I'm a healthcare provider and have worked in a various EHR settings. I have mixed feelings about all of this, and think the problem with EHRs isn't really the

I'm a healthcare provider and have worked in a various EHR settings. I have mixed feelings about all of this, and think the problem with EHRs isn't really the EHRs, it's the systemic problems underlying the EHRs. The EHRs are just a tangible way to vent about them. First, the way these EHRs were rolled out, under federal mandate, was a fucking fiasco. I am definitely not anti-government when it comes to healthcare, but I do not think EHRs should have been mandated. People forget that in all of this. Administrators did not want to purchase them, because they were huge cost sinks (the rollout of one EHR at a hospital my wife works at was 2 billion dollars over what they initially estimated it to be). So, you have these systems which weren't purchased because they were appealing solutions, or cost effective, but because the hospitals had to to avoid losing reimbursements. This led to systems being rushed early, without adequate hardening, and all sorts of things. Before EHRs, records were done in-house by people who were highly trained in this area. My guess is that if markets had been allowed to progress naturally, you would have seen more in-house open-source implementations that would have happened more gradually, at much lower cost, and with more back-and-forth with providers. Second, I'm a little tired of griping from physicians about having to do paperwork. Sorry if this comes across as hostile, but a lot of it is narcissistic bullshit, frankly. Records in high-stakes settings is not just about documentation, it's about checks, and making sure you're following protocol. Studies have shown this increases safety. We all have to do it. Someone asked about scribes, but wait until some lawsuit happens because of ambiguity about whose responsibility it was when some instruction or note was done incorrectly. This way, it's ultimately the provider's responsibility, coming directly from them. And yes, you can still do transcription for lengthy notes. I know this because I've done it. One of the elephants in the room when it comes to healthcare costs is that there's too much top-down authority, too much monopoly, too little competition in provider models, and people feed into this when they start going down the route of suggesting it's too much to ask physicians to be responsible for their own damn communication with the rest of the providers in healthcare. Finally, going back to my original point: the real problem in a lot of cases isn't the EHRs, it's the business-model administrative hierarchy that's taking over all sorts of fields. Regardless of whether or not this should be the case, physicians want to be in charge, to have autonomy and authority, and suddenly they're finding themselves being treated like widgets in a vast healthcare machine that benefits administration primarily. They have to use some system they didn't approve of, and they realize that the decisions in some sense aren't coming from them, they're being told what to do by administration. So rather than feeling like they're the top dog at the hospital, they're feeling like cubicle workers. That's what I suspect this is mostly about, not the time with patients, or whatever the hell the complaint du jour is. Note that on this point I sympathize with them--this administrative hierarchical model that's squeezing workers, whether it be healthcare, or IT, or education, or whatever, is fundamentally flawed. It's just new to physicians, or something they didn't think they'd have to deal with. This is my little tangential rant, but I'm sick of healthcare discussions in congress being so focused on costs, and not on deregulating healthcare and increasing transparency. There needs to be less of this kind of EHR red tape, more use of EHRs that is driven by their utility, more competition among provider models, greater consumer access to drugs and healthcare options (and I don't mean by giving them more money, I mean by letting them do whatever the hell they want), and more transparency about costs. Right now, we have a model where you have an extremely small number of people telling everyone else--including different types of providers, as well as consumers--what they can and cannot do with their own healthcare decisions, and billing them without them even knowing or agreeing to the cost of a service. Imagine if the government said that only accountants they approve of, with doctoral level finance degrees, could do your taxes, and that those accountants could charge whatever they want without telling you the cost ahead of time. People would be in an uproar. We spend all this time assuming that our healthcare system should basically stay as it is, but that we should reorganize how we pay for things, when the discussion should be about both.