If Apple decided to create an EHR with the clinical end-user in mind, it would clean up. The same is likely true for other companies that specialize in attending to the user experience, e.g. Google.
EHRs are, first, for clinicians to use in order to provide care to patients. I think that point may be lost somewhere. They are not primarily for administrators or politicians or software engineers or geeks or auditors.
An EHR must be intuitive, like a well-designed marketing Web site, and do things with data we didn't even know we wanted, but won't want to relinquish. It should cause no more effort than our existing written work flow, and not slow us down as we see our load of patients. It should conform to our idiosyncrasies—and not the other way around.
Ultimately, if clinicians don't buy into and actually want to use an EHR, the whole concept will dwindle, political pressures notwithstanding. The current swell of interest fueled by temporary money will end in disuse atrophy. We have to want to use an EHR because we find it has become an indispensable tool—so that we can't imagine seeing our patients without one, any more than a family doc can imagine getting by without a stethoscope.
Thus far, in my daily experience, we are not there yet.
David Hager, M.D.