“It’s the Interface, Stupid” Revisited: If X-Box Can, Why Can’t our EMRs?

I wrote about this three years ago, which is long enough to make a cell phone outdated, if not downright obsolete. From what I can see, nothing has changed in terms of what EMRs look like. In one of my practices we have a new (?!) EMR that’s even clunkier than its predecessor from the same company (Greenway, you know who you are: Why do you make me SCROLL down Every Blood Test Known To Man instead of starting to type in a search box???).

Doctors are still mostly charting on laptops or even desktops. Haven’t the EMR companies heard of iPads? eCW has a fair app, but with bugs that haven’t gone away in the last three years and new ones that are appearing. Nobody has an interface that works like a doctor thinks, and nobody has the user interface simplicity of the technically sophisticated games my grandson plays on his Xbox. Actually, video games allow you to do everything without awkward commands or click boxes. And they go back to the early 90’s (see post script below).

If I open a patient’s “chart” today and try to prescribe a drug, the software asks what day’s encounter and what type of encounter I want this to be under. Excuse me: It’s today and I’m sending in a script. Why do I have to tell my multimillion dollar system that?

The technical unsophistication of EHRs is mind boggling, but even more appaling is the worse-than-DOS-era interfaces we have to deal with. My nurse gets a paper depression questionnaire from my patient. It is abnormal. She enters the details and the score in the computer. I don’t get a pop-up. Instead, I have to remember to click FORMS-Nurse Work Flow-Screening-PHQ9 and then see the score and click one of the boxes to document my action. How sad, how nerdy, is that?

I would like to know what the excuse is for the fact that children’s games have better interfaces than EMRs. And don’t tell me that medical records are more complex. They are not, at least not yet. I can mark a patient as allergic to iodine and having stage 3 or 4 kidney disease but many systems would still let me order a CT scan with iodine contrast. Someone (many of them) is making indecent amounts of money selling indefensibly inadequate, incompetent software to the nation’s health care providers. And laughing all the way to the bank.

P.S. Historical footnote: My Brooklin home was once owned by Mark Lesser, who was the programmer behind NHL 94, one of the most famous video hockey games of all time. His office on the third floor of the barn was my “man cave” for several years.

5 Responses to ““It’s the Interface, Stupid” Revisited: If X-Box Can, Why Can’t our EMRs?”


  1. 1 Charlotte Duncan September 15, 2020 at 9:55 am

    It’s the money. People who are not medical professionals write software that will not interface with any other software. Its purpose is for billing, not keeping track of patients (hence it allows you to order the CT scan because it will bring in money, not protect the patient). It is just part of the US “healthcare system.”

  2. 2 Keith Wilkerson, MD September 27, 2020 at 8:42 am

    I think that the simple answer is that EHRs have never been about patients or the clinicians who care for them; they are more for data collection for insurers, payors, government entities, etc. We as a medical community at large made the error of thinking they were tools developed for us to use; conversely, I think they were tools that were developed to use us. Ease of use, workflow efficiency, negative impact on our workday, negative impact on face to face meetings with patients, etc. have very evidently never been their concern.

  3. 4 Edward Wilson September 27, 2020 at 9:28 am

    Welllll, the reality is that there are only a few video game makers and lots of users, therefore lots more money available for creating the xbox platform than for creating a medical software system. The investment by the game user is not high enough to keep him from switching platforms, so competitive influences are high. The data set management has to be a lot simpler for games and does not have to satisfy medicare. Seems odd that Microsoft or Apple or another huge software creator has not gotten directly involved. My biggest gripe as a solo practitioner was actually that government did not step in and standardize the data structure in such a way as to make the systems interchangeable. I was really concerned that when I sold my practice I would have to maintain my system and service contacts for years to preserve patient records. Can’t just hand a stack of charts to another doctor anymore. Fortunately, I was able to transfer the practice with the system intact, so avoided that mess. whew!

  4. 5 Mamadoc September 27, 2020 at 11:10 am

    EMR is one of the biggest reasons I retired. Keith (and Zdogg) pointed out the major flaw. It wasn’t about patient care: “a billing platform with some patient stuff tacked on.”


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