The link between configuration requirements and feature adoption

Question: Why aren’t customers adopting our newest features at the scale we anticipated?

For the first engagement, I put together a research plan that incorporated desk research, prior art review, and interviews with EHR administrators. The initial goal was to help us understand how our clients decided which features to adopt in a given release.

However, a cognitive walkthrough of recent feature releases that saw limited adoption showed me that configuration was not only a major part of adopting the feature, but was complex enough to turn someone off from adopting the feature in the first place. That adjusted our research plan to encompass a couple of other goals:

Initial discovery made it clear that the problem was much deeper than we originally thought. In addition to internal conversations and cognitive walkthroughs, I brought in some customer interviews.

Introducing Wendy and Lisa

Through the initial wave of research, I ended up finding two clear EHR administrator archetypes, who I called Wendy and Lisa. While Lisa handled more strategic “how should we set things up?” types of initiatives, Wendy was the person who ultimately had to implement changes. I developed these archetypes into a set of personas, that is still being used internally as of 2026.

Research showed two clear archetypes within Health IT, as well as a third archetype of practice leadership that guided decisions on which features to adopt.

We also found a handful of critical moments related to configuration within the journey of an EHR administrator. While the work required to prep for and react to a release was a critical moment, there were actually five additional moments that were easily as important, and had their own set of issues that needed digging into.

These six critical moments of EHR configuration laid the foundation for several initiatives to follow over the years.

Helping clients find, assess, and adopt new features easily

By the end of this research, we understood a few core things about how practices evaluate and get ready for features that are about to be released:

  1. Understanding the level of change management involved is a crucial component of evaluation. Features that required a lot of change management often took longer to adopt — or didn’t get adopted at all.
  2. While Wendy and Lisa are core archetypes, they tend to specialize in clinical vs. non-clinical workflows; the person who manages Clinicals features is different than the person dealing with RCM features.
  3. EHR Administrators are a buffer between providers and whatever new features show up in the EHR; part of their role is creating training and “marketing” materials informing providers about what’s coming in the new release, curated from our release materials.
The research highlighted two major issues with release readiness: determining what change management would look like, and understanding what was even turned on in their tablespace.

Reimagining the release experience

As the research was socialized throughout the organization, we started to see changes happening to various aspects of the release process. First, we started redefining how we measure release awareness, with increased focus on IT administrators and practice leadership, who acted as a “filter” between clinicians and the release.

Two of the most compelling changes we made were in how we measured release awareness, and how we organized the athenahealth Release Center.

The most visible was in the athenahealth Release Center, which implemented several recommendations from the research, including:

These changes made it easier for Wendy and Lisa to evaluate our new features. More importantly, it gave them material for the promotional and training materials they created to effectively manage the rollout in their practices.

Setting standards for new configuration experiences

As teams continued to reimagine the release process based on this research, I was working with teams to dig into some of the other critical moments we had found. In Summer 2021, I joined a team in our company Hackathon interested in developing a React framework for configuration pages. I provided best practices based on the research and prototyped an experience with Figma for the team to work from. Our team, called “The Basics,” won two separate Hackathon awards: “Most Useful” and "People's Choice," and was picked up by our Design Systems team.

In July 2022, I led on an initiative with folks across R&D to align on interaction standards for admin experiences and incorporate them into the framework. The resulting work informed the re-design of several core configuration experiences, as well as the design of new experiences, such as the user and practice management features for Ambient Notes, which we validated at the Thrive user conference in 2024.

Analysis of existing pages and a set of clear product principles for configuration led to the creation of standards for admin pages throughout athenaOne.

Outcome

This research, which began in 2021, ultimately led to multiple of initiatives that touched how athenahealth approached product releases, onboarded clients, developed clinical content, and built products. The standards I helped develop are still informing the design of configuration experiences five years after their creation.