Getting Your EMR’s UI/UX RIght

A couple of weeks ago, someone posted an interesting question on the buzzing question and answer site Is there room for any more new EMRs in the insanely crowded marketplace we have today? According to one very sharp medical student who’s keeping an eye on the field, the best response isn’t “yes,” or “no,” but “you’ve got the wrong question.”

His answer, which I’d like to share with you, argues that there’s no point whatsoever trying to introduce a new EMR with a shiny new feature set when none of the existing field have a decent UI/UX right now. Jae Won Joh then lays out the steps he believes vendors should take if they want to get the basic UI/UX right (steps excerpted for brevity):

Step 0: Architect the patient data structure carefully
I mention this because you’re going to need to be able to pass this patient data around for clinical use, billing, research, auditing, etc, so design for flexibility and expandability from the get-go. Too many EMRs make it painfully obvious that things were thrown in as afterthoughts.

Step 1: Decide on your market…
…because you need to do everything possible to totally kill it. It’s the only way to go. If you’re going to take on group practices, great, take on group practices. If you’re going to work the hospital scene, fine, work the hospital scene. Stop trying to make something that does everything everywhere. This is not a feature, it’s a horrible bug.

Step 2: Analyze what your market does
If it’s a hospital, you need multiple classes of user, ranging all the way from student to nurse to physician to administrator. You’ll also want a competent notification system, because inpatient things tend to be more urgent and if the ICU patient’s potassium is critically high, you probably want to warn the physician immediately instead of waiting for the physician to check on it manually, because gee, the patient might code and die before that happens….The concerns are different for an outpatient scenario: you don’t need a lot of the stuff that hospitals require in an office. Less orders, more scripts, greater throughput in terms of number of patients, scheduling functionality, etc.

Step 3a: Abstract workflows to a very high level first
In other words, they are as follows: 
1) read data
2) interpret data
3) input data

There’s really not much else to it. Every workflow is a permutation of those three. For example: a physician orders a lab, and it’s performed. The result is read by the tech who provides the input to the system, where it is then read and interpreted by the physician so they can go from there. Figure out how each workflow revolves around these three abstractions.


Step 3c: Design for a 5-year-old
If a five-year old couldn’t use your UI, you screwed up. Period.

There’s a lot more to Joh’s answer, and I suggest you hit Quora youself and read his entire piece. When it comes to usability, most EMRs have barely scratched the surface, and talking about these issues more is always a Good Thing.

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.

1 Comment

  • This is right on. Too many EMR systems are designed by starting with the database definition. Then they created forms that quickly stuffed data into this schema. Finally they found a way to link these forms together so the physician can get to them. Not one time did they consider physician usability was important, because when this started, moving from paper to electronic by any means was revolutionary. A decade later, these systems are still the “safe” buy for many physicians.

    There are systems, including ours, that were designed from step one with physicians in mind. These employ a flexible schema that can handle discrete items for today’s needs plus accommodate expansion into tomorrows needs gracefully. The user experience is designed to work as much as possible like the paper experience only better.

    I don’t agree with the design for a five year old. They have not yet had time to complete their residency. Seriously, it is much better to design for someone who begins like a five year old, but has sufficient ingenuity to start pushing the system way beyond this. The simplistic design is one of the reasons physicians hate their EMRs. Once they realize the power of an electronic system, they are constrained by too much simplicity. EMR design should be like a Disney animation. Entertaining for the five year old, yet sophisticated enough to engage the adults.


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