When it comes to Norman Doors, the real shame lies with the designer who failed to account for basic human factors. Far too many HIT applications reflect a disregard for basic principles of human factors engineering.

The title may not be very sexy, but the content and direction of CMS’s latest fact sheet on information blocking should grab everyone’s attention. As the fact sheet makes clear, in order to qualify for the Merit-based Incentive Payment System (MIPS), eligible clinicians must attest that they have not knowingly and willfully limited or restricted the compatibility or interoperability of their certified electronic health record (EHR) technology. The fact sheet specifically calls out technical, policy and workflow decisions as the keys to meeting the requirement and, by implication, the ways that providers and EMR vendors might fail to show “good faith efforts” to meet these requirements.

If you build it, will they come? But, there was a problem. One that virtually all clinical applications face. The calculator, built as a web-based application, did not integrate with Epic, the electronic medical record (EMR) used at Cleveland Clinic. The vision of providing clinicians with a useful and important tool was stymied by the difficulty of accessing and using the calculator.

In Part I of this series, we made the case that the U.S. Department of Veterans Affairs (VA) selection of the same EMR being adopted by the Department of Defense (DoD), will not, in and of itself, solve the problem of fragmented medical records and better care. We looked at how active duty military, veterans and their dependents receive care from a hybrid of public and private health care providers and regularly move between the DoD, VA and civilian health systems. We also examined how EMR-to-EMR integration is limited and that even using the same brand of EMR is not the same as being on the same EMR.