better off with version 1.x even though the vendor has moved-on to 2.x, 3.x …

    I will review your link.

  • We practice Kaizen ( which is DAILY improvements that are unique to each user. Each provider we meet has a different opinion about how an EHR should be organized and manage work flow, and they are very good at supporting their opinion. Also providers want it done today, or tomorrow at the latest. To achieve this we looked at Non-Medical businesses who routinely improve Microsoft Excel spread sheets daily to meet the challenge of the day. So we implemented EHR in Excel, and our clients enjoy the experience of daily changes unique to their needs that often they can accomplish themselves.

  • Tripp,
    Do you have some example excel notes that we could look at? I’d be interested to see what a note looks like in Excel. Might be interesting to see the data entry method as well. I assume you might have some videos demoing it?

  • Hey John, please contact and arrange for a needs assessment first. We do this because we have so many different examples we like to get to know you a bit before we show you an example to make sure it’s relevant to your needs. MS Excel is used for the forms (data entry) that collect and manage the data, the note is generated from the Excel data based upon a flexible MS WORD template using technology similar to standard “mail merge” but we wrote it ourselves to deal with some special needs. The note looks great as we have patterned it after the CMS auditors check list so WHEN you get audited the auditor is likely to say, “wow, this is perfect, I wish all notes looked like this…” a real quote from a real CMS auditor….

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