An Untraditional Website for an Untraditional EMR

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Folks ask why EMR workflow systems looks so different from traditional EMRs. I’m also asked why our product website looks so different from other EMR product websites. There is a connection.

The following Dilbert comic strip (circa 1999) was taped to my door for years (and must be around somewhere, because I would not have knowingly tossed it).

I’ll get back to the strip later.

The High-Usability EncounterPRO Pediatric EMR Workflow System is designed to be used in the fast-paced, dynamic, and distracting environment of a pediatric office. Its large buttons, and ability of compensate for less than perfect environmental conditions, are based on the same usability design principles that make senior-friendly products senior-friendly and pilot-friendly cockpits pilot-friendly. The basic idea is “senior-friendly is everyone-friendly is pediatrician-friendly.”

My Top Ten Age-related Usability  Accessibility Guidelines

  1. Large buttons (”actual” EncounterPRO buttons) and underlined hyperlinks (retro!)
  2. No menus, shallow hierarchy
  3. Large san-serif font, extra space between lines
  4. Black on white and lots white space (most important material in foveal vision)
  5. Frequent emphasized headlines (chunked for skimming)
  6. Important phrases highlighted (again, for skimming)
  7. Glossary for technical terms
  8. Text-relevant illustrations (no generic clip art or photos, multimodal depth of processing issue)
  9. Omnipresent sitemap (such as a comprehensive navbar or fat footer)
  10. Redundant and intrapage navigation, backward and forward links (retro!)

You may disagree with some of these guidelines (and accessibility researchers often disagree among themselves). They’re just the ones that have made the most sense to me over the years. By the way, senior-friendly and child-friendly usability guidelines have a lot in common, but I’m going to reserve that material for a  future post.

Feel free to do your own research and weigh in.

Traditional EMR product websites do not typically follow these kinds of guidelines. Many websites are (allusion to comic strip ahead) some combination of Flash and html, or, even if there is no Flash present, they look “webbish” in that way: small form factor crammed with small font text, lots of menus, and generic medical illustrations (mostly happy medical professionals). And no fat footers or backward and forward links.

If you design for usability based on age-related accessibility guidelines, interestingly, the result is a bit retro. This is both understandable and not bad. After all, the DrudgeReport is, by some accounts, the best designed site on the web *and* looks like it’s caught in a mid-nineties time warp. One shouldn’t be surprised, since design principles should be timeless. They are a consequence of the structure and function, and therefore limitations, of our human body and cognitive systems. Part of the problem is that “webbishness” trumps good old-fashioned usability and accessibility.

Some of the following are a bit whimsical, but all contain at least a grain of truth:

My Top Ten Reasons for Designing A Senior-Friendly EMR Website

  1. Show that we know and care about EMR EHR usability and accessibility.
  2. Maximize length of time on website by making it easy on the eyes and obvious to navigate.
  3. Appeal to older pediatricians. Supposedly, older physicians are slower to adopt EMRs. Andrew Erikson posted this comment about traditional EMRs prompting physicians to retire. (Might the teensie-weensie little eye-straining checkboxes and radio buttons be part of the problem?) An EMR EHR workflow systems, with its simplified displays and order entry (made possible by a workflow engine executing process definitions) is ideal for the semi-retired physician who just wants a part-time practice.
  4. Seniors are the fastest growing web user demographic.
  5. Both sets of my, and my wife’s, parents are alive and clicking, and I’d like them to appreciate this work of great usefulness and beauty.
  6. I am the most frequent visitor to our website and *I* appreciate less eye strain, easy to recognize hyperlinks, and large targets to click.
  7. To make a point by being symbolically different and memorably distinctive.
  8. Generate interesting material for a blog post; after all, *you’re* reading this, right?
  9. More and more children have senior caretakers. Pediatric practices sometimes link to the website of their EMR vendor (example, lower right) to show they are using the latest technology to help their patients.
  10. Seniors like to print websites. I do too. The pages print well.

The Unbearable Sameness of EMR Websites

Most EMR product websites look and feel alike for three reasons.

  1. They are based on templates.
  2. They are “designed” by management.
  3. They are about similar products.

By “based on templates” I do not refer to templates used by EMRs, but rather to the templates into which is stuffed information about the EMR product. It used to be that you could tell a Frontpage website from a mile away. Now what’s obvious is the whole generic corporate sameness and lack of personality that characterizes most EMR websites.

By “designed by management” I mean that most EMR websites are designed to please upper level EMR vendor management (a la Dilbert’s Pointy-Haired Boss: “The website needs to be more webbish. But not too webbish.”). The result is a distance between the professional marketing orientation of the website and the immediate authentic experience and dreams of EMR users and designers.

By “similar products” I mean that most traditional EMRs are the clickity-clickity-click-click-click structured document management systems to which I referred in last week’s post.

Applying similar website templates to similar EMR products to please similar people yields similar outcomes. That’s why the EncounterPRO Pediatric EMR Workflow System website doesn’t look like other EMR websites. You can’t tell a book by its cover, but sometimes you can tell an EMR by its website.

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  1. Dustin
    Posted October 30, 2009 at 5:14 pm | Permalink

    Unfortunately, I am capable of mis-judging a website (especially a technology-centered website) based on it being “senior-friendly”. That phrase, smilar to “child-friendly”, produces in my mind the idea that the subject (toy, utensil, website, application, etc.) is technologically-dated even before I look at it. I expect a ‘child-friendly’ phone, for example, to be bulkier, slower, less powerful, less featured than the average ‘normal’ phone before I even look at it. The idea is that simplification in form must come at the cost of function and features. For most viewrs/users of an EMR website or application that may give that ’senior-friendly’ or ‘child-friendly’ feel, a potentially perceived handicap in form might need to be quickly overcome by impressive features and function. Or, the majority of viewers/users will need to allow themselves to be challenged and consider that simplification of form might not necessarily relate to loss of features and function.

  2. chuckwebster
    Posted October 31, 2009 at 6:30 am | Permalink

    The EMR industry, like every industry (and life itself), is full of stereotypes: how an EMR should look, how it should work, how long it should take to get up and running, how much can be achieved in the long run, etc. There is a profound connection between “simplification of form” (your phrase) and simplification of workflow. The former is due to the latter (as in architecture’s “form follows function” , I wonder if we’ll see a similar, pre-modern, modern, postmodern progression in EMR appearance). Many of my posts in this blog challenge preconceived and deeply ingrained beliefs about EMR appearance, operation, and impact on practice profitability, patient satisfaction, and clinical performance.

    Musical cognition and cognitive science, senior- and child-friendly design (see postscript), an untraditional website, aviation human factors, the fastest gun in the west, and even kickbikes, are all part of a creative attempt to explode EMR stereotypes by becoming even more blue in the face (that does seem close to a mixed metaphor, sorry).

    Thank you much for your post and I hope you do so again!

    P.S. While we’re on the subject of exploding stereotypes, I’m working on a sci-fi styled post about what pediatric EMRs will look like in twenty years. Children’s art on the walls, Little Mermaid running on a VVVVUUUHDTV, interactive toys in the corner, and an EMR that looks like it was designed by a children’s book illustrator. It’s all part of gradual evolution toward increasingly child-friendly ecosystems of reassurance and meaning. My wife works in the hotel industry, where scenography is a hot topic. As I understand it, scenography is design of a space as if it were a stage or movie set to tell a story. As in, when you check into a luxury hotel, part of what you are paying for is starring in your favorite movie. Hotel consultants are finding demand for their services in healthcare. I wouldn’t be surprised to see pediatric practices set up using scenographic techniques to achieve similar effects for their own child stars (may already be happening in rudimentary form). The pediatric EMR is part of the set, so it needs to be part of the story. It needs to have big (48 pixel square) buttons with soccer balls, flowers, and arms in casts.

    EncounterPRO Pediatric Buttons

  3. chuckwebster
    Posted November 10, 2009 at 11:16 am | Permalink

    Combining toys and cartoons with EMR device and user interfaces does seem futuristic. However, here is some research that is paving the way.

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