What level is your EMR/EHR?

Level 1 EMRs

Warning: The following text is needlessly cruel

Level 1 the PITA : EMRs that double the work — systems where the EMR is used for documentation or compliance, but all the real work happens in written form, so this just increases the net amount of work done. [Admittedly, this is a problem of the administrative system, not so much the EMR itself, at times] (a large  majority of  EMR deployments in india are this kind)

Level 2 the copycat : EMRs that successfully replicate all the physical record keeping and so work isn’t double, but  worsens things because replicating physical workflows in-toto  invariably will make everything slower (This is what most new EMR implementations are)

Level 3 The trying-very-hard-to-be-cool: EMRs that have some automation and short cuts built in, like medication templates, discharge summary templates and suchlike which in some areas, significantly reduce the time taken to do a task and are overall nearly as fast as paper and pen ( I’ve seen a few of these)

Level 4 The we-do-design-thinking-and-listen-to-the-money : EMRs that have thought through the clinical processes  and removed all parts that do not need to be there, and have largely click and pick workflows these are faster to use than other EMR/EHR and might even be faster than pen and paper. (I’ve seen maybe one of these of these)

Level 5 : EMRs that are faster than pen and paper, assist and improve decision making and make things easier for patients. (Haven’t met one of these so far)


  1. EMR will never ever attain what it should be because in India NOBODY conducts research before they write even the “basic expectations” from software. Worse, those who design simply design anything, because they have no idea of the basic expectations.

    I have had such a disastrous experience in one Mission Hospital where I was the Trustee.

    A properly designed EMR software should be so comprehensive, without taxing the person filling it, that all possible and impossible data is taken care of. What is more, they should be able to input data using any device, mobile, tabs, computers, even dumb terminals.

    One reason why this is not going to happen (just one out of a dozen) is that in our country designers are not users and users are not designers. Never shall the twain meet.

    Dr. Johnson C. Philip

    1. I agree that we have a lot of this problem of design by non users, i see it in tech a lot. but that is not always avoidable. we can definitely do better. I am not so sure that it is NOT going to happen or doesnt happen, i think it does, just not very commonly, and that there are economic and cultural reasons for this. EMRs are broken all over the world, information-dense interfaces are tough to create.

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