Is Your EMR a Spoon or a Backhoe? – Importance of How an EMR Vendor Implements Meaningful Use

It has become more and more apparent that the way an EMR vendor implements the meaningful use requirements is going to be critically important to a doctor’s successful adoption of the meaningful use criteria which is of course essential to get the $44,000 in EMR stimulus money.

I think it’s easy for doctors and practice managers that aren’t as familiar with the various EMR software and with the details of the EMR stimulus to get confused. On face, it seems that the effort to get the EMR stimulus money shouldn’t be affected by which EMR software you choose as long as it is an ONC-ATCB certified EMR. However, this is just categorically WRONG!

The EHR certification is meant to tell you that it CAN meet the meaningful use guidelines. It doesn’t tell you how easily it is to meet the meaningful use guidelines. It doesn’t tell you how well they integrated the meaningful use guidelines into your regular workflow. It doesn’t tell you how well it lets you delegate the meaningful use tasks to other staff members so you can optimize the doctors time. So, yes, EHR certification should mean it’s possible to show meaningful use. EHR certification does not make any claims to how effective that EHR software will actually accomplish the task.

Here’s a simple analogy:
If I wanted to dig a hole for a footing on a house, I could probably use a spoon to dig the hole. It would take forever to actually dig the hole, but a spoon could work. It would suck to use a spoon to dig the hole and quite honestly I’d probably give up before I finished, but with enough blood sweat and tears I could get the hole dug.

Of course, if I had a shovel, digging the hole would be much easier. I could get it done with just a bit of hard work. It would obviously go a lot faster than a spoon. Now, if I had a backhoe, digging the hole would basically be academic. Achieving the goal would be simple to accomplish, because the tool was designed perfectly to achieve it.

It’s worth asking yourself whether the EMR you use or the EMR you choose is a golden spoon or a powerful backhoe when it comes to achieving meaningful use. Maybe both can achieve the goal of meaningful use, but is it just made to look nice and shiny or was it really designed to make achieving meaningful use as painless as possible?

Thanks to Randall Oates from SOAPware and Evan Steele from SRSsoft for inspiring this post.

I was talking with Randall recently about SOAPware’s approach to EHR certification and meaningful use. He told me that SOAPware could have thrown something together quickly and been easily certified against the EHR certification criteria when it first opened. However, he didn’t like that approach. Instead he wanted SOAPware to take its time and make sure that the criteria were implemented in a usable and useful way.

Evan just posted a blog post about not all meaningful use EMR being equal. Here’s one portion of what he said that prompted this post:

Demonstrating meaningful use will still demand additional work, and certified—or to-be-certified—EMRs are not alike in how they facilitate doing this. It is critical for physicians to understand and evaluate the differences among EMRs in terms of how they deliver meaningful use capability and the impact on the time it takes to meet the requirements with each.

Evan also offers a few suggestions on things you might ask your EMR vendor:
*How easy is it to enter the required data? (This is particularly important as requirements become more demanding in future stages of the program.)
*What changes will you have to make to the way you see patients?
*How will you document the care you provide?
*Does the system effectively allow delegation of tasks to staff members to minimize the time physicians must spend doing data entry?
*Does the vendor’s software platform enable keeping up with evolving requirements?

There you go! Now you have a list of questions you can ask SRSsoft (and other EMR vendors) when you’re evaluating them.

I’d love to hear other ways people are evaluating an EMR vendor’s implementation of meaningful use. Not to mention ways that EMR vendor’s have implemented meaningful use that differentiates themselves from other EMR vendors.

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.


  • …then continuing our previous ARRA dialog … looks like HITECH adoption is in too many cases “spoon ready” as opposed to shovel ready.

  • lol…nice inside joke Don B.

    I think there’s some certified shovels amidst the certified spoons. Even a few certified backhoes. Although, from my experience not everyone needs a backhoe. A nice shovel with a good handle and a sturdy build works just fine.

  • Great visual. Would be beneficial to have ONC break out the apps by spoon, shovel, and backhoe category. But they don’t know the difference…

  • John, thanks for your insights and the ongoing dialog. Great stuff! I’m curious to know what assistance, if any, the EMR/EHR vendors are planning to give their clients re: applying for incentive payments.

  • Mary Jo,
    Glad to provide my perspective. Hopefully I keep it interesting, relevant and useful.

    I’m quite sure we’re going to see everything under the sun from EMR/EHR vendors when it comes to applying for the incentives. Everything from literal hand holding to some who barely acknowledge that there is a program.

    That said, if this meaningful use resource poll is any indication, it looks like most practices are planning to rely heavily on their EMR vendors for support in the process. We’ll see how many EMR vendors are really ready to support it.

  • “The EHR certification is meant to tell you that it CAN meet the meaningful use guidelines. It doesn’t tell you how easily it is to meet the meaningful use guidelines. It doesn’t tell you how well they integrated the meaningful use guidelines into your regular workflow. It doesn’t tell you how well it lets you delegate the meaningful use tasks to other staff members so you can optimize the doctors time”

    Yep. The NIST ONC-ATCB Cert stds are here btw:

    They are limited to verification of MU I/O functionality, nothing more. No requirements for the vendors to document the MU data capture and reporting workflow navigation paths. Nothing whatsoever regarding platform “efficiency.”

    Although, the government has finally gotten around to paying more serious attention to EHR “usability.”

    NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records [Nov 2010]

    “Usability has been a topic of considerable interest in the health IT community. Gans et al. (2005) provided evidence that some frequently cited reasons for lack of adoption of Electronic Health Records (EHRs) – security, privacy, and systems integration – are outranked by productivity and usability concerns…”

    Better late than never, One supposes. Hey, what’s a mere five years?

  • Bobby,
    That’s an interesting document. I guess my challenge is trying to see how that government published document is going to do anything to change the EMR software’s usability. Do EMR vendors even know about it? If they do know about it, do they care?

  • Read the NIST paper. This is a very nice find Bobby.

    Author is a contractor … Robert M. Schumacher, User Centric, Inc. Logical that NIST would engage and publish papers which outline testing parameters for EHRs.

    An excellent presentation. Quoting one very interesting section:

    “4.5. Comparing Usability and Utility

    Usability is not usefulness or ‗utility‘. Utility refers to the existence (or absence) of feature or function necessary to carry out a specific task (e.g., does the EHR have the capability of recording smoking status?). Utility does not reflect whether a feature or function is usable, simply that it is there. Usability is the ease with which those functions can be carried out.

    While utility and usability are not truly independent, as a practical matter they can be considered as such. Some functions that are very useful may be very difficult to use. Others that are barely useful may be quite easy to use. The goal for the designer is to make all functions usable, but particularly those that are most useful.

    When utility and usability are confused, it is often difficult to untangle the underlying user concerns. For example, if clinical users describe an interface as having ‗too many clicks‘ to perform a task, does this mean that the feature is useful? Or does the number of clicks indicate that the feature is unusable? This can only be evaluated in context.

    In the domain of EHRs, usability has, up to this point, been secondary to utility. Ensuring that an EHR has all the features and functions has taken precedence over usability. As the number of features increases, the complexity also increases, demanding more attention to usability. The aim of this document is to expand attention to include usability.

  • Thanks, Don. Another link:

    Found it in the NIST document. Nearly 300 pages of “usability design” detail proffered by HHS. While it’s “generic” it still has applicable utility, particularly when triangulated with other more HIT-specific “usability” offerings (also in light of the increasing penetration of SaaS model EHR apps).

    The Research-Based Web Design & Usability Guidelines (Guidelines) were developed by the U.S. Department of Health and Human Services (HHS), in partnership with the U.S. General Services Administration. This new edition of the Guidelines updates the original set of 187 guidelines, and adds 22 new ones. Many of the guidelines were edited, and numerous new references have been added. There are now 209 guidelines.

    The Guidelines were developed to assist those involved in the creation of Web sites to base their decisions on the most current and best available evidence. The Guidelines are particularly relevant to the design of information-oriented sites, but can be applied across the wide spectrum of Web sites.

    Who Are the Guidelines for?
    The primary audiences for the Guidelines are Web site managers, designers, and others involved in the creation or maintenance of Web sites. A secondary audience is researchers who investigate Web design issues. This resource will help researchers determine what research has been conducted, and where little or no research exists.

    I will be reviewing this in detail this weekend.

  • Bobby … must not be a CA wkd.

    GSA doc may be a little bit dated … forward is by past HHS Sec Michael Leavitt. Not sure why Leavitt’s name is associated with the document or why HHS has any involvement in promulgating guidelines for the U.S. government and private sector.

    It is alos not surprising the private sector written NIST document on improving EHR usability is 62 pages … while the GSA document on improving web design and usability guidelines produced by the Univ of Maryland is as you noted … 292pages.

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