Enhancing EHR implementations at hospitals
ALLSCRIPTS
Project in brief
Sunrise EHR — core product of Allscripts — implementations at hospitals frequently exceeded time and budget due to extensive customization requests from clinicians. Allscripts needed a seamless but modular solution that would enable all critical decision makers to be involved in the configuration process while allowing Allscripts consultants to share their expertise.
We designed a web platform to engage clinical end-users early on, guide clients to best practices and facilitate data collection to reduce customizations between clients and configuration time. The idea was received so well by the Allscripts executive team that they started building a version of the product based our research.
My Role
UX designer and researcher
Timeline
8 months, completed on Aug 2018
Team
5 MHCI Students
The Solution
Facilitating decision-making and transparency during Sunrise EHR configuration with Chorus
The aUDIENCE
Understanding the people
SETTING THE SCENE
Implementing Sunrise EHR at Michelle's hospital
The FEATURES
Why Chorus instead of emails and excel sheets? (or Sharepoint?)
Provides just the right amount of information to clinicians to receive an informed response every time
Physicians like Michelle who missed meetings always had the same two questions:
"What happened at the meeting?"
"What do I need to do?"
Chorus ensures that all communications answer those questions where emails are inconsistent.
Tracks the status of all design decisions to ensure timeliness
Assigning deadlines and owners to each decision for both the client and Allscripts ensures that no item falls through the cracks.
Speeds up decision-recording with templates and smart fields
Instead of each implementation consultant creating their own documents for note-taking and recording decisions from scratch (which is what currently happens).
Aggregating all design decisions in one platform for all clients to power analytics
The implementation expertise Allscripts has currently live in scattered documents or in the minds of experienced implementation consultants.
A system that would collect all the decisions and then relate it to client results would give both Allscripts and its clients an edge in the industry.
Electronic Health Records (EHR) are complicated — and ugly!
Physicians who spend approximately 50% of their time on EHRs are getting burnt out.
Process
RESEARCH
We talked to many people, visited a hospital, even went to HIMMS
During our research, we conducted 45 interviews with healthcare executives, EHR implementation consultants, IT experts, and EHR end-users. What we found was that the healthcare IT space is rife with conflicting goals from different stakeholders—each with their own valid perspectives.
STORYTIME
A senior implementation consultant shared a story about a clinician who kept changing his mind about how he wanted to review patient information. After a month of customizations—adding calendars, tweaking prescription widgets, and adjusting layouts for the entire department—he was still unsatisfied.
Finally, in a conversation with the clinician, the consultant uncovered the real issue: his team often ran late to their next appointments or worked through their breaks. All he really needed was a way to quickly see his next scheduled appointment or break during patient conversations. A much simpler request than the extensive customizations that had been made.
RESEARCH FINDINGS — USER’S PERSPECTIVE
EHR Workflows ≠ clinical workflows
A key frustration for clinicians is the misalignment between EHR workflows and their real-world clinical processes. The rigid structure of many EHR systems creates inefficiencies, adding friction to their daily tasks rather than streamlining them. Clinicians often struggle to articulate exactly what they need to solve their specific problems, which further complicates the design process. This disconnect breeds resistance, as clinicians anticipate spending much of their day navigating systems that hinder rather than support their workflow.
“If you put 10 physicians in a room, you will have 12 different opinions within the hour.”
– Implementation Consultant
RESEARCH FINDINGS — BUSINESS PERSPECTIVE
Clinicians are trained on many subjects, product design is not one of them
Yet, some clinicians wield disproportionate influence over EHR features — only to later disengage, missing key meetings due to their demanding schedules. This disconnect was a key frustration we heard from Allscripts, contributing to why EHR systems are notoriously difficult to use.
Additionally, Allscripts leadership faced challenges in rolling out updates across different EHR instances due to excessive and unnecessary product variations between organizations.
Design Goals
IDEATION & TESTING
There is a reason why no one solved this problem, yet
During ideation, we used techniques like brainstorming, sketching, and storyboarding to visually refine our ideas and give them more clarity. However, the most valuable insights came from the feedback we gathered from clinicians and other stakeholders, which ultimately shaped our direction.
The effort required to build and maintain a tool for navigating EHR configurations proved to be a significant deterrent. Moreover, organizing this complex meta-conversation demanded a solid information architecture just to make sense of it all. Perhaps most importantly, a digital solution alone couldn't address the human challenges—busy clinicians and resistance to change.
REFINING IDEAS
Focusing on what we can solve: Bringing structure to the mess
Despite the discouraging findings during our testing phase, the insights we gathered helped us refine our approach. We shifted our focus to solving problems we could address: simplifying communication by organizing existing educational resources to reflect the clinician mental model and enabling implementation consultants to spend more time truly listening to clinicians, rather than getting lost in unnecessary details.
Asking for approval vs input
Emailing clinicians who missed meetings with questions and a demo video wasn’t effective—consultants either received no response or unhelpful feedback.
We refined the process by clearly distinguishing between requests for input and approvals for decisions already made. Using multiple-choice options instead of freeform responses further narrowed the range of answers, improving clarity and efficiency.
Commenting in situ
Enabling clinicians to leave comments directly on the demo interface streamlined feedback, eliminating the need for lengthy notes and reducing friction in the process.
Allscripts to provide guidance
A comment from a Medical Director shaped our approach:
"I’d want the software vendor to point to past examples or resources that help me make better choices."
Both clinicians and Allscripts sought structure and guidance. Offering recommendations at key moments helped steer the conversation effectively.
FInal Thoughts
Organized chaos is better than plain chaos
Our final version of Chorus received highly positive feedback from both providers and implementation consultants, with the only major concern being the investment required for full development. After presenting our final concept to Allscripts' leadership team, they saw its potential and decided to integrate a lightweight version of our ideas into their existing process, using our features as a foundation for future improvements.