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Intelligent Healthcare Information Integration 2/18/09

February 17, 2009 News 4 Comments

10 Things I Hate About EHRs

  1. So many EHRs look so Windows 95-ish…or like an accountant’s spreadsheet. Why? I dunno about you, but my brain doesn’t thrive on constant rows and columns.
  2. I shun EHR vendor Web sites that require me to provide my contact information just to see a basic demo. I don’t have to give the Piggly Wiggly my phone number just to see an apple.
  3. Most EHRs want you to drink from a fire hose when all you really want at first is a sippy cup.
  4. EHR sales pitches and their pitchers always assure you that their particular product can cure cancer … while watering your tulips. (My tulips have all wilted, by the way.)
  5. Template creation. ‘Nuff said.
  6. EHR support or sales people who know less than I do about the product.
  7. I’m gonna be really P.O.’ed if Obama money allows all the latecomers to buy EHRs for a song while I’m still paying off the second mortgage I needed to buy mine.
  8. Most EHR vendors/creators think “clicking” somehow beats writing. But, when it takes 4,357 clicks to complete a 99213 visit and you can handwrite the same 99213 note in under a minute — meeting all coding requirements — well, how do you convince anyone that the trouble of workflow and habit change is beneficial?
  9. We’re going to have “Minority Report”-style computing interfaces while EHRs will still be clunking along awkwardly, clumsily, bound to those old rows and columns.
  10. Why (virtually) no Flash or PHP? Wouldn’t a little panache and Web 2.0-ness work in EHRs?
  11. Faxed reports from an EHR-enabled ER or urgent care for one of my patients with an earache that uses five sheets of my paper and toner to tell me they got amoxicillin.

I know. That’s more than ten. But, as I alluded to in number one, “Damn it, Jim, I’m a doctor, not an accountant!” (Props to Bones.)


Dr. Gregg Alexander is a grunt-in-the-trenches physician and admitted geek. He runs an innovative, high-tech, rural pediatric practice in London, OH, and can be reached at doc@madisonpediatric.com.

Comments 4
  • Dr. Alexander’s spreadsheet style list (without Flash or PHP even!) is fun reading, but he stumbled into the same paradigm as many EMR vendors- providing information in a list-style But I’m a busy man, just as Dr. Alexander, and I appreciate the list that he ironically rails against. Nevertheless, it’s a good list.

  • Matthew…you win! I wondered if anyone would catch the meaning.

    (While I suppose we cannot avoid lists, maybe we could at least decrease the incessant row & column lines !!!)

    Appreciate your comments.

  • Right on brother! We all wish user-friendly Web 2.0 technologies were allowed in HIT, but they are usually off limits since they don’t enable the EMR to log the necessary date/time stamping and click-tracking deemed imperative by CCHIT. Because without these “safeguards,” how would an EMR help the patient’s case when they sue for malpractice?!?

  • Dr. Alexander’s humorous but painfully-poignant view again points out how much the industry needs some kind of usability-oriented, qualitative view on EMR products. CCHIT has made a great attempt to create standards around functions, features and capabilities in EMR’s. But it does NOTHING to assess the qualitative aspects between products and how “usable” they are by the average, non-technically fluent user.

    If 160 EMR’s have been certified, according to CCHIT, does that mean they are all just as hard/easy to use? If they all have the same base-line functionality, shouldn’t the “usability” factors become the standard that will help providers decide? Especially for each given cost-level of product?

    Lets get “usability” on the map and compare how these products rate on that scale…then I think providers will have a more reliable index than the CCHIT seal of approval, which, at best says, for each of 400+ features, “Yup, can do that”…without saying how arcane, or how many god-forsaken “clicks” it will take to do so.

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