Items that Make a Strong EMR System

Natalie Hodge MD posted an interesting list on Quora of what she considers a strong EMR system:

I am a pediatrician. Here is what I must have in 2011.
1. Usability. When I say usability, I mean I decide the definition of usability.
2. Patient Health Record. nuf said.
3. Lab interfaces that help my patients get convenient and timely blood draws that flow directly into their medical record.
4. Eprescriber that is easy to use and hosted within the same platform so I don’t have to worry about a third parties server being slow.
5. Secure messaging.
a. I need to be able to email patients in a secure fashion, and they need to be able to email me.
b. Text. I need to have secure text messaging visits with patients.
c. Video. I need to be able to do video visits with patients at times.
d. I need to be able to communicate with my team securely.
6. Inbound fax that brings any external communication directly into my emr system. Seriously it’s 2011.
7. Ecommerce. I do membership practice so I can’t be running to the bank all day long depositing checks.
8. Web based. I have to work in a web based world, because I don’t like the expense of maintaining servers and I have to be able to access my data from anywhere.
9. Iteration. I have to have a rapid feedback loop with the developers of the application. If I can’t continually give feedback that makes the emr better, then I may as well go buy an old dell desktop computer from 2004 and start using that.
10. Mobile. I must be able to access all of this on my mobile, right now, I’m Iphone 4 but next week I might be android.
11. Open. The EMR must continually create further opportunities to help physicians manage health of their patients, whether it’s by integrations with, or nike training camp’s iphone ap. Self tracking may be a key tool physicians may use to solving our nation’s health crisis.

So what I am saying is I have to be able to function in an entirely paperless loop, despite the distractions of reform, medicaid, medicare, meaningful use, and payors.

I’m sure many will have a lot to say about this list. Here are a few of my comments:
1. I wonder how Dr. Hodge defines usable. Of course, that’s the problem. She wants it usable, but likely can’t really define it.
5. I love a number of these ideas. Just a few HIPAA/security issues to deal with. Back in March 2006 I wrote a post with the idea of just having the full video recording from a visit in the EMR. I think it’s the long term future of healthcare. It is interesting that in many companies they want more video recording to protect them from liability. In other cases like many in healthcare, they don’t want video recording since it adds to their liability. I’ll be interested to see EMR vendors text message strategies going forward.
7. You don’t like the checks? Imagine that. Online bill pay. Amazing!
9. This is INCREDIBLY INCREDIBLY valuable. It’s one of the reasons why a smaller, but stable EHR vendor is often more desirable than one of the big name EHR vendors.

What do you think about this list? Is it reasonable? What’s it missing?

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.


  • The only issue is, clinics want every bell and whistle but most are not willing to pay for it. Providers want every single feature but think paying even 3% per chart is ridiculous.

  • Real good points! Agree totally! But from the point of a software development company this would cost a lot of money. Every single point of your list is very complex (which lead to high development costs).

    So the question is: who will pay for the features?

  • The two comments above are right on. This is a “dream team” wish list.

    Before I address these point-by-point I’ll say this: in my opinion what has been a key reason EMR’s have become overly complex to use is they try to do everything.

    The reality is, EMR is EMR. It isn’t practice management software…that is another specialty area.

    It isn’t document management software or fax software.

    BUT: what has made Facebook and the current batch of smart phones so great? People creating apps for them…SO the EMR shouldn’t be closed as they all are now, they should have an easy to use API so anybody can create a great add on to the EMR. Below I’ll refer to the API as an answer to some of the items. What is meant here is, probably shouldn’t be part of the EMR core, but an add-on.

    1 & 2: yes.
    3. There should be an app for that
    4. Hosted for most eprescribe makes sense. API
    5.a,b,c: API
    6: yes, API
    7. Too complex for an EMR to build in, API
    8. Web based can work for a small office, but once you get to a few physicians, it doesn’t work. Why? too much data has to be passed around. We can argue this point until we are blue in the face, but all it takes is using a web based EMR and you’ll see that you will prefer a non-web based EMR.
    9. Ok, any software vendor should have a solid feedback mechanism…that doesn’t mean your ideas are a good fit to the software.
    10. EMR access via your mobile phone. Sounds cool, but not practical. Yes, there should be the ability to pull up vital info in an emergency situation, but seriously, web based EMR’s barely work…now you want everything on your phone?
    11. Yes, a solid API so others can build add-ons (apps).

    All of this makes me wonder if aVista, the open source EMR, wouldn’t be able to tackle much of this.

    The challenge a software developer has is not straying from the core objective.

  • Strong APIs are a foundation and its a cost by itself; opening the app up to the outside world is the dream. Working towards it; costs are to be taken into account as well as the standards and support associated with it.

    LIst is a decent list; most of the features are available and reasonable. Accessing from IPHONE, DROID, RIM, MS and all other platforms out there!!!!!!!!!!!!!! Nope, we are not even going there. Its a cost and time issue.

  • I want my Provider to also be my accountant, attorney, fireman, auto mechanic, butcher :), pilot, school teacher, plumber… Will he or she be really good at ANY of these?

  • Wes,
    I’ll just stick with cook. I can handle most of the rest;-)

    Eletronic processing is still much better than scanning checks or something. Although, there’s some pretty cool iPhone check picture taking apps that are starting to come out.

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