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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.

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.

Teaching To The EMR Template?

Posted on October 7, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Are teachers of family medicine being forced to teach to EMR templates?  According to one blogger, the answer is a decided “yes” — and it’s probably not a good thing.

In a posting on the blog for the Society of Teachers of Family Medicine, Bill Cayley, Jr., MD. argues: “With the increasing use of electronic medical records (EMRs) and their ever-so-helpful templates, smart sets, and forms for capturing information needed to support billing and guide protocols, I fear we are losing the narrative forest for the well-documented trees.”

Cayley writes  that teachers of family medicine  have a particularly strong tradition of teaching students to write nuanced narratives. “The flow of meaning and story that comes from a patient’s history and give far more insight into what may be going on than one gets from simple documentation,” he notes.

These days, however, EMR documentation pushes  physicians and learners to document positives and negatives rather than the patient’s story, he says. For example:

* Emergency department documentation is growing in length, but conveying less meaningful information. “Documentation of an ER visit that in the past was captured by a one or two page dictated note now comes in an eight or nine page template document that gives no real clue as to what really brought the patient in,” he says.

* Doctors are increasingly responding to the template in office visits, sometimes ordering something because it’s there in the template, rather than listening to the patient’s narrative, he says.

* Far too often, doctors are being forced to re-gather the entire history with the patient themselves, because prior documentation fails to provide the nuance needed to understand what happened during the last visit, Cayley reports.

Even if everything Cayley says is true, it’s worth nothing that templates offer some relief over paper charting duties.  As John Lynn notes, doctors have historically had to go through stacks and stacks of paper to do traditional charting, often bringing home piles of charts just to stay caught up. That sort of backlog has consequences of its own.

But if using an EMR is squeezing meaning out of doctors’ — and future doctors’ — record-making process, that’s a warning sign that shouldn’t be ignored.  Let’s hope vendors find more of a happy medium going forward.

ICSA Labs Questions Strength of ONC Certification Rules

Posted on August 11, 2011 I Written By

You’ve undoubtedly heard the argument before: EHR certification is about assuring that systems meet minimum requirements for functionality and interoperability, but the certification process falls way short in terms of usability, privacy and security. But have you heard the argument from one of the ONC-authorized certification bodies?

This is an excerpt from an e-mail I received today:

Meaningful Use criteria have become a massive EHR certification driver for healthcare organizations. Hospitals and other providers rely on the criteria to ensure that their health IT systems meet minimum government-specified functionality and interoperability requirements to support Stage 1 of Meaningful Use.  Achieving Meaningful Use also ensures a health care organization qualifies for reimbursement under the American Recovery and Reinvestment Act as a way to incent adoption of e-health processes among health organizations. The ultimate goal is to improve our nation’s healthcare system by leveraging technology to allow greater access to important health information and empower patients to securely access their own health information.

However, as one of only five organizations authorized to test both complete and modular EHRs by the Office of the National Coordinator (ONC) for Health IT, ICSA Labs questions whether EHR certifications are enough as the criteria represents only minimum requirements. Amit Trivedi, healthcare program manager at ICSA Labs, believes providers should take further steps to heighten the security and privacy of their health IT systems. He also suggests vendors should look beyond the current regulations to address and improve usability, data portability, and information exchange in their products.

That’s right, ICSA Labs, one of five organizations currently authorized to test and certify complete EHRs on behalf of the Office of the National Coordinator for Health Information Technology, seems to think that the standards it tests EHRs against are inadequate, which is something that critics of certification—particularly critics of the Certification Commission for Healthcare Information Technology—have been saying for years. Critics of many of the larger vendors have been saying that, too. But it’s shockingly refreshing to hear this from an actual certification body.

In fact, the publicist for ICSA, a unit of Verizon Business, has offered interviews with executives of two lesser-known vendors,  Health System Technology and Design Clinicals, to talk about how they are going beyond the minimum certification requirements. Deadlines beckon, so I didn’t really have time to wait for the publicist to try to find me an schedule opening for one of the executives, but here’s a statement from a March 30 ICSA press release that is somewhat telling:

“This year we are expanding our certification programs into health IT, a much-needed area of focus to help modernize today’s health care system,” said George Japak, managing director for ICSA Labs. “With our new focus on safeguarding patient information within electronic health records, we are committed to helping accelerate the adoption of health IT.”

We don’t hear too much about security in the context of certification from too many other camps, so it’s nice to hear that at least one certification organization is critical of the rules it is under contract to follow. Perhaps we’ll see tougher usability, privacy and security standards in the permanent certification program ONC needs to have in place by the beginning of 2012 to support the forthcoming Stage 2 “meaningful use” requirements from CMS.

Wishful thinking?

The NIST Workshop on EHR Usability

Posted on June 14, 2011 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.

As much as I’d like to visit DC (I’ve never been), I wasn’t able to make it out there to attend the NIST workshop on EHR usability. However, Carl Bergman from EHR Selector did make it to the event and sent the following notes on EHR usability according to NIST.  Most of the speakers name link to their slides in PDF format.

National Institute of Standard and Technology’s Workshop on EHR Usability

This week I went to a NIST workshop examining the state of EHR usability. The workshop was at its administrative headquarters, a large 60s building on its sprawling Gaithersburg, MD campus about 20 miles outside Washington.

You might wonder what NIST is doing in the EHR business? I certainly did. NIST’s mission is to promote commerce and technical innovation including methods to determine, independently, the safety and security of a broad range of technologies including software. (It’s part of the Department of Commerce.) Since WW II, this has involved looking at the human factors involved in operation of every thing from nuclear plants to robotics. Interestingly, it’s not a regulatory agency, such as, the FDA or FCC. NIST’s standards work is through consensus building among manufacturers, consumers, regulators, etc.

The workshop, attended by about 200 persons, had two parts:

•      A review of the state of EHR usability studies by academics, practioners and system administrators and,

•      Introduction of NIST’s draft for a usability standard.

Part I. EHR Usability Today. There were many speakers, here’re the ones that had the most new information for me:

•      Mat Quinn of NIST covered its approach and work with ONC on the issue. Notably, NIST has published several documents in the area such as, NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records, (NISTIR 7741) which promotes a user centric approach to design and development.

•      I was really taken by Muhammad Walji’s study using a unified framework for EHR testing. The study compared user experience with the VA’s Vista program and a prototype system. It looked at:

o   What percent of an operation was substantive and what was overhead?

o   How long it took users to reach various performance levels.

o   How much memorization tasks took.

o   How many steps tasks required.

o   Error and recovery occurrence.

o   Time to complete defined tasks.

The study then applied its findings to rework the EHRs’ structure and workflow showing potential time and effort savings.

•      Anjum Chagpar of Toronto’s University Health Network. A human factors manager for this large healthcare network, she discussed the problems of integrating various vendor products into their system and their approach to usability and user satisfaction.

•      Buckminster Fuller famously declared, “I am a verb.” Dr. Lyle Berkowitz may not be a verb, but he is at least a gerund. His presentation swiftly covered several topics from HIMSS’ EHR Usability Task Force to usability definitions to stakeholder roles, and applying metrics to see how much of the problem was the system and how much the user.

•      The VA’s Dr. Jorge Ferrer provided several key references on usability studies.

Part II. NIST’s Proposed Protocol. If the first part took a broad and free ranging approach to usability, NIST’s staff approach was more focused. After an outline of the study’s setting and approach, the study director, Lana Lowery, outlined the protocol’s goal: prevention of unacceptable medical errors. These include errors of both omission and commission, for example:

•      Writing an order for the wrong patient.

•      Prescribing the wrong dosage.

•      Omitted information causing an error.

•      Critical delays in delivery due to system design errors.

•      Errors due to incorrect sequencing of actions.

Next, came examples of EHRs allowing errors. Unfortunately, several of the examples weren’t well thought out. For example, a patient ID error showed two patient records on the screen. One had the first patient’s x-ray, but the second patient’s name. Most likely, this would be a database problem or an x-ray production error not an EHR problem.

Robert Schumacher of User Centric, outlined how the protocol would be tested. For example, review and update of a problem list or replacement of one medication with another. The plan included testing several of ONC’s meaningful use functions that had usability factors.

Part III. Workshop Reactions. The workshop finally broke into two discussion groups: one for the draft protocol and the other on consensus building. In both cases, the discussion quickly went off script. Participants were quick to criticize the staff’s error oriented protocol as too narrow. Why, for example, did the protocol focus on internal EHR processes to the exclusion of workflow generated errors?

I understand NIST has a high interest in eliminating catastrophic errors, but I think there is not enough solid evidence on the kind and extent of the problem. No one discounts the need to prevent catastrophic errors, however, much of the EHR error focus is due to anecdotal reports of computer prescribing errors. From what I read, many of these reports are both old and recycled. Does anyone know the actual extent of major errors?

The FDA has developed several systems for dealing with medical device errors. These now include the software that the devices use. Even if the FDA does not regulate EHRs, it may step up its efforts to record important errors. I’d sure like to know FDA’s findings before I started an effort to shape EHRs.

This is not to say that safety is not important in EHRs, obviously the types of errors that are outlined by the staff are major. However, I think there are three points that are missing in the NIST approach:

•      Design for Success. You can’t design for failure. You have to design for success. The object of EHRs, as with any system, must be to accomplish certain ends. If you loose sight of that, you may not make mistakes, but you also will fail your objective.

•      Risk Analysis. Risk analysis measures the impact on a given population of an action, its potential and costs broadly defined. It also specifies mitigation efforts. I’d be far more comfortable about the protocol if there were a risk analysis behind it.

•      Error Handling. There should be more thought to error handling. For example, when the stall warning alarm goes off on a plane, it doesn’t grab the stick and take control. It’s a warning, just that. Physicians should be warned if they are about to prescribe beyond the recommended dose, but they may have good clinical reason to do it.

NIST put on a worthwhile workshop. My guess is that the draft protocol is not going to survive without modifications that take into account a broader range of usability issues and approaches.

EHR Usability Will Be Part of Meaningful Use Stage 2 – #HIMSS11

Posted on February 20, 2011 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.

In probably the biggest news of the day at HIMSS, we got the following tweet spreading quickly through the Twittersphere:

There you have it. Word out of ONC is that meaningful use stage 2 will include some form of EHR usability. How that will be, I don’t think even ONC knows. Although, I’m sure they’ll consider looking at the EHR usability that’s already in CCHIT.

What I don’t understand is why they would do this. First, it should be part of the EHR certification and not meaningful use (maybe it was a mistweet). Why would ONC want to measure an EHR’s usability during meaningful use? That’s too late, no? Although, maybe it’s just ONC trying to collect data for other doctors that will select an EHR later? I don’t understand it.

Plus, let’s look at the EHR usability that’s been done by CCHIT. Has it really improved the usability of EHR systems?

I asked someone at HIMSS this question, and they said something like, “Of course not.”

We all want the EHR software to be usable. I just don’t understand how ONC adding it to meaningful use stage 2 will help achieve that goal.

EMRandHIPAA.com’s HIMSS11 coverage is sponsored by Practice Fusion, provider of the free, web-based Electronic Medical Records (EMR) system used by over 70,000 healthcare providers in the US.

Complaints of EMR Documentation Aren’t Completely the EMR Vendors’ Fault

Posted on November 24, 2010 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 the biggest complaints surrounding the implementation of an EMR is the way the EMR software handles the documentation method. Beyond just the learning curve, there are plenty of EMR software that have a terrible user experience.

While I don’t want to totally let EMR vendors off the hook, I do think it’s worth noting that EMR vendors aren’t completely to blame for the unwieldy interfaces. I believe one of the biggest reasons that the EMR documentation interfaces are so terrible is thanks to the crazy insurance billing and documentation requirements.

Seriously, it’s a total mess. Everyone that’s involved with insurance billing in healthcare knows what I’m talking about. Trying to code an application that’s easy to use, works well for the doctors and still handles all the insurance billing and documentation requirements is a serious challenge and so it’s not surprising why so many EMR software fails to deliver a great user experience.

That’s not to say that all EMR software have terrible user experiences. Although, let’s be honest that they’re taking on a nearly impossible task. I guess I compare the insurance documentation and billing requirements to cleaning a toilet. Nobody really likes to do either. Yet, they’re absolutely necessary jobs. Certainly there are some tools that can make cleaning a toilet easier (gloves, wands, cleaning solutions, etc). However, it’s still a task that isn’t fun to do no matter how you slice it (unless you pay someone else to do it, but the pain of the expense is still there). The billing and documentation parts of an EMR software are trying to do the same thing: make a task that no one likes easier. Unfortunately, using an EMR isn’t going to change a task that no one likes into something fun.

I hope that EMR vendors don’t use this as an excuse to not focus on creating usable software. It’s NOT! However, I think it’s important to consider the true impact of the EMR. Is it really the EMR software that is so bad or did you hate these parts of practicing medicine before having an EMR as well?

If you find that it’s the EMR software that’s so bad, then hopefully you were smart in the contract you signed with your EMR vendor (see the EMR contract section of my Free EMR Selection e-Book). You won’t be the first or the last practice to switch EMR vendors.

Of course, if the complicated insurance billing and documentation is the problem. Maybe Obamacare’s single payer insurance plan will help to solve that issue. At least there would only be one organization to deal with.

Future EMR Differentiation Will Be Usability and Not Features

Posted on October 4, 2010 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 week I saw a product demo of EMR vendor, SOAPware. Now that SOAPware has their fully integrated practice management system, they have a great demo and all the features you could want in an EMR system.

In fact, as I was watching the demo and asking questions about different features they might have or not have I came to an interesting realization. SOAPware, and most EMR vendors that have been around for any reasonable amount of time, have all of the features covered. They all have ePrescribing. They all have CPOE, and Clinical Decision Support. They all have allergy and drug interaction checking, etc etc etc.

Basically, it seems like the EMR market has matured to the point that we’ve covered all the base features that a doctor could use for their clinic. The real challenge now is going to be how usable an EMR vendor can make their software.

That’s right, Usability is going to start to trump features as a provider differentiates the various EMR software.

The fundamental challenge of an EMR software has been the time a doctor spends charting in their EMR. I don’t think that we’ve really nailed down the user interface that’s going to change this yet. Certainly there’s been some really great progress since EMR software was first launched. The iPad and other touch screen devices present and interesting alternative input method. However, I think there’s still a lot of room for some EMR vendor to dramatically change the game on how a doctor interacts with their EMR software. I’m talking revolutionary change to the interface and approach. I look forward to that day.

Full Disclosure: SOAPware is an advertiser on EMR and HIPAA, but they didn’t pay me to write this article or talk about seeing their demo.

Designing an EMR as More Than a Paper Chart

Posted on February 21, 2010 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.

EMR Quote of the Day comes from a comment on one of my most popular posts:

“An EMR is not a paper chart on the computer screen and as long as users think that way, complain when it doesn’t work that way, and vendors design that way… there will be issues with electronic medical records.”