In the course of interviewing two sources for two different stories, interviewees took me down the same interesting side street, conversationally. They both were convinced the best electronic health record (EHR) applications are built when programmers first shadow a clinician before they design their systems — when the tabula is still rasa. They end up creating a much more common-sense EHR application than those who build their systems first and then get real-world exposure in time for the final tweaks.
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Software engineer Brad Jannenga, co-founder of physical therapy-focused EHR WebPT, told of his entrée into the field: He met his eventual wife, a physical therapist, who was in the process of choosing an EHR vendor. She asked him for some help making the considerably expensive decision. He threw himself into the task — even following her around for a shift and then comparing her actual needs to the feature sets they offered.
“I found the software that was out there to be out of date, [featuring] terrible [user interfaces], just not very good. And really expensive,” Jannenga said. “I chose the best of the worst, and got a quote. $60,000 for a good-sized clinic to get started. Basically, I told her I could build something better. Maybe that was a little cocky on my part, but I followed her around the clinic, learning how she did her job, learning how she did the treatment of patients, and what she needed. We put our heads together, and I built the app.”
The rest, as they say, is history. And the subscription-model WebPT is making a run at the physical therapy EHR market.
Georgia obstetrician Dr. Anne Patterson is also an engineer, and her story will be told more in-depth elsewhere on our site. She started out her career working for NASA, and later earned her M.D. after a fellow engineer who developed medicine’s earliest laser equipment convinced her that it would be better for her to become a physician — or she’d never get to use the tools she was helping design.
She has a unique perspective on technology and medicine, coming from both sides of the fence — unlike many physicians and CIOs, who typically live on one side or the other. Her take echoes Jannenga’s — EHR applications should be designed in the way he wrote WebPT. Get the software architects to see the clinician in action, first. Or at the very least, the applications should be extensible and flexible so that integrators can either add to the EHR or otherwise customize each individual installation, bending it to a particular clinician’s workflow.
“If people were writing a program or modifying something a physician’s going to use…sit down with a physician and say, ‘We’re working with you today,’ and get more than one opinion,” Patterson said. “It would break down barriers, [and] you have an understanding of what’s going on.”
Interesting stuff. How many EHR systems start out with a database component or another licensed product, with code bolted on to it until it’s hammered into the shape of an EHR? How many EHRs sort of evolve from back-office billing or insurance information systems? Or were afterthoughts to those applications?
A lot of physicians are signing up for EHRs for the first time because the federal government is making an offer they can’t refuse. There are hundreds of EHR vendors out there competing for a pool of customers that dwindles every day. Vendors who pull their heads out of their laptop screens and actually follow their target customers around before they begin building their apps might be able to sling stones at the current Goliaths dominating the market.
For those physicians still in the process of vetting EHR vendors, that could also be a question to ask the various sales reps: Did your team watch first, and code later? According to these two interviewees, when that happens, more intuitive EHR applications emerge from the software development process.