Having been at this for about 20 years--both in design and implementation--the current crop of electronic records is most definitely not ready for prime time. In the beginning, the software applications we now call electronic health records were designed to automate back office functions and capture charges for the hospitals. For the functions they were designed to do, they actually do a decent job. Sometimes, a really good job. Like all systems.
When the extension to clinical use took place, not much thought was given to how they should enhance clinical work. And the assumptions upon which they were built were not much more than beliefs about how nurses, physicians and other providers actually deliver care. The goal of even keeping information electronically became muddled in the philosophical war between public health and individual health...deduction vs. induction.
One could go through a very long list of assumptions now memorialized in these products that are simply wrong not by belief, but empirically so. The most egregious, and the one resulting in the greatest barrier to adoption, assumes the complex, cognitive task of diagnosis, and prescription can be reduced to a long list of check boxes. If this is true, then we need no providers--only computers and check boxes. And for some problems, this may actually be true, though for anything requiring judgment, it is not. Very little design time has been given to understanding how information is actually used in this process, much less understanding the process itself. The user experience is terrible, and thus most electronic records are not only unusable for the most part, but potentially dangerous.
This fault in current design doesn't even account for the many, many other flaws in these products, such as the list from Anne Carroll that was posted. The lack of connectivity and interoperability, not to mention the lack of automated retrieval of vital information, remains a dream.
It would be our hope that the current administration does not just throw a hand full of billions of dollars at this and expect it somehow to change. The worst thing that could happen to patients and providers alike is to have the current generation of products fossilized forever as our standard.
Robert Teague, MD
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