Are “User” And “Process” – Centered EMR Design On A Collision Course?

Most of the critiques I read of EMR design ding the EMR for its difficulty to use or its inability to accomodate the workflow of the institution that bought it — and of course, sometimes both. What I’ve never heard suggested, however, is the following idea proposed by Chuck Webster, a guy who clearly doesn’t stop short when he decides to study something. (He’s an MD, an MSIE and an MSIS in intelligent systems design, which is only one of the reasons I think he’s onto something here.)

In a thoughtful and nuanced blog entry, Dr. Webster outlines the work of a pioneer in usability design, Donald Norman, and comes away with the conclusion that the current trend toward “human-centered design” might actually be a mistake.  What a pain — health IT limps along catching  up with a trend from the 1980s, and now may be too late to catch the bus.

In any event, Dr. Webster argues instead of focusing on human/user-centered design, EMR vendors should be focused on activity- or process-centered design. I love what he says about one of the potential problems with human-centered UIs:

Optimization around a user, or user screen, risks the ultimate systems engineering sin: suboptimization. Individual EHR user screens are routinely optimized at the expense of total EHR system workflow usability…I’ve seen EHR screens, which, considered individually, are jewel-like in appearance and cognitive science-savvy in design philosophy, but which do not work together well.

It’s better, he suggests, to have EMRs model “interleaved and interacting sequences of task accomplishment” first and foremost. For example, he writes, key task collections that should be considered as a whole include workflow management systems, business process management, case management and process-aware information systems.

While there’s much more to say here, of course, I’ll close with Dr. Webster’s words, who once makes his point with wonderful clarity:

User-centered EHR design does help get to good EHRs. Good isn’t good enough. If EHRs and HIT are going to help transform healthcare they need to be better than world-class (compared to what?). They need to be stellar. Traditional user-centered design isn’t going to get us there.

The question I’m left with, readers, is whether you can have your cake and eat it too. Does one side of UI/UX design literally have to be jettisoned to support the other?

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.


  • Great. EMR designers are just now realizing this? We providers are screwed. As a long-time eClinicalWorks user who has been frustrated with the near absence of workflow oriented design in that product, this article gives little hope that another EMR would release us from the prison imposed by eCW. It isn’t just the UI though. That EMR is a disjointed amalgam of various programs and interfaces – like playing a symphony with a one man band. Nothing is seemless, nothing works as a whole. In contrast, a day at the clinic is a series of inter-related encounters, events, actions – and each step involves keeping records. An EMR must make these processes flow – you know, “work flow.”

  • Thank you Anne,

    For your kind comments and for featuring my recent blog post.

    It was fun watching links to it ricochet around Twitter!

    Process-aware ideas and technology are indeed diffusing into healthcare.

    I look forward seeing more coverage of this topic here, in other social media, as well as in more traditional media and venues. (Today! Tomorrow the world!)

    Thanks again!


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