Health IT Pulse

Jul 7 2011   11:29AM GMT

EHR vendors: Watch first, code later

Don Fluckinger Profile: Don Fluckinger

Tags:
EHR
electronic health record

In the course of interviewing two sources for two different stories, interviewees took me down the same interesting side street, conversationally. They both were convinced the best electronic health record (EHR) applications are built when programmers first shadow a clinician before they design their systems — when the tabula is still rasa. They end up creating a much more common-sense EHR application than those who build their systems first and then get real-world exposure in time for the final tweaks.

Software engineer Brad Jannenga, co-founder of physical therapy-focused EHR WebPT, told of his entrée into the field: He met his eventual wife, a physical therapist, who was in the process of choosing an EHR vendor. She asked him for some help making the considerably expensive decision. He threw himself into the task — even following her around for a shift and then comparing her actual needs to the feature sets they offered.

“I found the software that was out there to be out of date, [featuring] terrible [user interfaces], just not very good. And really expensive,” Jannenga said. “I chose the best of the worst, and got a quote. $60,000 for a good-sized clinic to get started. Basically, I told her I could build something better. Maybe that was a little cocky on my part, but I followed her around the clinic, learning how she did her job, learning how she did the treatment of patients, and what she needed. We put our heads together, and I built the app.”

The rest, as they say, is history. And the subscription-model WebPT is making a run at the physical therapy EHR market.

Georgia obstetrician Dr. Anne Patterson is also an engineer, and her story will be told more in-depth elsewhere on our site. She started out her career working for NASA, and later earned her M.D. after a fellow engineer who developed medicine’s earliest laser equipment convinced her that it would be better for her to become a physician — or she’d never get to use the tools she was helping design.

She has a unique perspective on technology and medicine, coming from both sides of the fence — unlike many physicians and CIOs, who typically live on one side or the other. Her take echoes Jannenga’s — EHR applications should be designed in the way he wrote WebPT. Get the software architects to see the clinician in action, first. Or at the very least, the applications should be extensible and flexible so that integrators can either add to the EHR or otherwise customize each individual installation, bending it to a particular clinician’s workflow.

“If people were writing a program or modifying something a physician’s going to use…sit down with a physician and say, ‘We’re working with you today,’ and get more than one opinion,” Patterson said. “It would break down barriers, [and] you have an understanding of what’s going on.”

Interesting stuff. How many EHR systems start out with a database component or another licensed product, with code bolted on to it until it’s hammered into the shape of an EHR? How many EHRs sort of evolve from back-office billing or insurance information systems? Or were afterthoughts to those applications?

A lot of physicians are signing up for EHRs for the first time because the federal government is making an offer they can’t refuse. There are hundreds of EHR vendors out there competing for a pool of customers that dwindles every day. Vendors who pull their heads out of their laptop screens and actually follow their target customers around before they begin building their apps might be able to sling stones at the current Goliaths dominating the market.

For those physicians still in the process of vetting EHR vendors, that could also be a question to ask the various sales reps: Did your team watch first, and code later? According to these two interviewees, when that happens, more intuitive EHR applications emerge from the software development process.

12  Comments on this Post

 
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  • Don Fluckinger
    Now *here's* a question to ask your prospective #EHR #EMR vendors https://bit.ly/nXTFkr
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  • SearchHealthIT
    Doctors to #EHR vendors: Observe our #clinical #workflow first, then design your systems https://bit.ly/nXTFkr #EMR #healthIT
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  • Canada's Smartest IT
    EHR vendors: Watch first, code later https://bit.ly/nXTFkr #EHR #EMR #HealthIT #HITsm
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  • tinamonod
    EHR vendors: Watch first, code later https://bit.ly/nXTFkr #EHR #EMR #HealthIT #HITsm
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  • WebPT
    The best #EMR applications always consider the clinician first and then code accordingly. http://t.co/FlU9Ocb #physicaltherapy
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  • Charles Webster, MD
    #EMR Vendor: Watch 1st, code later? "bending it to a particular clinician’s #workflow" < need #EHR workflow system! http://t.co/8hNj5p9 #BPM
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  • Jhoran1046
    I am in graduate school and studying healthcare information technology. One of the classes that I have taken was called Human Computer Interaction and it focused on User Centered Design. Studying who your end users are and how they perform their duties is key in designing an efficient and easy to use interface. I have been working with healthcare enterprise medical record system for several years and it seems to me that all the business requirements and functional requirements are placed well above the non-functional requirements of the users. I have seen several instances where providers have flat out refused to use software after thousands of dollars and hours of setup and training time have been spent on it. Many people believe that I.T. will save the healthcare industry billions of dollars, however I have seen EHR systems that have been implemented that have increased physicians workloads by forcing them to use and inefficient workflow. When these physicians complained about having their work day lengthened by as much as 2 hours a day they were told that this was the way it had to be done because of billing requirements.
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  • Don Fluckinger
    Get your degree and become a contributor to this HIT universe is all I have to say after reading that.
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  • Jenny Laurello
    EHR vendors: Watch first, code later https://bit.ly/nXTFkr #EHR #EMR #HealthIT #HITsm
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  • Absolute Software
    Agree? The best #EHR programs are when the programmer learns on-the-field. https://bit.ly/nGgoqo #healthit
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  • WebPT
    WebPT Founder featured in Search Health IT blog on designing EHR Software - http://t.co/FlU9Ocb
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  • Force TherEx
    The best #EMR applications always consider the clinician first and then code accordingly. http://t.co/FlU9Ocb #physicaltherapy
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