How to choose the 'right' electronic medical record system

February 5, 2010

Do not purchase the wrong electronic medical record (EMR) system.

Key Points

It was not that we didn't try. We had an EMR committee from the single specialty pediatric clinics in the Salt Lake City and Park City, Utah, metropolitan area. This group met for months to sort through the morass of vendors. The more than 400 variations did not make the choice easy. We went to tech conferences offered by our specialty society and national trade shows. All was for naught.

We thought we did our due diligence of investigating the companies, testing the software, and hearing the sales pitches. We had more committee meetings, and then we voted. And we all lost. The hurt continues to this day, more than two years after the contract was signed.

A FAILURE TO FOCUS ON DESIGN

We failed to focus on the most important part of the decision -- the human/computer interface. We talked about how the practice management system handed claims, the viability of the vendor, and reliance on national standards and certification. Our IT guy told us he liked the computer language. But we didn't listen to our guts on the design of the computer screen that we would have to look at for hours on end.

It is about functionality and workflow. It is all about design, which we see every day, but mostly ignore. Mention design and people think fashion shows. But EMR design is more critical than skirt lengths and fabric. Design of the computer screen and the underlying program is how our brains see the whole picture of the patient.

Human/computer interface is the key to success in adopting an EHR. People talk about the learning curve. The reason for the steep slope of our curve is poor design. If the design were correct, then the clicks and their results would be intuitive. One does not need an instruction manual to open a door. Proper design leads to doing the right thing. Poor design makes it easy to do the wrong thing--the door doesn't open, or it slams shut on your fingers.

Color, space, placement, size, shape, and form all guide how one looks at the medical record. Information is not all the same. Monotony is not only boring; it is dangerous for care if everything is hidden in the same dull, green camouflage.

The mistake is attempting to recreate a paper document on the computer instead of making a usable display. It is as though the paper chart still reigns supreme. I lug around this tablet laptop to input sentences that I crafted as templates so that the printed page looks good. If the result only makes my handwriting legible without making me a better clinician, then send me back to second grade; don't force me to pretend I am practicing better medicine by computerizing my notes.