Oh man, this is so insanely true, allow me to just contextualize this for you with a POV from the States. I'm not in medicine (oh thank Christ) but I come from

Oh man, this is so insanely true, allow me to just contextualize this for you with a POV from the States. I'm not in medicine (oh thank Christ) but I come from a family where I couldn't ignore the the industry if I wanted to. (Literally every male for 3 generations on both sides have worked directly in either medicine in a university capacity after their PhD, actively practice(d) medicine, or more commonly done both.) My mother's an RN, and my sister's a BS/LPN who's one of those "do gooders" who jumps around (on her third graduate degree now) working usually neuro AC or OR full-time concurrently. So I've heard it from the board-level to the overworked resident side to the 'thank god that fellowship is over' and the 'just got off a double and had three GSRs and a handfull of standard MeOHs', from the the early EHR adopters (interestingly enough, B&W/Partners in Boston) side, the pen-and-paper side, to the 'in between'. The 'in between' is the worst for every one, at every level, bar none, unless you're the one on the steaks-and-strippers sales side. The limbo period is where absolutely everyone is frazzled because things don't work the way they used to. That's fine for us since we design the damn things, if the scheduling API changes we can just use ...anything really... to make that new JSON invocation or XML-RPC call and Bob's your uncle. But everyone can't be expected to "just pop the hood change the carburetor's flow by 3cfm"; they just want their damned car's engine to turn over so they can use the vehicle. So everyone else is fighting new apps and new workflows while still having to make sure that you're still maintaining an SLA of literally 24/7 operational functionality in certain departments with maybe 3 hours a quarter of scheduled yellow-time for upgrades on 3AMs of the first Sunday each month. Let's start with getting paid, since everyone needs a paycheck, right? The new system dictates that all employees have to badge-in with new RFID's at certain points (entrances, exits, secure regions, etc). In theory, great idea. Part-time employees salary now gets automated plus now we can ensure better operational security (why is Dr Jane, 9AM-6PM, internal medicine, badging into the OR, 4 floors from her office 5 hours after her shift, where all the Demerol happens to be kept...?). Any non-salaried employees pay-check gets tied into the badge-in/out and literally 70% of the staffers forget to do this, since they never had to before and after lunch they're just walking back in as they normally would. Jon the Janitor pulls up his Bank of America statement and is wondering why last weeks check (bi-monthly, with one pay-cycle close period for adjustment/payout -- so some of these hours, remember, are from potentially 5 weeks ago) was for $90 instead of $2400. So he calls HR to get the money he worked for, and Oprah who's been a great HR employee tries to figure out where the 'alter' feature is and after 5 minutes of "bear with me, sorry, this is a new system...(awkward pause)..." they finally figure out how to make adjustments to the hours (turns out the a manager 2 levels up has to authorize the labor change, since it's past the adjustment business rule of +/- 10% of the hours). AP is slammed with a 40% increase of workload since all those checks have been sent out and we're already in to the second week of the new cost-accounting period. So everyone is frantically calling in 5 weeks after the quarter closed as to why last weeks check was for $90 instead of $3400. Having fun yet? So Tim works the support-desk phones making sure Derm's scheduling is taken care of. He's spent 20 years making sure all those follow-ups are properly scheduled, all the new patients coming in have the proper primary referrals, etc. Not a glamorous job but he's good at it. Jane's in her 50s and been seeing Dr Eczema for 8 years. She's calling to schedule her yearly just to make sure that mole on her neck which was 2 of 5 on the ABCDE ("looks alright now, let's keep an eye on it though") hasn't developed into a malignant growth. He tries to pull up her file (there's about a 75 second delay there as he fumbles around with the new system's UI and "no no, that's not your subscriber ID, that's your patient ID, your member ID is 8 digits and begins with 40", he finally gets to the right modal menu, and has no idea to even see if her doctor has any availability on the Tuesdays mornings she's got some free-time to take off from work. (Before this, he's would have always just told Jane to "please hold.." and punched in the extension number for Dr Eczema's PA, Mr Clockwork to see if there's availability.) So now he's literally iterates through every possible drop-down, for every 15-minute interval Jane can take off work (9AM to 11:30AM, 10 slots), for the next 6 weeks (takes say 4min30sec per patient). It ends up taking him five minutes, but he gets really good over the course of 8 months at clicking buttons (clocks that down to just under 2 minutes, boom!) before a co-worker tells him there's an "Availability" modal hidden 3 sub-screens in that lets you access Dr Eczema's full calendar. (He was sick on that training session day.) Tim's ecstatic. Don't get me started on the the custom iPads that the CIO thought "we gotta have, it's the new thing!" which no one uses since the GUI is obtuse and every room has a desktop which is far easier to take notes while talking to your patients. 6 months later, 2k iPads are gathering dust and everyone just uses an RDP session into the Win2k12 server since it's way way easier to take notes/make referrals/write scripts. Don't get me started on actual selection process, as board-level CIOs' wife happens to hold 200k shares of pre-IPO stock she scored 12 years ago that's worth a small fortune now. He conveniently omitted that fact, and rather than recusing from the selection committee was actively pushing for it. (True story.) Now the CIO is evaluating 'hmm should we go to Cerner?' because we have 2k iPads sitting around doing nothing, some 60 year old absolutely-brilliant neurologist who's responsible for a ton of patient draw (as such, a lot of political clout) can't figure out how to use the damned thing. (An apt comparison would be "ever tried to help your grandparents use email during the hotmail-era?" for those of you who remember that sort of thing.) [Basically the equivalent of moving from SAP to Sage500/Dynamics/other-ERP which also happens; the Mayo Clinic transitioned from EPIC to another EHR while my uncle was there, all sorts of fun I heard!] There are all sorts of issues on the logistics "who gets what money for what and when". E.g. you have changing insurance issues (i.e. OK, so this patient with this internal medical record saw Dr Foo in dept Bar, which we can internal cost accounted at $x, let's get this invoice for $y out to... (oh damnit, ok who is their health insurance company, let's ping the state's open exchange since this patient gave us their MassHealth ID number[or whatever appropriate exchange your state has if they opted to take the ACA federal funding] and see who their insurance provider is so we can bill this out). Single-payer would be a blessing in reducing complexity! If you've ever wondered why some cities drop 12 million dollars on a new HR platform only to have it fail 18 months in, it's because information management is hard, regulatory reporting burdens are high, and transition costs (both the political stake the primary project manager who initiates the change-over, as well as the actual quantifiable monetary costs) are astronomical. ATC still uses software designed in the 70s where their web interface is literally screen-scraping IBM CISC software. It's horribly inefficent, but it's been battle-field tested.