First Hand EMR User Experiences, Slaying the Paper Dragon, and EMR GUIs

Time again for a quick look around some of the EHR and Health IT topics being discussed on Twitter. It’s an interesting time for healthcare IT on Twitter. They’ve started accepting nominations for what they’re calling the #HIT100. A number of people have already nominated my @techguy and my @ehrandhit Twitter accounts as a #HIT100 nomination. I’m honored that people would consider me in that group. I’ll be interested to see who ends up making it on the list. Those lists aren’t perfect, but I enjoy them for discovering new people I didn’t know about.

Also, before I go through some tweets, be sure you check out the Around Healthcare Scene post on EMR and EHR.

I love Inga from HIStalk and I love these first person perspectives and comments on EMR software. We need more doctors, practice managers, nurses, etc talking about their experience. Props to Inga for putting that together.

I love the concept of the “paper beast.” Such a perfect description and something that so many people forget about when their planning their EHR implementation. Dealing with the existing and future paper (yes, paperless is a myth) is an absolute must in a good EHR implementation.

This is a topic we’ve discussed many times before. Although, I think we need to keep pointing it out so that physicians take a good hard look at the documentation method of EHR software. There are so many options out there that doctors shouldn’t settle for something less than optimal.

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.

1 Comment

  • Re that last tweet…

    “Also, I’m worried about the “web form database schema enforcement” mentality of EMR GUIs – I’ve seen a doctor fight them and curse.”

    …I am reminded of a quote that has stuck with me:

    “Most CMSs look like a database got drunk and vomited all over the screen”

    I’ve seen similar regarding EHRs, but was not able to locate the link. (Hence the above quote and link, instead of what I originally intended to supply.)

    I like content management systems, especially the way they can be extended by non-programmers.

    This, EHRs should emulate.

    However, many EHRs suffer from usability issues resembling issues with databases. One way to “protect” users is to put some sort of mediating layer between them and the database.

    Read the following quotes while mentally replacing “database” with “EHR.”

    “We need database systems that reflect the user’s model of the data, rather than forcing the data to fit a particular model. Even if we have a relational implementation under the hood, it should be hidden from the user, who should see the data presented in a form that is “natural.” This means there is no single standard presentation data model of data.”


    “Database systems today, for all their virtues, are extremely difficult for most people to interact with. This difficulty cannot be fixed just by improving the query interface. Rather, we must rethink the architecture of the database system as a whole. This paper has suggested a framework for this purpose comprising a presentation data model as a distinct layer above the usual logical data model”

    The authors suggest a “direct data manipulation” approach.

    While the above article does not mention workflow (except briefly, relative to data provenance), workflow engines, process definitions, and related technology represent user goals and task constraints (adaptive case management comes to mind). They are relevant to creating more usable presentation layers for EHRs. Folks usually think of workflow systems as facilitating user-to-user communication or system-to-system communication, but facilitating user-to-database and database-to-user communication will be key to improving EHR usability.

    Thus, a candidate for improving EHR usability is a workflow engine using process definitions to present the right screen with the right data or order entry contents in the right format, to the right person at the right time, in the right order. Workflow and case management systems rely on explicit declarative representations of goals, tasks, constraints, and workflows, often exposing them to users for (relatively) direct manipulation (cancel this, postpone that, escalate this, try that again, that’s been accomplished, etc.).

    I should note that major CMSs such as Joomla! and Drupal have workflow plugins and are adding this capability to their core platforms.

    EHRs should too.

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