Why does it seem like so many physicians have embraced the iPhone, but only 15 percent of them are using some form of electronic health record EHR technology? That’s one of the questions that Dr. David Kibbe posed to the audience at Healthcare Unbound here in Seattle, Washington.
Kibbe suggested a number of reasons for why physicians are adopting smartphones like the iPhone while shirking EHRs, but the most striking reason was accompanied by a drawing of Apple’s basic UI: A screen with a button that said Push. On the following slide Kibbe showed what he called the typical EHR user interface design: A big mess of buttons and blinking boxes, including a blinking box that lights up when there’s an error. Design and ease of use are crucial barriers to any new technology’s adoption and Kibbe is wise to point out this simple but important point.
Once EMR vendors begin to open up their APIs, the industry will begin to see thousands of new applications built on the EHR platform just like Apple’s AppStore, Kibbe predicted. Those apps would include remote monitoring apps, he said. Kibbe also predicted that in the beginning a number of EMR platforms will emerge and some of them will come from outside of traditional healthcare incumbents, but the ones to succeed will be the ones that create clinical groupware that is interoperable, substitutable, low-cost and low risk.
The fact that 15 percent of physicians are using some form of EHR indicates that the other 85 percent don’t want them.
This situation is ripe for disruptive innovation, a term often misused and misunderstood, Kibbe explained. Clayton Christensen’s theory of Disruptive Innovation actually begins with disruptive innovations or technologies that are actually “crummy” in the beginning. The key is that they are good enough, open enough and substitutable to the point where they overtake the incumbents’ offerings, despite the obvious gap in quality.
We recently reported that Boston’s Children’s Hospital’s Informatics Program published a group of principles to guide the creation of a new health information infrastructure for the U.S. The piece was a follow-up on an article published in The New England Journal of Medicine in March. The latest article argued for the development of a platform model, very much like Apple iPhone’s setup, to encourage the development of “substitutable” health care applications.
June 24th, 2009 at 6:53 am
[...] Kibbe: Successful EMRs will be like the iPhone platform (mobihealthnews) [...]
June 24th, 2009 at 11:13 am
[...] Article Brian Dolan, Mobihealthnews, 24 June 2009 [...]
June 24th, 2009 at 1:02 pm
What is being asked for, is a well designed system. Many EMR systems available today have been hacked together, not designed with Engineering principles. I hear these complains from both HIT and from Domain/caregivers experts. What is needed when creating any system is tried and true engineering process. Start with the domain experts, doctors, nurses, lab tech, etc. add an group of software system architects and develop the requirements. Then design a system based on requirement and build system. The domain experts and system architects also develop a test and acceptance plan that is used to determine if the system works per design. It takes both sides of the equation to build a good system, domain expertise and engineering.
This is the first generation of real EMRs. Like most new technologies the domain expert has a great idea and learns how to program a prototype (a few buttons) which evolves into a product. The products are introduced to the market, many more functions and more buttons are added until you have a mess. Second generation, the idea’s are taken to the next level, this usually comes after an influx of money. Some companies start over using standard engineering practices. Other companies keep the original system and keep hacking away. Look how long it took Microsoft to get rid of DOS. Almost all software companies face these problems from time to time. Ebay started as a small program that was written in a guy’s garage to sell his wife figurines.
The good new is that Enterprise system in HIT are relatively new and the market will wash out the bad EMR or they will redesign to meet the needs of their customers. The problem is that these systems are very expensive and it will cost us all to flesh them out. Make sure that when selecting such an important system that you have done your due diligence.
Jeff Brandt
CTO motionPHR mobile Personal Health Record for the iPhone
MyMobileMedBox for Android
June 28th, 2009 at 11:40 am
[...] mysterious Wave participants that I’ve been calling Bots. As a related example, consider that most physicians are more keen to adopt the iPhone than EMR simply because existing EMR systems are poorly designed, and because EMR vendors haven’t opened [...]
June 29th, 2009 at 7:38 am
[...] » Kibbe: Successful EMRs will be like the iPhone platform | mobihealthnews [...]
June 29th, 2009 at 4:58 pm
I largely diagree.
“What is needed when creating any system is tried and true engineering process. Start with the domain experts, doctors, nurses, lab tech, etc. add an group of software system architects and develop the requirements. Then design a system based on requirement and build system. The domain experts and system architects also develop a test and acceptance plan that is used to determine if the system works per design. It takes both sides of the equation to build a good system, domain expertise and engineering.”
What is REALLY needed is a well thought-out user experience design. Many EHR applications have great architecture–the data and data handling infrastructure does not lack–it’s how the user is interacting with the software that is the problem. EHR applications need a thorough user experience design process applied to them. It needs thoughtful, inventive, clearly design workflows based on the actual needs of the user.
July 10th, 2009 at 1:43 am
I agree with Tony Jacobson. The designs of the EHR apps should be user friendly easy to use and the data structure should be up to mark for the better utilization of ehr system.
August 19th, 2009 at 10:00 pm
Tony & John are correct. The best way to design a new EMR platform is to start with the user interface – the look, feel, and how information is entered (stylus, keyboard, gestures, etc.) Most of the current EMR solutions do basically the same thing with some variation in features. You could have the best application on the market that does everything, but if the interface fails and has a big learning curve, providers will not use the product.
The company, 37signals, put out a book called “Getting Real” that describes this process of starting with the user interface, then building the applications functions within that framework. For a real world example, check out 37signals’ contact mgmt solutions called Highrise – then look at Salesforce.com. Highrise is purposely built to have fewer features, but it does exactly what it tries to do with a clean, easy to understand interface.
As a healthcare provider and practice owner, I’ve reviewed at least two dozen EMR/practice mgmt solutions. While I did focus on the applications features, work flow, and ability to address my needs, the interface was also a key piece for me. A dashboard screen packed with buttons, options, features, etc is confusing and causes many providers to avoid using the software. You want the software to conform to your work flow. If you require that the providers change their work flow to fit the software, you adoption rate with suffer.
Bud Ward