Not All EHR Clicks Are Evil

There’s a great blog post on HIStalk that is a beautiful CMIO Rant. He provides some really needed perspective on the issues with EHR software. In many ways, the post reminded me of my post titled “Don’t Act Like Charting on Paper Was Fast.” In that post, I highlight the fact that far too many people are comparing EHR against doing nothing versus comparing EHR against the alternative. Those are two very different comparisons.

The money line from the CMIO rant was this one:

If we insist that all clicks are wasted time, then we can’t have a conversation about usability, because under the prescription pad scenario, the only usable computer is one you don’t have to use at all.

I love when you take something to the extreme. It’s true that we all want stuff to just happen with no work. That’s perfect usability. However, that’s just not the reality (at least not yet). If we want the data to be accurate and to be recorded, then it takes human intervention (ie. clicks). Some clicking is necessary.

The CMIO goes on to say that the key to EHR usability is expectations. I thought that was an interesting word to describe EHR usability. I’ve written about this topic before when I compared the number of EHR clicks to the keys on a piano. In that article I suggested that the number of clicks wasn’t the core issue. If we could create EHR software that was hyper responsive (like a piano key), was consistent in its response speed, and we provided proper training, then having a lot of EHR clicks wasn’t nearly as big an issue.

Not that this should be an excuse for EHR vendors to make crappy software. They should still do what they can to minimize clicks where possible. However, the bigger problem is that we haven’t achieved all three of these goals. So, we’ll continue to hear many people complaining about all the EMR clicks.

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.


  • I like the piano analogy.

    I also like an economic analogy: the marginal return per EHR click.

    What is the additional value accruing to a user of each additional click? As long as the benefit of adding a click is more than the cost of adding a click, by all means, add clicks!

    Unfortunately, this return is often negative. Or, the value of a click accrues to someone else besides the user.

    One of the reasons I like workflow tech is that is breaks tasks down into units to which value and cost can potentially be associated. By systematically comparing different workflow configurations across estimates of value (perhaps from satisfaction surveys) and cost (perhaps based on time to chart), specific workflow and usability pain points could be found and fixed.



  • Software companies could benefit from the help of industrial engineers with experience in motion time studies.

    If you think about it, all of us come into the office/clinic each day and we go through the same routine (i.e. look at your fixed-time appointments, then attend to items on your to-do list).

    This what we all do, every day, all day long. It follows that all that any of us needs is a split-screen with a calendar on one side and a to-list on the other.

    Given that EMRs are here to stay, aside from getting a copy of “Mavis Beacon Teaches Typing”, the logical solution is a simplified user interface plus a software suite that lets a clinic/hospital map out their workflows/their forms.

    This immediately gets rid of complaints re too much data. If a data item is not needed AND you don’t consider it as relevant to short-term patient status improvement, delete that data item.

    There is, of course, more to an EMR than a proper User Interface.

    If a clinic/hospital gets on board with Business Process Management (BPM) and Adaptive Case Management (ACM) augmented with clinical decision support and a good scheduling capability, it’s possible to avoid navigation up/down hundreds of menus.

    Software for healthcare professionals who either see patients face-to-face or work in ERs, presents a number of unique challenges – you don’t have to watch a healthcare professional very long to discover there is very little time to attend to to-do tasks. Nevertheless, these have to get done.

    Unfortunately there aren’t too many options for multi-tasking.

    Typing at a keyboard whilst a patient sits watching you takes a lot away from the doctor-patient encounter. Talking into headset is no better. Setting up a desk mic works for some. Remote scribes? . . .

  • Delighted to see more discussion of business process management and adaptive case management in healthcare!

    May I recommend my 2012 chapter in How Knowledge Workers Get Things Done (Future Strategies, full text PDF available at link below)?

    Natural Language Processing, Business Process Management and Adaptive Case Management in Healthcare

    Here’s the abstract:

    “Two great information technology industries, health IT and workflow IT, increasingly overlap. Traditional health IT (HIT) has solved many healthcare information management problems, but not others, especially involving complex processes and workflows. Over several decades business process management (BPM) and case management systems have had great success automating workflow and supporting problem solving that requires human interpretation, creativity, and guidance. Nonetheless, within the BPM community a debate has raged over where and what to automate and how to support Drucker’s “knowledge worker.” These issues, and their resolution, are central and critical to a parallel debate within healthcare about usability of electronic health records (EHR) and HIT and effects on physician productivity and patient safety. The BPM and adaptive case management debate is reviewed and lessons drawn for creating efficient, effective, and flexible EHR and HIT workflows. P.S. Plus a dash of natural language processing!”

    [end of quote]

    EHRs and health IT have two big problems: usability and interoperability. Process-aware information systems (or PAIS, as academics call them) have the necessary secret sauce to address both.

    There’s a beautiful idea from design, expressed aptly by Antoine de Saint-Exupery:

    “A designer knows he has achieved perfection not when there is nothing left to add, but when there is nothing left to take away.”

    This is what workflow tech can do for user experience. Consulting workflow maps of clinical and administrative workflow, at each step of workflow execution, only present to users relevant information and options.

    Regarding interoperability, the health IT industry is myopically focusing on so-called syntactic and semantic interop. There’s a layer above those called pragmatic or workflow interoperability. People seem to think that once we get the lower level layers “done” we can finally focus on workflow. The problem with this mistaken view is that syntactic and semantic interop are essentially tactical activities, while workflow is a strategic activity. In other words, workflows can compensate for problems at message format, content, and transmission, but the reverse cannot be true. We need workflow interop to make syntactic and semantic interop work smoothly and resiliently.

    Anyway, delighted to see not just discussion, but actual BPM and ACM tech finally gaining traction in healthcare.

    Atención workflowistas… Viva la workflow!


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