My Top 10 EHR Wish List

EHRs continue to spread untold misery, and with each year a new EHR comes along that promises to be “better” than the last.
EHRs continue to spread untold misery, and with each year a new EHR comes along that promises to be “better” than the last.

If there's one universal truth in medicine, this is it: doctors hate EHRs like the plague.

I take that back — worse than the plague. At least Yersinia pestis can be stopped with antibiotics.

But EHRs continue to spread untold misery, and with each year a new EHR comes along that promises to be “better” than the last.

Note the word “promises.” The sad truth is that EHRs have been “promising” improvement since their inception. 

But they have just become more intrusive, complicated and all encompassing — the bane of existence for most, if not all, physicians.

EHRs were clearly not designed for the benefit of the patient or the doctor. As far as I know, there is no reliable scientific evidence that EMRs help to improve patient outcomes. And don't believe a word of what the EHR companies tell you. Let's just say they've learned to mutate the truth to their advantage.

“The EHR has not become a useful companion to physicians,” said Keith Martin, editorial director of Medical Economics. “It's become a troublesome captor, holding doctors back rather than advancing them forward.”

I say “amen” to that!

What we've seen from EHRs so far is scary at best – horripilation-and-trembling scary.

To help overcome some of the fear, I have created an “EHR Top 10 Wish List.” It details what I would most like to see in future versions of EHRs—and I think my colleagues will agree:

1. It shouldn't slow me down. Minimize extra mouse clicks, extraneous menus and confusing nonclinical stuff. If I can't crank out a progress note in 2 minutes, forget it — your EHR is too damn slow.

2. Shorten the learning curve. Make using the EHR very intuitive. If I need to go to a special "training class for idiot doctors” to learn the thing, give me back my paper chart — your EHR is too abstruse.

3. It should be designed by and for doctors. It shouldn't be geared toward bean counters, bureaucrats or "quality” metric analyzers. Let these folks all kindly retire to their ivory towers somewhere and stay out of my clinic.

4. It should provide access from anywhere on any device. I should be able to use my iPhone, my iPad, my PC or my Macbook. Get the thing to run on all operating-system platforms — even in the bathroom, if I want to get some important work done there.

5. It should communicate with other systems. It should easily transfer information about the patient from one doctor to another in any file format desired — and translate that information into any language, even Farsi and Gangsta rap.

6. It should integrate all information in one place. Give me one easy menu that has it all — X-rays, MRIs, lab results, photos of patients and their interesting skin lesions and real-time stock market information. Make sure it contains a list of pharmaceutical reps offering free lunch this week.

7. Design it like a Mac. Make it simple and clean — not like a PC. Do auto updates only when I'm not using it. And don't ever ask me to re-boot when I'm using the system. This is absolute anathema to any doctor alive!

8. Make it downtime-proof. Give the EHR redundant systems with emergency backup power supplies built in. Even if the entire electrical grid goes down, the system should keep running. Make it so that I never need to turn patients away because "our EMR is down" — not even during a tsunami or serious nuclear accident.

9. Incorporate the finest amenities.  Integrate a world-class coffee and espresso maker into the EMR's elegant design. And make my deluxe coffee supply impossible to "hack into" by roaming medical students and interns.

10. Make it economical. Price the EHR so that even solo-practitioner “dinosaurs" can afford it. It's only software, after all.

Let's face it. Doctors do the heavy lifting, not software geeks. And profits made by EHR companies are egregious and unconscionable given the sorry — and scary — state of their current product offerings.

On that, I believe we can all agree.

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