How to Improve Electronic Health Records (EHRs)

As an expert on strategic simplicity®, I have worked with industries, including the medical and pharmaceutical fields, where workers need to interact with electronic user interfaces.  The biggest reason that doctors hate EHRs is because of the forced complexity.  EHRs, as currently implemented, lack the flexibility needed to make doctor's lives easier, and allow them to spend more time with their patients.   

Currently, doctors have to fill out many fields which do not apply to every situation, and they must select and enter precise codes and descriptions.

An improved EHR would be organized into sections that can be skipped or selected as needed, and would allow more freeform entries, rather than codes.  The reality is that medical records are shared between human professionals—not machines.  Allow doctors to enter information in a freeform manner, and let them evolve best practices for describing the information. 

E2C vs. E2E

You've probably heard terms like B2B, B2C, and B2G.

Have you heard of E2C and E2E?

E2C  =  Employees who service customers

E2E  = Employees who service other employees (internal customers)


I coined these terms because, in my experience, especially at large companies, internal customers are not treated with the respect given to external customers.

Internal customers have to jump through more hoops, suffer from more lousy service and delays, and often have to put up with sub-par user interfaces and computer systems.

This ultimately harms the entire business.

That is why, in my Strategic Simplicity® Framework, even though user simplicity is often regarded as "making the (external) customer's life easier", my definition of user simplicity includes applying it to internal customers (employees).

User Design Lesson From XM Radio

They always list the band name over the song title but, to remove any ambiguity, they also put a human icon next to the band name and a musical note icon next to the song title.

Simplicity + No Ambiguity = Good User Design  #design

ServiceNow: Another Example of the Link Between Simplicity and Innovation

Forbes magazine recently had a list of the most innovative companies in the world.  One of the companies it profiled was ServiceNow.

They offer a work flow system that makes it easy for employees to easily request IT services.

As Forbes says:

"The special sauce—the thing that gives ServiceNow the fat 'innovation premium' that drives our ranking—comes from two product traits with the potential to scale: simplicity and customizability.

ServiceNow's IT tools don't require the IT department to set them up.  Once running, they offer a single collection center for requests, data points and checkpoints, all of which in turn can be analyzed by algorithms to predict needs, flag concerns, and measure efficiency."


Now that ServiceNow has gotten into many large companies, they can leverage their IT service platform to move into other areas—to compete with other vendors such as  Salesforce by offering the same process (simplicity, customizability) to other content areas.

As ServiceNow CEO John Donahue (former CEO of eBay) is quoted in Forbes on the "need to make complex processes simple and elegant":

"Millennials say, Why can I reset my PayPal password in 20 seconds, but to reset my work email takes 20 minutes and a phone call? Consumers want a seamless experience, and employees are the same way."

This last point is something that I've noticed in many of my clients:  They focus on the user experience for customers (user simplicity), but they tolerate clunky interfaces for internal apps.  I tell my customers that user simplicity is also important for your employees.

Praveen's Strategic Simplicity® Framework

My Strategic Simplicity® framework helps leaders dramatically drive business growth and improvement.


Here are the components:

1. Change Simplicity -  This refers to thinking about a transformation / project as a TV series as opposed to a movie. We should break change into phases, or “micro projects,” that can be implemented iteratively. “Rinse and Repeat,” as the wisdom of the shampoo bottle tells us. This way, we can easily adjust to changing marketplace relevance.

2. Market Simplicity - This is about stating the “Why” of the project as succinctly and clearly as we can, so everyone understands what results we want. It is also about prioritizing, clarifying, and triaging business requirements, so that we focus on only implementing change that is strategic to the business. Transformations and projects are successful when the outcomes are relevant, stated simply, and clearly worded. Many problems occur not because of technical issues, but because of communication issues.

3. Decision Simplicity - Having to make decisions based on ambiguity and/or having too many options results in paralysis by analysis. We need to narrow choices and filter information in a way that allows apple-to-apple comparisons. All through the project—from strategy through implementation– we need to be able to synthesize information to make timely, informative decisions.

4. User Simplicity  - Most companies are aware of the need for positive user experiences for their customers, but they neglect their “internal customers” (employees). Many technology companies have employees straining to be productive on internal systems with clunky interfaces that they would never sell to their customers. Timely implementation success depends on teams being able to work effectively, without having to deal with unessential road blocks.

Time Magazine Unsubscribe Example of Non-User Design Simplicity

I have a subscription to Time Magazine, and they kept emailing me offers for other magazines.

I got tired of it and went to unsubscribe.  They had an email opt out.  I clicked on it and:

1. I had to enter my email.

2. They said that it will take effect within a week.

This is not user simplicity.  In most cases, when you want to opt out of email, you just click on the link and click "confirm".  You do not have to retype your email (which is already known, since you are clicking on their email), and it takes affect immediately.

When it comes to improving your business with Strategic Simplicity, its not always a matter of making a massive change.  A lot of irritating complexity is caused by little things that can be easily changed.

No "User Simplicity" At AT&T

One of the important components of Strategic Simplicity that I help companies with is User Simplicity.

In today's world of Attention Scarcity, you irritate your customers if you waste their time and make the user experience difficult or unpleasant.

This morning, I had a negative user experience at AT&T.  I needed to call on behalf of an elderly relative who wanted to make his number unlisted, to cut down on unwanted calls.

As soon as you call AT&T, your connected to an AU—Artificial Unintelligence.  It kept asking me to explain what I was looking for, without immediately giving me the option to reach a human.

In my case, getting a number unlisted seems to be an uncommon operation, so the AU struggled to understand.  It kept ping-ponging me between menus—until I jabbed the '0' key several times in a row.

Then, I finally got put into a queue and waited another 10 minutes before reaching a human...

Crazy Medicine! No User Simplicity in Healthcare

Here is yet another reason why U.S. Healthcare is not an example of strategic simplicity:

A relative was paying $63/month for medicine because the pharmacist said his insurance company didn't cover it.

We told the doctor that the medicine wasn't covered, but he said he prescribed the generic.

We went back to the pharmacy and told them that it's the generic.  The pharmacist contacted the insurance company.

It turns out that they don't cover 20mg pills, but they cover 40 mg.  So, as long as he orders twice the strength, and splits the pills, he pays $0!

Talk about crazy medicine!

How Important is User Design and Simplicity in Software?

I am a management consultant who specializes in the four areas of Strategic Simplicity®: change simplicity, market simplicity, decision simplicity, and user simplicity.

How important is user simplicity / design, especially with software?  

It can change an entire corporate strategy.

I consulted and worked for a large multinational bank that developed an IT strategy to develop it's own web portal—which would eventually serve as the user interface for all of its legacy applications.  They even hired away some key executives from a prominent travel website, who were responsible for the travel site's state of the art portal design.

Around the same time, this bank entered the Chicago area and bought a local bank 1/10 its size. The larger bank expected to shut down the smaller bank's technology group and move customers to it's platform.

It turned out that the small local bank's software was rated much higher than the larger bank's in a survey conducted by a prominent banking magazine.  Their user interface was so good that the larger bank had to do an about-face with its strategy.

They ended up scrapping plans for its own portal, and they ended up shutting down the larger bank's software and switching to the smaller bank's platform.  The newly hired key portal executives ended up leaving, and the smaller bank's technology executives (who thought they would lose their jobs) ended up running the larger bank's tech operations.