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The Perfect EHR Workflow – Video EHR

Posted on May 12, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been floating this idea out there for years (2006 to be exact), but I’d never put it together in one consolidated post that I could point to when talking about the concept. I call it the Video EHR and I think it could be the solution to many of our current EHR woes. I know that many of you will think it’s a bit far fetched and in some ways it is. However, I think we’re culturally and technically almost to the point where the video EHR is a feasible opportunity.

The concept is very simple. Put video cameras in each exam room and have those videos replace your EHR.

Technical Feasibility
Of course there are some massive technical challenges to make this a reality. However, the cost of everything related to this idea has come down in price significantly. The cost of HD video cameras negligible. The cost of video storage, extremely cheap and getting cheaper every day. The cost of bandwidth, cheaper and higher quality and so much potential to grow as more cities get fiber connectivity. If this was built on the internal network instead of the cloud, bandwidth is an easily solved issue.

When talking costs, it’s important to note that there would be increased costs over the current documentation solutions. No one is putting in high quality video cameras and audio equipment to record their visits today. Not to mention wiring the exam room so that it all works. So, this would be an added cost.

Otherwise, the technology is all available today. We can easily record, capture and process HD video and even synchronize it across multiple cameras, etc. None of this is technically a challenge. Voice recognition and NLP have progressed significantly so you could process the audio file and convert it into granular data elements that would be needed for billing, clinical decision support, advanced care, population health, etc. These would be compiled into a high quality presentation layer that would be useful for providers to consume data from past visits.

Facial recognition technology has also progressed to the point that we could use these videos to help address the patient identification and patient matching problems that plague healthcare today. We’d have to find the right balance between trusting the technology and human verification, but it would be much better and likely more convenient than what we have today.

Imagine the doctor walking into the exam room where the video cameras in the exam room have already identified the patient and it would identify the doctor as she walked in. Then, the patient’s medical record could be automatically pulled up on the doctor’s tablet and available to them as they’re ready to see the patient.

Plus, does the doctor even need a tablet at all? Could they instead use big digital signs on the walls which are voice controlled by a Siri or Alexa like AI solution. I can already hear, “Alexa, pull up John Lynn’s cholesterol lab results for the past year.” Next thing you know, a nice chart of my cholesterol appears on the big screen for both doctor and patient to see.

Feels pretty far fetched, but all of the technology I describe is already here. It just hasn’t been packaged in a way that makes sense for this application.

Pros
Ideal Workflow for Providers – I can think of no better workflow for a doctor or nurse. Assuming the tech works properly (and that’s a big assumption will discuss in the cons), the provider walks into the exam room and engages with the patient. Everything is documented automatically. Since it’s video, I mean literally everything would be documented automatically. The providers would just focus on engaging with the patient, learning about their health challenges, and addressing their issues.

Patient Experience – I’m pretty sure patients wouldn’t know what to do if their doctor or nurse was solely focused on them and wasn’t stuck with their head in a chart or in their screen. It would totally change patients’ relationship with their doctors.

Reduced Liability – Since you literally would have a multi angle video and audio recording of the visit, you’d have the proof you’d need to show that you had offered specific instructions or that you’d warned of certain side effects or any number of medical malpractice issues could be resolved by a quick look at the video from the visit. The truth will set you free, and you’d literally have the truth about what happened during the visit on video.

No Click Visit – This really is part of the “Ideal Workflow” section, but it’s worth pointing out all the things that providers do today to document in their EHR. The biggest complaint is the number of clicks a doctor has to do. In the video EHR world where everything is recorded and processed to document the visit you wouldn’t have any clicks.

Ergonomics – I’ve been meaning to write a series of posts on the health consequences doctors are experiencing thanks to EHR software. I know many who have reported major back trouble due to time spent hunched over their computer documenting in the EHR. You can imagine the risk of carpal tunnel and other hand and wrist issues that are bound to come up. All of this gets resolved if the doctor literally walks into the exam room and just sees the patient. Depending on how the Video EHR is implemented, the doctor might have to still spend time verifying the documentation or viewing past documentation. However, that could most likely be done on a simple tablet or even using a “Siri”-like voice implementation which is much better ergonomically.

Learning – In mental health this happens all the time. Practicum students are recording giving therapy and then a seasoned counselor advises them on how they did. No doubt we could see some of the same learning benefits in a medical practice. Sometimes that would be through peer review, but also just the mere fact of a doctor watching themselves on camera.

Cons
Privacy – The biggest fear with this idea is that most people think this is or could be a major privacy issue. They usually ask the question, “Will patients feel comfortable doing this?” On the privacy front, I agree that video is more personal than granular data elements. So, the video EHR would have to take extreme precautions to ensure the privacy and security of these videos. However, from an impact standpoint, it wouldn’t be that much different than granular health information being breached. Plus, it’s much harder to breach a massive video file being sent across the wire than a few granular text data elements. No doubt, privacy and security would be a challenge, but it’s a challenge today as well. I don’t think video would be that much more significant.

As to the point of whether patients would be comfortable with a video in the exam room, no doubt there would need to be a massive culture shift. Some may never reach the point that they’re comfortable with it. However, think about telemedicine. What are patients doing in telemedicine? They’re essentially having their patient visit on video, streamed across the internet and a lot of society is very comfortable with it. In fact, many (myself included) wish that telemedicine were more widely available. No doubt telemedicine would break down the barriers when it comes to the concept of a video EHR. I do acknowledge that a video EHR takes it to another level and they’re not equal. However, they are related and illustrate that people’s comfort in having their medical visits on video might not be as far fetched as it might seem on the surface.

Turns out that doctors will face the same culture shift challenge as patients and they might even be more reluctant than patients.

Trust – I believe this is currently the biggest challenge with the concept of a video EHR. Can providers trust that the video and audio will be captured? What happens if it fails to capture? What happens if the quality of the video or audio isn’t very good? What is the voice recognition or NLP isn’t accurate and something bad happens? How do we ensure that everything that happens in the visit is captured accurately?

Obviously there are a lot of challenges associated with ensuring the video EHR’s ability to capture and document the visit properly. If it doesn’t it will lose providers and patients’ trust and it will fail. However, it’s worth remembering that we don’t necessarily need it to be perfect. We just need it to be better than our current imperfect status quo. We also just need to design the video EHR to avoid making mistakes and warn about possible missing information so that it can be addressed properly. No doubt this would be a monumental challenge.

Requires New Techniques – A video EHR would definitely require modifications in how a provider sees a patient. For example, there may be times where a patient or the doctor need to be positioned a certain way to ensure the visit gets documented properly. You can already see one of the cameras being a portable camera that can be used for close up shots of rashes or other medical issues so that they’re documented properly.

No doubt providers would have to learn new techniques on what they say in the exam room to make sure that things are documented properly. Instead of just thinking something, they’ll have to ensure that they speak clinical orders, findings, diagnosis, etc. We could have a long discussion on the impact for good and bad of this type of transparency.

Double Edged Sword of Liability – While reduced liability is a pro, liability could also be a con for a video EHR. Having the video of a medical visit can set you free, but it can also be damning as well. If you practice improper medicine, you won’t have anywhere to hide. Plus, given our current legal environment, even well intentioned doctors could get caught in challenging situations if the technology doesn’t work quite right or the video is taken out of context.

Reality Check
I realize this is a massive vision with a lot of technical and cultural challenges that would need to be overcome. Although, when I first came up with the idea of a video EHR ~10 years ago, it was even more far fetched. Since then, so many things have come into place that make this idea seem much more reasonable.

That said, I’m realistic that a solution like this would likely start with some sort of half and half solution. The video would be captured, but the provider would need to verify and complete the documentation to ensure its accuracy. We couldn’t just trust the AI engine to capture everything and be 100% accurate.

I’m also interested in watching the evolution of remote scribes. In many ways, a remote scribe is a human doing the work of the video EHR AI engine. It’s an interesting middle ground which could illustrate the possibilities and also be a small way to make patients and providers more comfortable with cameras in the exam room.

I do think our current billing system and things like meaningful use (or now MACRA) are still a challenge for a video EHR. The documentation requirements for these programs are brutal and could make the video EHR workflow lose its luster. Could it be done to accommodate the current documentation requirements? Certainly, but it might take some of the polish off the solution.

There you have it. My concept for a video EHR. What do you think of the idea? I hope you tear it up in the comments.

The Myth of “Too Many EHR Clicks”

Posted on October 8, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve regularly talked about the myth of “too many clicks.” Long time readers may remember my piano analogy. That analogy is just as good today as it was 3+ years ago. I still think the key to clicks is providing consistent response and training.

While I still love that analogy, the Usability People offered another great insight into the myth of “too many clicks”:

Multiple clicks are not a deterrent to usability and user satisfaction, in fact there are many occasions where having more clicks may actually improve usability.

In our experience facilitating a large number of usability tests, people don’t complain about having too many clicks. Making the click is automatic.

The crux of the matter is that each click represents a decision point within a workflow. It isn’t too many clicks, it is too many decisions!

I love this added layer of insight into making something usable. The clicks aren’t the issue as much as the number of decision points that are available and how clearly those decision points are marked. In many respects this goes back to proper EHR training again, but it can also be due to really poor design as well.

Would it be wrong to say that the key is to make those clicks meaningful?

Videos of EHR Usability Suggestions

Posted on May 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my readers sent me a link to a new site they’re developing called SaveTimeMD. This website was created as a response by an internist and EHR developer that was tired of seeing so many EHR usability problems. He decided that he’d take usability problems from users and make videos explaining how he’d resolve the EHR usability issue.

I think the concept is quite interesting. Many might ask why he doesn’t just build the perfect EHR if he’s so good at solving the usability problems. That’s the way my entrepreneurial mind would work. However, some people don’t approach problems with that entrepreneurial mindset. I’m not sure this doctor’s motivation, but I think the concept is quite interesting.

Here’s one of the videos he’s created that talks about intuitively navigating an EHR:

What do you think of the video? More importantly, what do you think of the idea of someone offering answers to your EHR usability challenges which you could take back to your EHR vendor?

Usability Pyramid – How Does It Apply to EHR and Healthcare IT?

Posted on April 28, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I saw this wonderful usability pyramid come across my Twitter feed:

There’s so much we can learn in healthcare from this pyramid. I’m still chewing on whether the pyramid is the right way to display each of these 4 areas, but I love the way that it breaks it out into these 4 categories. Do they build on each other though?

As I look at these 4 categories of usability, I think that healthcare IT and EHR have done a pretty good job at the functional area. I also think that most of the advanced EHR users are able to work quickly in their EHR. In fact, it’s a complaint I often hear from EHR users that the EHR is so powerful that it takes forever to configure it. The experienced users love these extra configuration options.

I think very few EHR and healthcare IT companies have done a great job on the intuitive and beautiful side of usability. Many doctors think they can just pick up an EHR and start using it just like they did their iPad. This just isn’t the case. It requires a mix of configuration and training to make an EHR work effectively for an organization. Should it? I have yet to find an EHR where this isn’t the case.

I’d love to hear where people think various healthcare IT and EHR applications fit on this pyramid. Let’s hear it in the comments.

Usable EHR Workflow Is Natural, Consistent, Relevant, Supportive and Flexible

Posted on June 11, 2014 I Written By

Chuck Webster, MD, MSIE, MSIS has degrees in Accountancy, Industrial Engineering, Intelligent Systems, and Medicine (from the University of Chicago). He designed the first undergraduate program in medical informatics, was a software architect in a hospital MIS department, and also VP and CMIO for an EHR vendor for over a decade. Dr. Webster helped three healthcare organizations win the HIMSS Davies Award and is a judge for the annual Workflow Management Coalition Awards for Excellence in BPM and Workflow and Awards for Case Management. Chuck is a ceaseless evangelist for process-aware technologies in healthcare, including workflow management systems, Business Process Management, and dynamic and adaptive case management. Dr. Webster tweets from @wareFLO and maintains numerous websites, including EHR Workflow Management Systems (http://chuckwebster.com), Healthcare Business Process Management (http://HCBPM.com) and the People and Organizations improving Healthcare with Health Information Technology (http://EHRworkflow.com). Please join with Chuck to spread the message: Viva la workflow!

This is my third of five guest blog posts covering Health IT and EHR Workflow.

Workflow technology has a reputation, fortunately out of date, for trying to get rid of humans all together. Early on it was used for Straight-Through-Processing in which human stockbrokers were bypassed so stock trades happened in seconds instead of days. Business Process Management (BPM) can still do this. It can automate the logic and workflow that’d normally require a human to download something, check on a value and based on that value do something else useful, such as putting an item in a To-Do list. By automating low-level routine workflows, humans are freed to do more useful things that even workflow automation can’t automate.

But much of healthcare workflow requires human intervention. It is here that modern workflow technology really shines, by becoming an intelligent assistant proactively cooperating with human users to make their jobs easier. A decade ago, at MedInfo04 in San Francisco, I listed the five workflow usability principles that beg for workflow tech at the point-of-care.

Consider these major dimensions of workflow usability: naturalness, consistency, relevance, supportiveness, and flexibility. Workflow management concepts provide a useful bridge from usability concepts applied to single users to usability applied to users in teams. Each concept, realized correctly, contributes to shorter cycle time (encounter length) and increased throughput (patient volume).

Naturalness is the degree to which an application’s behavior matches task structure. In the case of workflow management, multiple task structures stretch across multiple EHR users in multiple roles. A patient visit to a medical practice office involves multiple interactions among patients, nurses, technicians, and physicians. Task analysis must therefore span all of these users and roles. Creation of a patient encounter process definition is an example of this kind of task analysis, and results in a machine executable (by the BPM workflow engine) representation of task structure.

Consistency is the degree to which an application reinforces and relies on user expectations. Process definitions enforce (and therefore reinforce) consistency of EHR user interactions with each other with respect to task goals and context. Over time, team members rely on this consistency to achieve highly automated and interleaved behavior. Consistent repetition leads to increased speed and accuracy.

Relevance is the degree to which extraneous input and output, which may confuse a user, is eliminated. Too much information can be as bad as not enough. Here, process definitions rely on EHR user roles (related sets of activities, responsibilities, and skills) to select appropriate screens, screen contents, and interaction behavior.

Supportiveness is the degree to which enough information is provided to a user to accomplish tasks. An application can support users by contributing to the shared mental model of system state that allows users to coordinate their activities with respect to each other. For example, since a EMR  workflow system represents and updates task status and responsibility in real time, this data can drive a display that gives all EHR users the big picture of who is waiting for what, for how long, and who is responsible.

Flexibility is the degree to which an application can accommodate user requirements, competencies, and preferences. This obviously relates back to each of the previous usability principles. Unnatural, inconsistent, irrelevant, and unsupportive behaviors (from the perspective of a specific user, task, and context) need to be flexibly changed to become natural, consistent, relevant, and supportive. Plus, different EHR users may require different BPM process definitions, or shared process definitions that can be parameterized to behave differently in different user task-contexts.

The ideal EHR/EMR should make the simple easy and fast, and the complex possible and practical. Then ,the majority/minority rule applies. A majority of the time processing is simple, easy, and fast (generating the greatest output for the least input, thereby greatly increasing productivity). In the remaining minority of the time, the productivity increase may be less, but at least there are no showstoppers.

So, to summarize my five principles of workflow usability…

Workflow tech can more naturally match the task structure of a physician’s office through execution of workflow definitions. It can more consistently reinforce user expectations. Over time this leads to highly automated and interleaved team behavior. On a screen-by-screen basis, users encounter more relevant data and order entry options. Workflow tech can track pending tasks–which patients are waiting where, how long, for what, and who is responsible–and this data can be used to support a continually updated shared mental model among users. Finally, to the degree to which an EHR or health IT system is not natural, consistent, relevant, and supportive, the underlying flexibility of the workflow engine and process definitions can be used to mold workflow system behavior until it becomes natural, consistent, relevant, and supportive.

Tomorrow I’ll discuss workflow technology and patient safety.


Hospital Intern Time, Why ICD10?, and EHR Satisfaction Pre-MU

Posted on April 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Everyone that reads this immediately thinks that this is a terrible thing. It seems ghastly that a doctor that’s paid to treat patients would spend so much time with an EMR vs with patients. I agree with everyone that are highest paid resource should be using as much time as possible with and treating patients. However, this study would have a lot more meaning if it was paired with a previous study that showed how much time a hospital intern spent in a paper chart. Maybe they spent 400% more time with a paper chart than direct patient contact. Then, this stat would come off looking very different. You have to always remember that you have to take into account the previous status quo.


This article and the discussion around ICD-10 was phenomenal. Passionate viewpoints on each side. It fleshed out both sides of the arguments for me really well. Too bad no one will care too much for a while.


Oh…the good old days. When everyone love EHR, because they chose to do it and so they made the most of their choice. Ok, I’m being a little facetious, but I seem to remember a study I saw that showed how much more unsatisfied doctors are with EHR today versus pre-MU. I imagine it’s not all MU’s fault, but it certainly hasn’t helped with physician EHR satisfaction.

Usable EMR, Post EMR World, and Impact of Meaningful Use

Posted on February 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is an important nuance. Although, I’d argue that the biggest challenge to EMR usability is onerous billing requirements and prescriptive meaningful use requirements.


I’m really interested in the description of a post EMR world. It makes me ask myself the question, “What can we do with 100% EMR implementation?”


MU has spurred EHR adoption. No arguments there. Hard to argue against MU killing much of the EHR innovation and usability. We’ll see which exceptions emerge from the dust.

Daylight Savings Time EMR Impact, Blue Button, and 4000 clicks/shift

Posted on November 3, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Fall daylight savings is always a pain. Systems don’t like having something happen an hour later, but at the same time as something that happened an hour previous.


I’d love to hear what other people think of Blue Button. Do you think it’s great?


This stat really stood out to me. 4000 clicks/shift. That’s interesting to consider. Although, I wonder how many clicks I do every day of my job as well. I’ve always talked about how the number of clicks doesn’t matter as much as which clicks they are and how the software responds when you click. See my EMR to Piano Player analogy for more on that view.

TURF: An EHR Usability Assessment Tool

Posted on October 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Carl Bergman from EHR Selector.

To paraphrase Mark Twain, everyone talks about EHR usability, but no one does anything about it, at least until now. Led by Dr. Jiajie Zhang, the University of Texas Health Science Center at Houston’s National Center for Cognitive Informatics and Decision Making (NCCD) has developed several tools for measuring usability.

Now, Zhang’s team at NCCD has put several EHR usability tools into a Windows based app, TURF, an acronym for Task, User, Representation, Function. Funding for the project comes from ONC’s Strategic Health IT Advanced Research initiative.

TURF’s Tools. TURF has two major tools, Heuristic Evaluation and User Testing:

  • Tool One. Heuristic Evaluation: Expert Screen Capture and Markup. This tool takes EHR screen snapshots and let you compare them to usability standards. You can markup the screen and document the problem.
    Turf Expert Markup Tool - Showing Problem and Documentation
    For example, you can note if the error is minor, moderate, major or catastrophic. The system has a review function, so others can look at your markup and comment. The system also compiles your edits and can generate various statistics.

    • Administration. To work with groups, the system has several preset admin template forms and a template editor. The furnished templates cover these areas:
      • Demographics
      • Expert Review
      • Performance Evaluation, and
      • System Usability. This form asks 10 questions about the EHR, such as:
        • I think I would like to use the system frequently,
        • I thought there was too much inconsistency in this system,
    • Standards. The system uses the National Institute of Standards and Technology’s (NIST) EHR usability protocol, NISTIR 7804. You may also add your own rules to the system. (Also, see EMRandEHR.com, June 14, 2012.)
    • EHR Sections. Using the NIST protocol, the system’s review areas are:
      • Clinical Decision
      • Clinical Information Reconciliation
      • Drug-drug, drug-allergy interactions
      • Electronic Medical Administration
      • ePrescribing
      • Med – Allergies
      • Medications list
      • Order Entry
      • User defined
  • Tool Two. Live Session Testing. TURF’s user test tool sits on top of an EHR and recording each movement. TURF’s designers have created a system that not only tracks use, but also adds these major functions:
    • User Sessions. TURF captures live screens, keystrokes, mouse clicks and can record a user’s verbal comments in an audio file.
    • Administration. The tool is designed for testing by groups of users as well as individuals. It captures user demographics, consent forms, non disclosures, etc. All of these can be tailored.
    •  Testing for Specifics. TURF allows managers to test for specific problems. For example, you can see how users eprescribe, or create continuity of care documents.
    • Comparing Steps. Managers can set up an optimum selection path or define the steps for a task and then compare these with user actions.
    • Reporting. TURF builds in several counting and statistical analysis tools such as one way ANOVA.

  • Running TURF. TURF isn’t your basic run and gun app. I downloaded it and then tried to duff my way through, as I would do with most new programs. It was a no go. Before you can use it, you need to spend some time setting it up. This applies to both its tools.

    Fortunately, TURF has about 30 YouTube tutorials. Each covers a single topic such as Setup for Electronic Data Capture and runs a minute or so. Here’s what they cover:
    Turf Tutorials Screen
  • Hands On. Installing TURF was straightforward with one exception. If you don’t have Microsoft’s .Net Framework 4.5 installed, put it up before you install TURF. Otherwise, the install stops for your to do it. TURF will also want the Codex that it uses for recordings installed, but the install deals with that.

    TURF is a Windows program, so I ran it in a virtual Win 7 session on my iMac. Given the environment, I kept the test simple. I ran TURF on top of a web based EHR and had it track my adding an antibiotic to a patient’s meds. TURF stayed out of the way, recording in the background.

    Here’s how TURF captured my session:
    Turf Playback Screen
    The left side screen played back my actions click for click. It let me run the screen at various speeds or stop it to add notes. The right screen lists each move’s attributes. You can mark any notable actions and document them for review by others. You can save your sessions for comparisons.

I found TURF to be a versatile, robust tool for EHR usability analysis. Its seeming complexity masks an ability to work in various settings and tackle hosts of problems.

If you aren’t happy with your EHR’s interface, TURF gives a remarkable tool to show what’s wrong and what you want. Indeed, with some adaptation you could use TURF to analyze almost any program’s usability. Not bad for a freebie.

World Health IT Market Size, Microsoft in Healthcare, Advanced EHR Usage, EHR Usability, and ICD-10

Posted on March 4, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Back once again for our weekend roundup of EMR and Health IT tweets. A number of interesting tweets out there this weekend, so let’s get to it.


$162.2 Billion (yes, that’s billion with a B) for the world Healthcare IT market. That’s a lot of money going to healthcare IT. Considering how far along we are (or maybe I should’t say aren’t) in the US, imagine how much bigger that’s going to be. Although, much of this market is in equipment. Just take a look at the RSNA conference to see what I mean.


Google Health gave us this lesson as well. Although, I love seeing bigger companies take risks.


I’m always surprised when I hear story after story of someone “adopting an EHR” and then realizing that they use a very small subset of the EHR features. So, I definitely agree with this tweet.

These next 2 tweets go together:


This is a pretty complex question. One I’ll have to consider a bit more. I’d love to hear your thoughts.


This was a tweet from the #HealthITJam chat I participated in for a bit. If you haven’t read my post on ICD-10, you should.