Co-Design or Collapse: Making Electronic Health Records (EHRs) Work for Clinicians, Not Against Them

The recent go-live of new clinical applications at Beaumont Hospital– a clear illustration of the Digital for Care 2030 national plan in action -provides a powerful example of what can be achieved when the implementation of new technology is aligned with clinical reality. Over 3,000 staff were trained in advance of the rollout, and the collaborative effort between project teams, clinical leads, and support staff has been rightly celebrated. This wasn’t just a systems deployment – it was a collective transformation grounded in trust, preparation, and real engagement.

And that’s exactly the point. When it comes to embedding EHRs at scale, co-design is not a luxury, it’s a prerequisite. Without clinician buy-in, digital health will fail. Not might. Will.

Why Clinician-Centred Design Matters

Clinicians aren’t resistant to technology. They’re resistant to bad technology, systems that disrupt rather than support, that complicate rather than clarify, and that add administrative burden without improving clinical outcomes.

At the recent Smart Health Summit in Dublin, this theme came through loud and clear. Speaker after speaker, from practising doctors to public health leaders, emphasised the importance of clinician-centred design. It means involving users from the very beginning, understanding how they work, and designing systems around real workflows, not imagined ones.

And let’s be clear: this is not just a usability issue. High-quality data starts at the point of entry. If systems are confusing, clunky, or time-consuming, the data captured will be incomplete, inconsistent, or incorrect. That has implications not just for immediate care but for everything from population health planning to the development of AI tools.

Co-design ensures that the data we collect is not only usable, but useful. It makes systems intuitive. It reduces training time. And it encourages clinicians to see technology not as a burden, but as a partner.

Lessons from Beaumont Hospital

The EHR implementation at Beaumont Hospital offers practical proof of this principle. This was not a top-down rollout imposed on staff: it was a deeply collaborative process, where clinician input was sought early and often. The result? One of the most significant digital health transformations in Ireland, delivered smoothly in one of the country’s busiest acute hospitals.

Crucially, the project included a fully digital Emergency Department, an achievement that deserves particular attention. Emergency Departments are high-pressure, high-volume environments where even small inefficiencies can have a ripple effect on patient safety and staff wellbeing.

Introducing new systems in this kind of setting is inherently risky, unless it’s done with care, insight, and deep respect for the context. At Beaumont, the ED transition was successful precisely because clinicians were not just trained on the system, they helped shape it.

Why A&E is the Ultimate Stress Test

If you want to know whether an EHR system is fit for purpose, put it in an A&E. There, the stakes are high, time is short, and the demands are relentless. Clinicians are multi-tasking in a near-constant state of triage, balancing risk, urgency, and limited resources.

In this environment, poorly designed systems can be dangerous. As one emergency physician put it at the Summit, “The notion of a ‘digital front door’ terrifies me – demand is already sky-high, and the risk is that we open the door wider without preparing the inside.”

Clinicians in these settings often don’t have the time or bandwidth. They need systems that meet them where they are -intuitive, reliable, and requiring minimal clicks to get to what matters. They also need reassurance that digital tools will improve their working lives, not add to an already unmanageable burden.

This is why listening is non-negotiable. Not just at the beginning of the project, but throughout its lifecycle. Not just from senior consultants, but from nurses, registrars, allied health professionals – all of whom interact with the system in different ways.

Getting It Right from the Start

Too often, digital health projects are driven by procurement timelines or budget constraints, rather than by service needs. Systems are bought and rolled out, then adapted, retrofitted, or tolerated because they don’t align with established clinical pathways.

We need to flip this script. That means:

• Engaging clinicians at the design stage, not just the deployment stage.
• Building governance structures that include clinical leads, not just IT and admin.
• Creating feedback loops that allow real-world use to inform iteration and improvement.
• Valuing time, both by respecting the time clinicians give and by designing systems that give them time back.

This is not just good practice. It’s how we ensure that health systems can evolve safely, sustainably, and in line with what matters most: better care for patients.

From Transactional to Transformational

Development and deployment of technology across hospital and community health settings is not just about digital filing cabinets. At its best, an enabler of transformation—surfacing care patterns, supporting clinical decisions, and enabling joined-up care. But that only happens if the foundation is solid. And the foundation is usability, built with clinician insight.

Co-design doesn’t just happen during implementation—it starts earlier, during core product development. By embedding clinical feedback into the design of standardised software, we can deliver solutions that meet user needs from the outset, easing the burden on individual sites and enabling faster, more consistent rollouts.

This approach aligns with the vision behind Ireland’s Digital for Care 2030 plan: a national blueprint for digital health that is standardised where it matters, deployed regionally, and flexible enough to work in local settings. That’s how transformation becomes scalable, sustainable, and real.

 By Cathy McCartan, Director, Dedalus Ireland