Meaningful EHR Customization

Curt Rosinski offered some really good advice on a previous meaningful use post for those doctors who are evaluating EHR software and the customization features that they offer:

The thing all potential consumers should keep in mind when buying an EHR, EMR or any medical management software is this; the more out-of-the-box the product is, the less customization the product is capable of. Customization in this case being meaningful customization, not screen color or placement of toolbar.

I’m not sure I agree completely that the more out-of-the box the product is, the less customization will be available. This could be the case, but EHR vendors can make it so you can customize everything in the EHR while still preserving a great out-of-the-box EHR experience.

However, the second comment was even more interesting to me. I’m always amazed how some people evaluating an EHR get so annoyed by the color of a window or get so enamored by the size of the font. I’m not saying that the color of the window and size of the font aren’t important. They can be really important in improving the usability of the software. However, if those things are so important to the usability of the system, then they shouldn’t likely make those things part of the customization preference package.

The idea of meaningful EHR customizations is a good one. Look for the EHR that does a great job balancing the out-of-the box EHR implementation experience while still making lots of customizations possible, because you can be sure that 6 months into your EMR implementation you’ll be ready to look at ways to really maximize the use of your EHR.

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 more out-of-the-box the product is, the less customization the product is capable of”… what a great post, thanks for sharing the info!

  • One of the most difficult rows to hoe in designing a functional EHR is the balance between a customizable experience and a focused experience. Apple is notorious for sacrificing usability and customization for the sake of a focused experience and yet they have been the driving force of the computer industry for the past several years. While I wouldn’t begin to attempt a correlation between the computer using folk of the rest of the world and doctors in need of a good EHR package I don’t think they’re as different as some might proclaim. For the most part, the early adopter doctors were technology geeks, like the early adopter general computer users. These people demand the ability to customize their experience because they, like myself are crazy enough to spend as much time tweaking and optimizing their workflow as they do getting work done. If recent years have shown us anything though, it’s that these people are a minority and in reality, most folks are looking for simple, easy to use, focused experiences with their devices and applications.

    So that’s a long way of saying, I don’t think people are necessarily looking for customization as much as they used to and that this is only the market adapting to what the majority of people want.

  • Andrew,
    I agree that at first everyone just wants a nice easy to use, focused experience. However, 6 months in they want to make minor tweaks to the system. The problem is that each user will want to make their own minor tweaks and so that’s why you have to have broad customization available so you can customize the little things they want to adjust. I agree we do the same with our PC user and customization. It’s a good example.

  • Andrew hits the nail on the head. Most EHR’s end up being designed for Expert users: the beta testers, the early adopters, the super-users. These users are eager to offer feedback and they want to affect the design of the system, they are also easy to work with since they understand technology.

    However, the focus should always be on the Mainstreamers. I heard an interesting statistic, something like over 80% of users have never changed a setting in Microsoft word. This insight would seem to contradict John’s statement that six months in users will want to make a change to their settings. Perhaps they will, but they may just ask their EHR vendor to do it for them if the settings are not easily accessible. The word settings are easily accessible though and I think it is telling that the vast majority of users never touch them.

    As Giles Colborne put it in his book, “Simple and Usable,” he said something to the effect of Experts want to open up the car’s hood and tinker with the engine, Mainstreamers want to get in the car and drive.

    In design sessions for our EHR, when we are thinking about a feature, I like to bring up the fact that several of our customers can barely use a mouse. It reminds us just who we are designing for.

  • The question is not one of making the EMR for anyone to use regardless of their familiarity with apps, etc. Rather it is how well does the system support someone carrying out their role. There are many different types of users with a variety of needs, a system should be able to take into account their professional roles and responsibilities.

    Simply because an EMR can meet the needs of the most sophisticated and demanding users does not mean it will be good for those in other positions.

    However, the demands of the most sophisticated dominate selection. I don’t mean the most sophisticated IT types, but the users who will produce the most sophisticated work product.

  • Mixing “meaningful” in with this post may cause confusion.

    When I see meaningful these days, I automatically (in my head) follow that with “use” or “way”. So I had to read this twice to clarify this wasn’t about customizing in a “meaningful way”.

    That said, in general something highly customizable can be very complex, but that is only really if you want to customize it. If it works fine out of the box, who cares how powerful/complex customizing it is.

    What I see is this: most EHR vendors have created an EHR based on some optimal work flow.

    The problem is, most docs have reinvented the wheel, again, and are happy with their wheel. They didn’t buy into a new “system” they just want electronic records, hence the need for customization of the EHR so it will work like the doc does.

    There is nothing wrong with this at all, as long as the customization gets completed…which it rarely does.

    An extreme example of customization is I had a client who wanted the on-screen form to look exactly like his paper form, including the color of the paper, etc.

    It is funny, and seems ridiculous, but I get it.

    A doc starting a new practice might be open to a “franchise” proven system, but most docs who’ve been around want to keep their wheel.

  • I’m afraid I have to disagree with the axiom “The more out-of-the-box the product is, the less customization the product is capable of”. Claydata’s PuttyHealth is designed with user-cutomisation as a priority. It works out of the box (which actually is a box containing a free ipad!) but lets you sculpt the experience very easily.

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