Lousy EMR User Interfaces Aren’t Getting Enough Attention

Though EMR vendors might argue the point, I keep hearing the same complaints from the field — that virtually none of them offer an intuitive user interface.

Readers of this blog are well aware of this issue, I’m sure, but I’d argue that it’s still worth discussing. After all, few if any EMR firms seem to have solved the problem. (If you know of an EMR you consider intuitive to use, please let me know and I’ll discuss it in a future article.)

Given the incredible problems clumsy UIs can create, I’m surprised pundits and consultants don’t speak out on the subject more often. My journalistic colleagues turn out story after story about wayward doctors who won’t use their institution’s EMR, but few dig into what’s wrong with the EMRs themselves.

Far too many EMR front-ends feel like jury-rigged database interfaces, rather than systems designed to support clinician workflow.  If I had to get my work done using counterintuitive forms, menus and checklists, I think I might leave journalism!

Unfortunately, the decision-makers who buy big EMR systems — you know, the ones who spend hundreds of millions over several years — don’t seem to be very concerned about this issue.  I assume it’s because they’re more worried about systems integration than user satisfaction, and hope they can force kludgy interfaces down clinicians’ throats. Under these circumstances, vendors don’t have a lot of incentive to change.

So, is there a way to change this dynamic? A couple of interesting, though unlikely, possibilities come to mind:

* I may have said this before, but isn’t it about time someone got Apple to design an EMR interface? I know the company has some serious detractors, but even if you don’t buy into the Apple legend  it hard to argue that it’s created some of the most usable interfaces on earth.

* Why not to develop a standard for measuring EMR usability, one which is publicly shared and built by consensus? I’m not saying it would be easy to develop such measures — in fact, I’m sure it would be very complicated — but if we could establish a few user experience benchmarks, it would be very helpful.

The bottom line, though, is that vendors do what the market demands.  Until providers dig their heels in and refuse to buy clumsily-designed systems, nothing’s really going to change.  Maybe CIOs will get more demanding when users stage a revolt and refuse to touch their painfully awkward EMR?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

20 Comments

  • Try checking out the ALERT EMR. It is by far the most user friendly EMR I’ve ever seen.

  • HI John; I usually agree with you in more ways than one; but Apple developing and supporting UI and EMR!!!!!! That’s a …………….. First thing that comes to my mind is user calling in for support will never get a call back……………. That’s the first thing that comes to my mind based on all the HW related experience. And secondly, it will be closed system and everyone will have to pay a royalty……. Apple will then dictate how healthcare needs to be delivered!!!!!!!!!!!!!! Having said this,

    I do agree that the UIs have to improve. I look at the time period we are now in with Health IT, as being in the bottom of the first; and there are 8 more innings to go. Going by our experience, functionalities take the priority and once they are in production, we then work continuously towards bettering user experience – whether by reducing clicks, better intuitive UI, reducing the page load times, creating favorites or whatever it takes to make the system simple to use and a comprehensive tool that can enable the provider to better focus on delivering healthcare while the ‘Processor’ is able to deliver the process/data driven elements of healthcare leading to better preventive care.

    On another note Dr. West, your comments earlier this year/late last year had helped us redefine our implementation methodology. And all our 500+ practices like the way we advise the providers to get online at their own pace – starting with the last patient of the day! Its really worked well with almost all the practices. We owe you some royalty on that!!!!!!!!! But that was a great piece of advice and I thank you. Thanks to John who brings many such great minds together.

  • Anthony,
    First, I can’t take any credit (or blame) for this post. Katherine Rourke wrote this post and not me. You can see which posts she writes and which ones I write near the title of the post.

    I agree that it’s silly to think that Apple would make an EMR. Now what wouldn’t be all that silly is to take some of the smart UI designers at Apple and have them design the EMR interface for another EMR company. Would be interesting to see the result.

    I think the EMR interfaces aren’t nearly as bad in the ambulatory EMR space as they are in the hospital space. Although, that generally has to do with ambulatory being much less complex than some of the integrated beasts that are being implemented in hospitals. Not to mention a lot of other factors.

    Lots more that could be said about user interfaces. I think I might have to save that for a future post.

    I’m glad Dr. West’s advice helped you out Anthony. Readers of this site are some of the very best in the industry for sure. I like Dr. West so much, that we’ve partnered on his own blog: Happy EMR Doctor. I’m not sure if you’ve seen and read it.

  • John, I agree that Apple is unlikely to create an EMR; was just trying to provoke discussion. I was really speaking figuratively — agreed that we need Apple’s UI designers, not the company itself.

    As whether ambulatory EMRs have better interfaces than hospital ones, as a journalist rather than tech specialist I confess that I haven’t toured enough of them in depth to draw a conclusion.

    That being said, the reality is that hospitals are likely to drive what vendors do for the near future, as they’re the ones spending the big bucks — and their decisions may tie doctors to those nasty awkward interfaces.

  • What are the general guidelines you feel interface designers should adhere to when creating EHR interfaces? I’m a designer for a small EHR and feel that our interface is far and away better than the average; but we still have a lot of room for improvement.

    Off the top of my head:
    1) Minimize clicks
    2) Minimize navigations; i.e., allow the user to take more actions from a single screen
    3) Minimize alerts; even things like drug-interactions should have a high threshold as to not spam the user into automatically clicking off the alert.
    4) Make the system status visible to the user – i.e., if the system is busy/loading – the user should know
    5) Be consistent in implementation of functionalities – i.e., adding a med and an allergy should follow the same process/functions.
    6) Error recovery/prevention – if the user takes an action that is undesirable – they should be able to initiate recovery (i.e., if they delete something they should be able to immediately “undo” the delete)
    7) Be Minimal – the interface should look clean – everything we display to the user should have a purpose
    8) Progressive Disclosure – The user only needs to see the basic action options for any given task; advanced options should be accessible via a separate menu
    9) Consider workflow in design – everything should support the daily workflows of the physician/RN/Staff
    10) Looks pleasant – pleasant things are more enjoyable to use

    How important is having an intuitive UI vs. having more features? Even if the use of those features is diminished because they are poorly designed / poorly integrated into the application workflow.

  • @ Katherine and John
    Agreed 100% about the UI; Apple has done a tremendous job and how can that be replicated? That’s where, like us, many other EHR vendors are going towards; and in the journey towards a better UI, many a time, the functional requirements take priority over UI. Its a journey and the competitive market place will make sure that we get there.

    Dr. West, once again thank you and will follow your/John’s combined blog.

  • I/we could not agree with you more. We believe that there is so much misleading information out there that the Healthcare Professional does not know who to believe. There are giant systems, there are niche systems.

    The federal government awarded a large amount of money to non-profit state organizations to assist the health-care professionals, with incentive monies, and it doesn’t seem to helping.

    I will save my comments about the helping organizations, or the lack of true support.

    We are focusing on small/medium sized hospital who seem to get the least attention/help, and can not afford technical staffs to evaluate internal requirements.

  • I invite everyone to try out the Drchrono EHR on the iPad of you are looking for an EHR with a simple and efficient user interface.

    We’re been featured on the business App section of Apple’s website and our users are VERY satisfied with the workflow and overall documentation of our EHR. We’re the EHR that allows you to finish your note before the patient leaves.

  • Anthony,
    “many a time, the functional requirements take priority over UI”

    Interesting comment. I wonder how many meaningful use and/or EHR certification requirements caused issues with an EMR UI?

    Hmm…sounds like a good future post.

  • I’m not saying that this is “the” answer to the original question, but it is a factor. The EMR situation absolutely parallels in many ways the appearance of 1st generation Enterprise Resource Planning software in the mid to late 70s. The most believable “pundits” from whom Katherine might expect these criticisms are those with practical hands-on knowledge. Many such people are now making a LOT of money as consultants & implementation specialists, further raising the TCO (total Cost of Ownership) of these systems by hospitals. Those hospitals that cannot afford them are struggling enormously – just as is described here.

  • It’s one thing to criticize many of the big EMR products and another to understand how they got built so badly. Many companies leading the field in EMRs got into their positions NOT from a history of producing great user-oriented software, but by access to major capital, experience using armies of cheap programmers to build vast systems and expertise in driving executive-level purchase decisions (which often have little to do with real product quality). Naturally, such companies have lots of lobbyists who succeed in driving Washington to “require” just what they offer, and to over-specify and over-complicate the regulations and standards to act as barriers to small, skilled companies who are focused on succeeding with great streamlined, value-focused, user-friendly products.

  • Don,
    You make some really great points. In your last analysis I think the “expertise in driving executive-level purchase decisions” is probably the key one (at least in hospitals). The decisions at that level are so politically driven it’s crazy.

  • Katherine and John,

    One of the most clumsily designed user interface components of all ambulatory and inpatient EHR, PHR and HIE platforms is the use of infinitely variable formats to report cumulative diagnostic test results as incomplete, fragmented data that is impossible to view and share efficiently.

    The practical solution is using a clinically logical, standardized format that can display complete, clinically integrated, easily read information with a media reduction of up to 80 percent fewer screens and can improve physician workflow, thought flow and care flow and care coordination.

    This specific cumbersome UI problem has been overlooked by both the private and public sectors since mainframe computers first appeared in hospitals in the 1960s. Its may finally be solved because of the cost and quality value of achieving data liquidity and seamless interoperability for billions of annual test results and emerging usability and price competition among the more than 500 electronic health record technology products certified by ONC-ATCBs (See: http://onc-chpl.force.com/ehrcert).

  • ProMed has an EDIS system that is an EHR and interfaces with almost all of the HIS systems out there and from what I have seen it is highly intuitive system.

  • I agree that large institutions struggle with pure functional requirements and interoperability, rather than user satisfaction. In fact, only UX professionals can take user complaints as the greatest gift. Those EHR implementation teams in the institutions have no clue how to understand user frustration, and explain to vendors effectively whether it is a design issue or technical issue or extra burden to physicians due to standardized data entry.

  • Following is my response to a related post on this site, “User Experience is Hot HIT Topic with Good Reason.” I have pasted it below because it speaks, as well, to the premise of this article. I hope it is helpful…

    I find your accolades for McKesson laughable and extremely ironic considering my own personal experience with them and their “VARs.” I can only describe McKesson as opportunists and extortionists. Having wasted almost years in a doomed attempt to implement McKesson’s antiquated and worthless EMR product, Medisoft Clinical, I can confidently say this, “Avoid McKesson and any EMR/EHR product marketed & sold via third parties (VARs or consultants)!”
    Skeptical? Consider the following: While anyone with any inkling of honesty will have to admit that the only reason for being in business is to make money, McKesson and it’s VARs have refined that monetary extraction process, as well as avoiding any responsibility to an art form. First, they sell you an antiquated product that they know can’t work or meet your needs. Also, they subtly and slyly reveal after the sale that portions of the purchased product really aren’t ready for delivery or usage, so they don’t even give you that software. “Maybe they’ll get to at later.” Second, they delay and drag their feet for months on the implementation, getting upset when we call to inquire or request progress or status reports. Then they claim that the implementation period has expired, despite the fact that the implementation is not even close to complete and the product is not even close to usable. They then claim that they need more money and a new support contract to continue the unfinished implementation.
    Severing the ties with the first VAR & paying another VAR for the support contract really doesn’t improve matters. The new VAR doesn’t do anything to keep customers apprised of updates or patches. Nor will they do anything to help complete the still incomplete implementation, unless more money is paid to them.
    Then we get to the core product itself… Medisoft Clinical is an antiquated code base that so restrictive and cumbersome that it simply can not fulfill the needs of a modern practice or clinic. For instance, when we finally got to the point that we could consider using it for billing encounters (office visits) we discovered that the program would allow no more than 4 diagnosis codes per encounter claim. This limitation was (or should have been) known to the VAR at the time of purchase. A casual perusal of our SuperBill and/or a single question during the preliminary conversations about our practice workflow and billing procedures would have identified this glaring problem. The fact that never during the conversations about our workflow and billing practices did the VAR mention this program limitation, despite being provided with numerous copies of actual encounter SuperBills that revealed the obvious practice billing needs, indicates nothing short of willfull, intentional omission and avoidance of this issue. Furthermore, we actually asked the VAR on several occasions when we would be able to begin using the EMR software for billing, only to be put off by the VAR with statement that we “were not even close to that point, yet.”

    I could go on, but I am getting too tired and frustrated.

    Suffice it to say that Meaningful use reporting for the McKesson Medisoft Clinical (Practice Partner) product was just a horrible after thought. A report generator is provided, but it provides only a sheet of paper with numbers on it. There is no way to research the validity of the reported numbers. So, good luck if any of your measure values are low and you wish to search for answers in the software. Also, the order and wording of the measures on the generated report don’t even correspond to the CMS measures. Furthermore, requests for assistance in researching measure reported numbers only falls on deaf ears. And don’t think for a minute that you’ll ever see a more useful MU tool for Medisoft Clinical (Practice Partner). Nor is any VAR likely ever to risk their relationship with their cash cow (McKesson) by relaying to McKesson the concerns or issues faced by the customers.

    So, tell me again how great McKesson is…

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