Future EMR Differentiation Will Be Usability and Not Features

This week I saw a product demo of EMR vendor, SOAPware. Now that SOAPware has their fully integrated practice management system, they have a great demo and all the features you could want in an EMR system.

In fact, as I was watching the demo and asking questions about different features they might have or not have I came to an interesting realization. SOAPware, and most EMR vendors that have been around for any reasonable amount of time, have all of the features covered. They all have ePrescribing. They all have CPOE, and Clinical Decision Support. They all have allergy and drug interaction checking, etc etc etc.

Basically, it seems like the EMR market has matured to the point that we’ve covered all the base features that a doctor could use for their clinic. The real challenge now is going to be how usable an EMR vendor can make their software.

That’s right, Usability is going to start to trump features as a provider differentiates the various EMR software.

The fundamental challenge of an EMR software has been the time a doctor spends charting in their EMR. I don’t think that we’ve really nailed down the user interface that’s going to change this yet. Certainly there’s been some really great progress since EMR software was first launched. The iPad and other touch screen devices present and interesting alternative input method. However, I think there’s still a lot of room for some EMR vendor to dramatically change the game on how a doctor interacts with their EMR software. I’m talking revolutionary change to the interface and approach. I look forward to that day.

Full Disclosure: SOAPware is an advertiser on EMR and HIPAA, but they didn’t pay me to write this article or talk about seeing their demo.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, 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, EXPO.health, 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.


  • John, You nailed It! Having worked in the medical field for the past 20 years and seen the advancements of PACS, RIS, HIS, HL7, etc. and now EMR, it’s all about usability and practicality. They sad thing is that most EMR vendors do not have enough R&D in the medical arena – meaning they don’t spend enough time in the medical field to realize what makes things efficient and what costs to much time and complications – they are more on standardizing and broad coverage that can be over the top. The key ‘and you can quote me on that’ will be automation. I can explain it further if anyone is interested…..

  • Shai,
    I’m definitely interested to hear what you mean by “the key will be automation.” If it’s good enough, I’ll turn the comment into a blog post.

  • With an EHR, nearly all of the FTE labor associated with physical “chart chasing” goes away. One of our DOQ-IT client clinics some years back did a stopwatch study which showed an average of 90 seconds just pulling and re-filing charts. Just in/out, not the overall chart travel through the clinic.

    Annualize that with a plausible G&A costed FTE labor rate. Expensive.

    So, that goes away (~98% of it anyway).

    However, to the extent the the EHR imposes additional net documentation time on the physician, it represents a problem, given that the physician is the only one generating revenue. Part of my REC adoption support workflow effort is going to focus as a priority on reducing net documentation time — particularly with respect to those tasks that can only be done by the physician.

    As I’ve noted on my blog, a mere 6 seconds average additional documentation time per meaningful use criterion will essentially nullify the incentive payments.

    One of the RECs posted a “usability analysis” ppt deck on the HITRC last week. In it were some “use cases,” one of which tabulated the stopwatched step-by-step navigation path times through Medsphere OpenVista during documentation of a CPOE lab order.

    35.06 seconds. Too many click-through steps. That is untenable.

  • I’ll be interested to hear the results of your effort to reduce net documentation time. It really is key since they’re the highest cost part of a practice and they don’t go searching for charts (usually).

  • John,

    Right on the money. My client has gone through more than one EMR vendor and each time, they threw their hands up in frustration when what they were delivered slowed their office to a halt.

    Why are we any different? We have an office inside their clinic and work with and talk to the actual users on a daily basis.

    The relevance and ease-of-use of the software we are writing is necessarily exceptional because we are constantly probing for comments, asking for feedback and delivering.

    I think it will be hard for an EMR company to compete with another company who has the customer next door (and listens).

  • So far, hospitals clearly feel that the experience of the end user is the least important consideration. The order of priorities is:

    1. Regulatory compliance
    2. Charge capture (ROI)
    3. Ease of integration (to save on IT personnel costs)
    4. Price of EMR or module
    5. End-user experience (which often isn’t considered until the doctors reject he product).

    Similarly, the order of influence in decision-making with regard to an EMR purchase tends to be:
    1. Board/CFO
    2. IT (usually divided and overwhelmed, and accustomed to thinking of doctors as a problem to be overcome)
    3. CEO/admin
    4. end-users

    Would be nice if you turn out to be right in the coming years.

  • One doctor recently asked me, when will the hospitals learn that they need to involve the doctors. They can tell the doctors to do something and they’ll just not do it. Doctors must be involved in the process.

  • Thank you for sending this very clear message, John!

    I am an Engineer, Human Factors, and Information Systems person consulting in healthcare systems, and it pains me to see so many systems out there (vendor, gov’t, etc.) spinning wheels to gain attraction due to weakness in usability and information design.

    I also teach at a School of Pharmacy and my main message to the students is to develop a baseline level of computer and technology literacy so they can communicate and articulate their needs to vendors, so that better products can be brought to market.

    Otherwise, you will always have providers on one side saying “It doesn’t meet my needs!” and IT on the other saying “But it’s already in the application!”

    For anyone interested to collaborate on healthcare usability and user research projects, please feel free to get in touch!

  • It helps to agree on a common, relevant operational definition of “usability,” no?

    I like this short statement:

    [EMR Usability] “centers on the importance of interacting with EMR systems and inputting accurate information in easy and usable way. The system must make accurate data entry as simple as possible at the point of patient service.”


    – quickest task completion times;
    – w/smallest error rates.

    Necessitating “user-centric” design.

  • Danny,
    Thanks for commenting and I hope you’ll join in on future discussions about EMR usability and design. Always good to have more perspectives.

    I like that description. Definitely worth considering. If more EMR vendors would adopt those 2 points as their criteria for development, we’d have much better EHR software.

  • John,
    Design in EMRs in NOTHING new. You and I have had conversations about this quite awhile ago. Unfortunately “Meaningful Use” tried to address this and missed the message. Also HIMSS continues to be so far off the mark with Design for EMRs. I totally agree that design and usability will be the differentiators for EMRs, but as long as we continue to believe clinicians are designers and not subject matter experts for true designers, we will continue to miss the mark and the opportunity to make a true difference

  • I’m pretty convinced John wasn’t writing this post with the belief that he was the first on earth to post this topic. Communication, repeating, enforcing ideas is just as important as practicing them, and as you point out, the practice is far from perfect to boot.

    Your post just prompted me to air a few more opinions here than I had originally planned… Some observations I’ve made from involving in health technologies is that everyone seems to believe THEIR product or idea is the ONE to solve the contemporary problems of the day, and that no other can be equal or better.

    Once several of these systems or ideas face off, then everyone goes into a philosophical “well, what does X really mean?” cycle almost as a way to split hairs without conceding any ground, or at the least to redefine the silo for which they can continue to call themselves experts. Or maybe it’s a simple battle of the egos.

    I’ll add to your argument that ANY idea, yours, mine, anyone’s are rarely new ideas. Think of a unique health informatics right now and Google it. Someone has likely already blogged or pondered it. It simply boils down to execution and practitioner buy-in, and we can let the market (and policies at times) vote with their dollars. It certainly doesn’t need to be the BEST idea, either. It just has to have enough balance to work and last.

    Many successful healthcare systems require coming together of very different minds to address health IT challenges which are highly multidisciplinary in nature. Healthcare is not a turnkey, cookie factory effort. We have people using computers to work with other people, to serve yet more people. Coordination will always be full of tradeoffs and workarounds, so computing technology is really just a small, very small, but still integral part of the larger picture.

    Finally, I can guarantee these views are nothing new, either.

  • Ann,
    Glad to see you commenting again. You make an interesting argument that I haven’t heard very much before. Most doctors like to say that “XYZ EMR vendor didn’t have enough doctors designing their EMR.” Which is kind of funny, because most of them worked hand in hand with a doctor or some sort to create their EMR.

    What you’re saying is that true designers should be designing it instead of doctors or programmers. Interesting.

  • If you think usability of EMRs is a problem for the docs, can you imagine what the situation is for patients trying to use the PHRs being fielded? Talk about being off the mark, entirely!! Someone needs to tell the PHR developers that what patients want and need to know is very different from what doctors want and need to know, and that presenting information to patients the way they’d present it to doctors is NOT GOING TO WORK. Developers are building the PHRs based on CCRs or CCDs – first mistake. Most patients don’t think that way or even in that language! The hallmark of human factors engineering is the systems approach in which the needs of ALL user groups are considered in design. Clearly, EMR developers haven’t really understood the needs of docs, either with respect to the data entry bottleneck, or with respect to mechanisms for effective physician access to and use of information in the record. As for patients, nobody seems to be hitting the mark on any of it. I simply can’t understand why even people high up in the HIT hierarchy, and the AMIA and HIMSS crowd, give only lip service only to human factors and usability, when it’s at the heart of so many failed systems. When will they get it?

  • Daryle,
    They have to only give lip service to those people. If they really held people accountable for usability, they’d lose their top sponsors at their conferences.

  • This is a great conversation. When I was completing my Master’s in Medical Informatics I realized that usability was of huge interest. So many of these interfaces are cluttered and difficult to use. Often making small changes through color/font can make a huge difference in the amount of time a clinician spends documenting. But an adept professional designer should be working on those screens. Physicians are subject matter experts. Graphic designers should be designing.

    Long ago, (pre-healthcare) I owned a graphic design firm. In the early days of computers, people thought their secretaries could produce high quality graphic design. Often, the company newsletter looked like a ransom note. Most people now know that because you have the technology does not mean you can create something useful or beautiful.

    John, Ann and Danny, you all nailed it. I hope I can be of service in the future to improve usability. Let’s hope EMR vendors will also.

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