opinion

Advocates of EMRs are not physicians and are not attuned to doctors' needs

LETTER — Posted Oct. 18, 2010

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Regarding "If EMRs were so useful, incentives and penalties would not be needed" (Letters, Oct. 4): Amen.

From my state-level work-group activity and hospital-level electronic health record use, I am left with the strong impression that those with the strongest investment in EHR adoption are not clinicians working at the sharp end of care. Rather, administrators, bureaucrats, politicians and vendors carry a disproportionate interest in our use of EHRs. I think this contributes significantly to a near absence of "usability" considerations in EHR design and implementation.

Clinicians want a usable, reliable, secure, affordable EHR system that feels intuitive and smooth and makes us work faster, smarter, safer and more profitably at the point of care.

Give clinicians these things, and federal incentives won't be needed. (The phenomenon of smartphone adoption by physicians is evidence of our spontaneous willingness to adopt usable, useful technologies.) Don't give clinicians these things, and federal incentives won't be enough.

A simple solution would be standardization of patient database structures. Clinicians would be free to interchange EHR application/GUI (graphic user interface) layers at will.

Current idiosyncrasies of proprietary product database structures render EHR product change prohibitively expensive due to the cost of data migration. On the other hand, if vendors know I can easily ditch their products in favor of better ones, market forces would drive improvements in product quality and cost.

David Hager, MD, Kerrville, Texas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2010/10/18/edlt1018.htm.

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