Usability & Adoption of EHRs

by | May 29, 2009

frustrationPolicy makers keep wondering why physicians do not readily adopt EMR/EHR software.  Under ONC’s first head, David Brailer, it was decided that a big problem was a lack of certification of EMR software to insure that it worked as advertised, which led to the founding of CCHIT.  Funny thing though – despite CCHIT’s best efforts to certify EMR software, EMR adoption has not seen any dramatic increase.

I won’t bother with the argument that hey doc, ever hear of caveat emptor?  Take the time to actually call a reference customer or two and go see the software in action before you buy it.  I mean do you really need someone to do that work for you by way of certification when you are paying for it?

Okay, so if it is not certification, it must be all about the money so let’s pour billions of dollars into the market to encourage clinicians to adopt “certified EHRs”.  Oh, and doctor, you are going to have to pay upfront for that software, install it and prove you can use it in a meaningful fashion before we give you one red penny.  To which a clinician may reply:

Well it’s nice to see some potential dollars come my way to buy such software, but is it really worth the trouble? I mean after all, it is well-known among the peers I talk to out on the golf course that one takes a huge productivity hit for months after installing this stuff.

To which policy makers and those that echo them reply, well if productivity is an issue, than it must be an issue of usability of the EHR software so let’s set-up a process to certify usability.

Now certifying usability is virtually impossible for a whole host of reasons and worse, traveling down such a path would detrimentally impact innovation, the last thing we need in this market so lacking in such within HIT.  And no, such a certification process will have absolutely no effect on adoption of EHRs.  Adoption will occur when there is sufficient reason (value) to adopt.

But for those EHR developers out there who are looking to increase the value proposition that they can offer clinicians, certainly making their software easier to use is a good place to start.  And to learn more about usability, you may want to take a look at the presentation below that the company User Centric recently presented to the Chicago HIMSS group.  Tip: Slide 33 will give you some idea why harried docs hate eCharts and maybe more broadly, EHRs for encounters (something which athenahealth confirmed when I visited their offices today – more on that next week).

[slideshare id=1501595&doc=gcchimss5-09show-090528104154-phpapp01]


  1. Bob Coli, MD


    The usability, connectivity and adoption of hospital and ambulatory EHRs has been poor since the mainframe era because the vendors have operated in a pure seller’s market, with absolutely no business incentives to either:

    (1) improve the usability of the interface that displays cumulative diagnostic test results to physicians and nurses,

    (2) create seamless interfaces and interoperability with competitors’ systems, or

    (3) compete for customers based on system value (i.e. price/quality).

    An independent group of Rhode Island physicians is trying to profitably correct the first problem as described and illustrated at:

    And, systemically reforming and replacing what Clayton M. Christensen describes as wasteful “Existing Value Networks” with “Disruptive Value Networks” can ultimately correct the second two problems.

    See “The Innovator’s Prescription: A Disruptive Solution for Health Care” Chapters 7 through 11 and the link to page 29 in the Introduction which is located under “Downloads” at:

  2. Claudio Luís Vera

    high upfront costs + low expectations + poor design != adoption

    In fact, it’s a recipe for a lot of misspent ARRA funds. Thanks for sharing Dr. Schumacher’s presentation, which is a great introduction to the practice of usability.

    Where the future lies, though, is not in the better layout of numbers or web forms, but with data visualization. A table of 60 fields can be easily condensed into a single chart, exposing relationships that can be seen in seconds.

    New front-end frameworks like AJAX and Flex allow users to use a variety of new tools that reach far beyond those illustrated in Dr. Shumacher’s slide show. More importantly, the allow for real-time interaction with numerical data and analysis of data over time. For an example of this, go see’s Flex-based time graphs.

    Let’s hope we don’t have to wait 10 years for these innovations to filter down to healthcare.

    • Robert Schumacher

      I 100% agree! Don’t misunderstand the point of the deck.

      Data visualization is very important and I use it every chance i get.

      We have to crawl before we can walk (let alone run).

      We must resist the temptation to believe that good design begins with Adobe Illustrator however.

      Good design begins with research in the field.

      Design the UI infrastructure well, then do the layout and data rendering.

      There are as many bad designs in AJAX, Flex, and Flash (maybe more!) than in traditional forms. Powerful tools implementing bad designs = disaster.

      Companies that do great design (where greatflashy) spend months doing user research before they ever do high-end graphic UI.

  3. Gerry Higgins, Ph.D.

    Thanks for sharing the presentation, I guess. I would recommend a textbook (yes, a book!) called ‘Designing the User Interface’ by Ben Shneiderman and Catherine Plaisant (you can find it on Amazon). It is the standard for UI design and data display.



  1. ICMCC Website - Articles » Blog Archive » Usability & Adoption of EHRs - [...] Article John Moore, Chilmark Research, 29 May 2009 SHARETHIS.addEntry({ title: "Usability & Adoption of EHRs", url: "" }); [...]
Submit a Comment

Your email address will not be published. Required fields are marked *

Related Content

Introducing the Health Impact Project

Introducing the Health Impact Project

The imperative for a new value assessment mindset in healthcare IT Early on in my taking the helm of Chilmark at the beginning of this year, it dawned on me how many new conversations I was seeing happen in the space about the difficulty assessing the value of IT in...

read more
Epic UGM 2023: Some News, Some Olds, and the March of Progress Continues

Epic UGM 2023: Some News, Some Olds, and the March of Progress Continues

Green FHIR APIs,
Climb Mount Fuji,
Come see the sunlight!
*Variation on Kobayashi Issa “O, Snail”

My second UGM (Epic’s User Group Meeting) offered a great perspective on the thousands of users on Epic coming together to share, exchange, learn, and advance their practices. Gathering around 13,000 attendees, Epic’s team has done a wonderful job just like a year before, making the atmosphere friendly while highly professional. The unique charm of Wisconsin, and Madison in particular, makes it a truly outstanding conference with a myriad of learning opportunities.

read more
Powered By MemberPress WooCommerce Plus Integration