Much of the EMR system I deal with was built primarily to address billing rather than patient care. The structured data (ICD-9 codes, service dates, etc) exist

Much of the EMR system I deal with was built primarily to address billing rather than patient care. The structured data (ICD-9 codes, service dates, etc) exists for that. The crufty part of the system is related to patient test results and other information (pathology reports related to tissue evaluations, etc). So, the data that is tangential to patient treatment is highly queryable, the data related to patient status is mostly free text. Worse yet, the free text does not follow much of a "standard" entry form - whoever entered the text followed, at best, a departmental standard, at worst, just some quick thoughts randomly sprayed into text. But even that terribly inefficient and crufty free text is highly useful to staff (MDs, nurses, etc) when reviewing patient treatment during, say, tumor board meetings discussing specific cancer treatments and patient status. What might be really nice would be to divorce the two functions - separate billing/scheduling from other information. For the patient treatment/status data, there is some fine line in the data model with having some structured data, plus (probably) some flexible key/value annotation system. One killer issue is that given any software tool, medical staff is smart enough to bend it to do what they want, rather than what it was designed for, if that makes sense.