EHR Architecture

EHR Science and the Coming of Clinical Swift

by Jerome Carter on November 23, 2015 · 4 comments

As you may have noticed, for the last two weeks, resource pages have not been updated and there was no post last week either.  That is because a minor accident resulted in a week’s worth of misery, and not much work being done.  Thankfully, things are quickly returning to normal.  Oddly, one consequence of my […]


Software should make one’s life better. Otherwise, why use it?   Clinical software should make completing clinical processes more efficient and productive. Unfortunately, the complexity of clinical processes, even those considered simple by most people, is often underestimated.   Clinical processes require thought and action. Thus, any given workflow must account for one or more of the […]


Everyone has his/her own way of accomplishing a task. Now that I have taken up gardening, I have my own way of mulching, preferred brands, and favorite tools. This is a natural consequence of repeating any task enough times—we all find ways to make things easier for ourselves.    Once habits are formed, we are loath […]


Pre/post-implementation studies typically use a few standard measures. Business metrics (e.g., total cost of ownership, return on investment, revenue changes) and clinical metrics (e.g., patient visit levels, visit duration) are employed to get an understanding of how the EHR’s presence has impacted the organization (1,2,3).   Unfortunately, clinical metrics often assess the post-implementation state from too […]


Building clinical care systems that intimately support clinical work has to begin with the acknowledgement that clinicians perform many tasks within the context of a patient encounter, and those tasks very in type, number, and sequence.   Everyone knows this. So, one might ask, if this is common knowledge, why are there so many problems with […]


As I have written more about EHR design, I have noticed the term has different meanings among various groups focused on HIT. There are so many different groups focused on HIT — each with its literature and jargon — that at times it is difficult to communicate. The rising interest in user-centered design has made […]


Everything changes.   The workflows from last year may not exist next year.   There will be new reporting requirements, new data elements, new forms, and new coding systems.   Creating software that grows gracefully with the times takes serious architectural thinking from the outset.   Vendor pain due to changing MU certification requirements makes the case that flexible […]