OMG-to-WTF spectrum

So I was at TechfestNW earlier this fall and I had the opportunity to hear James Keller at WalmartLabs speak about the importance of having a minimum valuable (versus viable) product that is tied into the user experience.  It is how the user’s emotional response to the application’s interface, which is so important to have, that gives a product meaning.

And this concept (although I admit I completely stumbled upon it) is at the very heart of what makes NOSH ChartingSystem so different.   As I have stated on my blogs before and on my Indiegogo campaign site, I wanted to have an EHR that was both intuitive to use AS WELL AS having an interface that was calming and meaningful at the same time.  So as an example from the medical world, having a pain scale is pretty good indicator of how user-friendly your application is.

Pain Scale

An analogous concept is the OMG-to-WTF scale (see above).

Where does your EMR stand on the scale?

I’d like to hope that NOSH is on the more “OMG, it’s painless!” scale.

One of the nice things about making a web-based app (like NOSH) versus an app that is based on a particular operating system is the ability to leverage the really cool interfaces that have made touch devices easy to use and how simple a particular click and function does what it is supposed to do and common tasks are close at hand to the user without having to figure out how to get from here to there.  AJAX technology, which NOSH uses plenty of it, makes the transfer of data into less bandwidth intensive processes, for both the server and the client, making information available quickly and appear effortlessly.

Maybe NOSH doesn’t look like it has all the bells and whistles as your “best-in-class” EHR, but that is the point.  To me, NOSH has a clear, simple, clutter-free interface.  I don’t need more stress with my computer when I’m dealing with a worried patient or some medical calamity that is happening before my eyes.

If EHR design is based on user-friendly design principles, I believe some outstanding issues with existing EHR’s can be addressed (not fully, but much closer to what it is now).  There are some that have worried (and rightly so) about the safety of EHR’s and how garbage data (like how an EHR gives a patient syphilis) is wrecking havoc with reliable and useful patient data.  I believe if you have a clean, easy-to-understand system, data entry errors are significantly reduced.

But the key to getting there is that doctors (and subsequently patients) are happy with their tool.  That’s all doctors ever wanted (whether it is a pen/paper combo, or an EHR).  It’s the simple truth.  And it’s what the other EHR’s now don’t really care about.

Michael Chen, MD is a family physician in Portland Oregon  as well as a developer and consultant for his own open source electronic health record system called the NOSH ChartingSystem.  He blogs regularly at, where this post originally appeared.

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2 Responses for “The OMG to WTF? EMR Pain Scale”

  1. Ah, this is great. RAND or somebody should score healthcare legislation using this delightful methodology.

    Actually, come to think of it, it would work well for blog posts too –

  2. rahul kapoor says:

    I do agree with the above mentioned points that most of the EMR ignores certain serious stuff.And also enhancing the UI/functionality of an EHR will always keep the doctor-patient communication on.

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