April 2016

Clinical Workflow Center NIST and AHRQ have funded a collection of studies that focus on EHR-related clinical workflow issues. Overall, the reports contain useful information. However, there were a few things that I found puzzling. NIST and AHRQ Workflow Reports: A Few Observations Clinical Swift Inheritance is one of the cornerstones of object-oriented programming. Unfortunately, […]


Either a programming language feature can be just what one needs or an obstacle to go around.  Swift provides features that make clinical software design easier. Tuples support clinical concepts cleanly, and Swift offers a good implementation. Thinking Clinically in Swift   Modeling clinical workflows with BPMN allows one to capture precise interactions. Using Level […]


CPC+ and the Advent of Primary Care EHR Systems

by Jerome Carter on April 18, 2016 · 2 comments

With the announcement of Comprehensive Primary Care Plus (CPC+), the Centers for Medicare and Medicaid Services (CMS) has started a program that may influence EHR design as much as MU has impacted EHR adoption.   CPC+ has two tracks, and both require use of certified EHR technology along with reporting of clinical quality measures. Track 2 […]


Studies of what goes wrong behind the scenes in clinical software are somewhat rare. More commonly, reports address issues as they affect end users, not how those issues arise from programming errors or architectural missteps. Analysis of Clinical Decision Support System Malfunctions: A Case Series and Survey, by Wright and colleagues, provides information about how […]

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This Week on Clinical Swift

by Jerome Carter on April 7, 2016 · 0 comments

The prn: OnCall project is moving along well.   I have identified the main classes for the project and, in this week’s post, I review the rationale for each class along with a few other design decisions. Assembling the Class List for prn: OnCall


Drug Alert Fatigue and Software Design

by Jerome Carter on April 4, 2016 · 0 comments

The rise in EHR adoption has brought with it a 21st-century headache–alert fatigue.   Every day clinicians deal with numerous medication-related alerts, such as allergies, drug interactions, and duplicate medications.   Making matters worse is the fact that many alerts are clinically insignificant, causing cognitive overload and workflow disruptions, which could result in lower quality care.   Faced […]