Can We Talk? Challenges of SaaS Type EMR User Interfaces

Forget about EMR interoperability between doctors’ offices and hospitals for a moment.

One of the recent developments in the ever-expanding SaaS (software as a service) world of electronic medical records must be the challenge of making all the individual software components talk together correctly.

There is (1) the EMR itself, (2) the programming platform/language, and the (3) internet browser.  Forgive the novice in me if I don’t get all my nomenclature correct.  I’m just a doctor.  If one component gets upgraded (and they always do), then the house of cards can come tumbling down in one fell swoop, at least temporarily.  We’ve experienced this recently at our office with our own EMR system and so I have a few thoughts on the matter.

In our office, first it was Firefox stopped working with the EMR.  Then we all switched over to Internet Explorer, which seemed to work for a time, but then that stopped working well and frequently froze up.  Chrome is working for now, but it seems to be only a ticking timebomb before this no longer works.

To make matters more complicated, different browsers have different ways of displaying information bars at the top, sides and bottom of the EMR window, and so some bars can get in the way of viewing different parts of the screen depending on which browser is used.  There are ways around this (conveniently called “workarounds”), but yet again, not so simple or straightforward and thus suboptimal.  I have to admit that it sort of feels like jiggling the handle on an old toilet to get it to stop running.  In other words, yes, you can do it, but, no, it doesn’t feel like it should work that way ideally.

We’ve been given the explanation that Adobe Flash is having problems interacting with the EMR system, or vice versa, since both the EMR and Flash have gone through successive, iterative upgrades to improve and add functionality to both services.  I can totally buy this explanation.  However, at what point will it just get too difficult to keep everything going?  Is it impossible?  Probably not.  But it’s a heck of a pain watching the EMR go through roadblocks as we forge into the future together, as vendor and provider.

This will undoubtedly affect any EMR system that is dependent upon other, third-party software.  It is a common situation that will change over time, and I’m almost certain that this is going to be a challenge, all around, for any EMR system on the market today.  As such is the case, I look forward to the day when it can be solved permanently by adopting a new standard for all platforms.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at


  • You’ve hit a most important issue of systems being dependent on other, non related systems. This is a common widespread IT issue. It drives users, admins, etc., nuts. It’s bad enough to deal with a new release of a main product that has not been well tested.

    One partial solution is to insist at the onset that the main vendor agree to be responsible for integration of all the components that their system uses. In those cases where the vendor is not someone you negotiate with, that is, you subscribe to a service, you have the type of problem he writes about.

    Finally, I would complain quite loudly to the vendor that you can’t use their system, but I would not expect a satisfying answer.

  • Great post. Oh the joys….err…pains of Flash. As I’ve mentioned to you before, Flash is going out and soon they’re going to have to move off Flash. What you describe is just one of the challenges. It’s no simple task to ensure that software runs on multiple browsers in a similar way.

    All of that said, I’d still rather upgrade a web browser than update a client.

  • Carl,

    As you have have correctly suspected, we have made our dissatisfaction known (as have other users), and you are absolutely correct in that our vendor does not seem to have much control over the situation. They have workarounds, but it is far from ideal.

  • John,

    Yes, I agree. For now, the workarounds are keeping it all going okay, but I dream of the future when we no longer need workarounds. So you think Flash will eventually go out of business? And HL7 will take over?

  • I think this is more a Flash/Browser compatibility issue more than an EMR/browser issue. Because of this (and iOS/Flash incompatibility) I think Flash-based EMR’s will need to dump Flash eventually. I use a web-based EMR (Elation EMR) that dictates use of a modern browser (Chrome/Firefox) and does not use Flash. It has had no compatibility/use issues despite multiple browser updates.

  • I agree with you in that using web platforms is not the best platform for an EMR, but the problem is also partially because of the system implementation by the developers, as they had to either standardise and test their end client application, therefore making it a fixed version of a browser that is known to fully function with the system, or else develop and test the system using common APIs so that its fully compatible across the range of browsers available throughout the system life cycle.

  • Mohamed,

    I wish it were that easy. The problem lies in the fact that software like Adobe Flash and various internet browsers are constantly changing to the point that it seems impossible to keep up especially the more complex the software is. And designing a one-size-fits-all software that will never change seems also impossible.

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