I’m not making up the fact that doctors really aren’t in love with EHRs

I’m already getting some pushback from my Upshot piece today, which doesn’t take as kindly to the (irrational) exuberance some are showing towards Healthkit. But Politico has got my back:

The government-led transformation of health information is driving doctors to distraction, igniting nurse protests and crushing hospitals under debt.

Most health care professionals accept the inevitability of going electronic and see its value. But they have a message for the administration’s multibillion-dollar push: not so fast.

The government has already delayed parts of the program, but the American Medical Association and others want more relaxation of the rules, and warn of disaster if they aren’t heeded.

The problem isn’t that docs don’t know about the potential of IT, or that they don’t like the incentives. The problems run deeper:

Paperless records still don’t flow smoothly among doctors, hospitals and patients and they won’t for some time. Nor have measurable savings or widespread improvements been seen yet.

And there’s a difference between liking the idea of electronic health records, or EHRs, and liking the particular systems in use. Even Karen DeSalvo, who as national coordinator of health IT is responsible for implementing national use of EHRs, notes that her own husband, an emergency room physician, considers his EHR “clunky.”


Many EHR products designed to meet federal guidelines are not user-friendly. They take months to learn, require lengthy data entries and often don’t communicate with other computer systems. Doctors complain that because of EHR design flaws, they spend so much time “clicking” that their hands hurt.

“Infuriating and cumbersome,” is how Steven Stack, president-elect of the American Medical Association, describes commercial electronic health record systems. “They slow us down and distract us from taking care of patients. And I’m a supporter of EHRs.”

So am I. I want to stress again that I believe in the potential of EHRs, and Health IT in general, to improve the quality of the care we deliver. Heck, I’ve dedicated much of professional career to that belief. But there are systemic issues here that must be addressed.

Some of them are technical. But a lot of them have to do with people and processes. We spend a heck of a lot of time focusing on the former, while continuing to ignore the latter. That won’t work. It violates the fundamental theorum of health informatics.


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