Wednesday, June 16, 2010

10 Point Program to Improve EHR software

The HISTalk Blog lets users write in with ideas, rants, and raves now and then - and a recent post by an anonymous writer was so good - I am reposting it here. He wrote up a ten point program to improve EHRs... it was great. I think the first four points are key for actual development, the others are important for deployment. Read on:

10 Point Program to Improve EHR software
1.Less configurable. The Demotivators® said it best “When people are free to do as they please, they usually imitate each other”. Every hospital or physician practice is unique — they uniquely solve the exact same problems everyone else is facing.
2.Better designed. End-user input and UI design should be part of the specs, not the pilot.
3.Customer-prioritized enhancements. Fifty percent vendor-driven (sales and demo feedback, regulatory requirements, infrastructure, etc.), 50% prioritized by customers. Yearly process, projects grouped to be equal number of hours, one vote per licensed bed, top x projects will be roadmapped to fill 50% time.
4.Consensus-driven standard content and configuration. Vendor designed, large group customer editing — majority rules, everyone uses.
5.Remote hosted. 99.999% uptime, capacity and response time are key requirements.
6.Rapid install. If you’ve followed 1-5, training the end-users should be the most time-intensive phase of the implementation.
7.Qualified buyers. We’ll sell to you if you agree to: follow our standard workflows, use our standard build and participate (end-user input, content design, and prioritization). Must agree to mandate adoption! Better to support 50 involved, committed customers than 100 unhappy, non-standard, partially-implemented, low-adoption targets.
8.Equitable pricing. Low upfront, subscription-based. Every customer pays the same, scaled by size or volume.
9.Play nice with other vendors. Integration > Interfacing > Interoperating.
10.Record portability. Remove vendor lock-in. The intersection of the NHIN and CCDs with the market transitioning to replacement will make this a necessity. You know it will be mandated eventually.

The only thing I'd add is the concept of "Open those platforms" - meaning the vendors should release APIs that allow 3rd parties to innovate on the user interfaces and functionality that can interact with the data model without changing it (as per some past posts).


  1. Lyle,

    Thanks for sharing this, and perhaps more importantly, the link back to the comments. I think KarlM and JimBo's retort top ten are a lot more on point.

    Like you, I've been on both organizational sides of the vendor and provider development equation, and for many years. Vilifying either vendors or providers, and making monolithic pronouncements (e.g. development philosophy, pricing, and design practices) misses the real issue. All organizations and individuals have strengths and weaknesses.

    What's important is focusing on true respect, responsibilities and results. Thanks to CEO Bob Watson for sharing and demonstrating these three Rs with me.

    Modernizing EHR software, especially in the setting of extremely tough financial incentives and change management requirements is challenging. Protecting prior investment where possible may also be extremely important. Especially if you've ever managed cash flow. Like paying your mortgage every month.

    The other two top ten lists are much more useful than Mr Recently-RIF'd, the author of the list above.

    And thank you Octo Barnett, the author of one of those lists, for trying to steer us in the right direction for the last fifty years.

  2. Dr. Octo Barnett's Guidelines from 1970 certainly bear repeating:
    1. Thou shall know what you want to do
    2. Thou shall construct modular systems – given chaotic nature of hospitals
    3. Thou shall build a computer system that can evolve in a graceful fashion
    4. Thou shall build a system that allows easy and rapid programming development and modification
    5. Thou shall build a system that has consistently rapid response time and is easy for the non-computernik to use
    6. Thou shall have duplicate hardware systems
    7. Thou shall build and implement your system in a joint effort with real users in a real situation with real problems
    8. Thou shall be concerned with realities of the cost and projected benefit of the computer system
    9. Innovation in computer technology is not enough; there must be a commitment to the potentials of radical change in other aspects of healthcare delivery, particularly those having to do with organization and manpower utilization
    10. Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism.

  3. Here is a useful new website you might want to consider:

    Biomedical Device Integration Tech Corner

    "An archive of technical documents, protocols, standards and procedures useful for clinical engineers and IT professionals involved in biomedical device integration and connectivity to electronic medical records (EMR)"

  4. Great post! I am sure this "10 Point Program to Improve EHR software" is really big help to more improve EHR software. Anyway, thanks for sharing this informative post.