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

“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.

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