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In: Clinical Care Systems, Clinical Process Management, Clinical Software Design, EHR Design

The Institute of Medicine report on the computer-based patient record (CPR) described two types of application users: primary and secondary (1). Primary users are those involved in direct patient care. Secondary users make use of the data captured or generated by primary users. Obviously, the two groups have different viewsContinue Reading

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In: Clinical Care Systems, Clinical Process Management, Clinical Software Design, EHR Design, EHR Usability, Results Management, Software Architecture/Design

No, the title is not a mistake. It simply reflects what I have come to realize over the last month or so. Innovation is about solving problems and, as the saying goes, “Necessity is the mother of invention.”   Misery is a source of innovation, and the loudest cries about EHRContinue Reading

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In: Clinical Care Systems, Clinical Process Management, Clinical Software Design, EHR Design

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 ofContinue Reading

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In: Clinical Care Systems, Decision Support, EHR Design, Software Development

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 andContinue Reading

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In: Clinical Informatics, Clinical Software Design, Decision Support, EHR Design

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 resultContinue Reading

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In: Clinical Care Systems, Clinical Process Management, EHR Design, Object-oriented Analysis & Design, Software Development

For the last six months or so, I have been doing parallel work with Apple Swift and BPMN 2.0.   For each, I decided to do a deep dive, meaning I tried to closely follow object-oriented analysis and design (OOA&D) best practices for Swift and an equivalent methodology for BPMN. TheContinue Reading

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In: Clinical Care Systems, Diagnotic Error, EHR & Malpractice, EHR Design, Electronic Health Record Systems

The first time an attorney contacted me after reading EHR Science, it was on behalf of a plaintiff who had a delayed diagnosis during a changeover from paper to an EHR.   That was three years ago.   Recently, a defense attorney contacted me because the plaintiff was challenging the validity ofContinue Reading