In response to Joseph Conns Rush for EHRs could stick docs with bad systems ":
Dr. Lyle Berkowitzs commentary is the first insightful and coherent description of the true nature of our health information technology crisis that I have read in a very long time, and points to the greatest disincentive to implementation of information systems by hospitals and physicians. We have been inundated with software designed by engineers with no understanding as to how physicians think, work, and arrive at diagnoses and treatment plans. There has been very little insight by the vendors as to what the clinician really needs to enhance medical (and nursing) practice.
The primary focus of virtually every computerized medical record system is documentation, meeting Joint Commission on the Accreditation of Healthcare Organizations, Health Insurance Portability and Accountability Act, third-party payer, medico-legal and regulatory stipulations. Only the most cursory and sophomoric thought is given to information and how to organize and present it to the clinician in a manner so that they can leverage that information to improve patient care. The inability to look simultaneously at multivariate, multimodal data in multiple windows to correlate and integrate information reveals an utter lack of understanding as to what physicians actually do when confronted with a clinical problem. This problem is exponentially compounded when this software is forced into environments like critical care, where the sheer amount of data that need correlation and comprehension can be overwhelming, and poor presentation can easily contribute to missed diagnoses and adverse outcomes. The aviation industry recognized this risk long ago, and spends countless research and development hours optimizing displays in the cockpit for safety.