Explorations in the Design and Implementation of Clinical Information Systems
Decreased productivity is one of the most often complained-about side effects of EHR adoption. Documentation time usually leads the pack in terms of complaints. One way to avoid “buyer’s remorse” when choosing an EHR is to conduct extensive product testing before signing a contract. Of course, for busy clinicians, this is easier said than done. [...]
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In my experience, the decision to implement an electronic health record is usually an attempt to solve ongoing practice problems. Whether or not an EHR successfully meets expectations depends on the complexity of the problems and how appropriate an EHR is for solving them. Some problems are straightforward and readily solved by implementing an EHR–remote [...]
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For an outside consultant, one of the most challenging aspects of helping an organization through an implementation is dealing with the attitudes, expectations, and beliefs of stakeholders. In my experience, turf battles and organization politics cause more project failures than technology issues. More often than not, stakeholders bring a range of backgrounds and viewpoints to [...]
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I have just finished rereading the NIST Draft EHR Usability Protocol (EUP). I am even more impressed with its quality now that I have a new software project underway. When developing software, creating an actionable set of requirements is difficult. Working with users only solves part of the problem because naïve users (those who have [...]
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Site visits are a staple of the EHR selection/evaluation process. Unfortunately, I regularly hear complaints from doctors who have purchased EHRs after seeing them working wonderfully during a site visit, but who later have difficulties in their practices. Site visits can be a helpful component of EHR selection, but only when used appropriately. When used [...]
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EHR contracts are not neutral documents; they are written from the vendor’s point of view and to the vendor’s advantage. Getting a fair contract is not impossible; however, it does require attention to detail. In this post, I will cover contracting issues that are a continual source of problems for unsuspecting practices. First, a few [...]
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Once the workflow analysis for a task has been completed, it can be used to create a test script for EHR evaluation. There is no standard process for creating a test script. The method described here is one that I used for the 1917 Clinic EHR project. Since there is no single correct way of [...]
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The ultimate purpose of an EHR is to assist in caring for patients. Analyzing personal workflows aids in gathering the information required to choose the best product. Personal workflow analysis is easier to do than group workflow analysis because the focus is on the activities of only one person. How you choose to document your [...]
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Every EHR is designed to work a certain way. The number of mouse clicks required to write a prescription; the number of screens viewed to order a lab; and the number of buttons pressed to generate a report all reflect the designers’ assumptions about how specific tasks are best accomplished. The combination of clicks, screens, [...]
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The EHR Science Blog presents the musings of Jerome H. Carter, MD, CEO of NTM Informatics, Inc. He is also the editor of Electronic Health Records, Second Edition, published by the American College of Physicians.
Posts on this blog are the personal views of Dr. Carter and do not reflect the official policies or positions of the American College of Physicians.