The reason we all struggle with our EMRs is simple: It’s not so much the underpinnings we object to, but the “User Interface”. And the User Interfaces of EMRs are awkward, to say the least.
UI is the look and functionality of the screen.
For example, if I have an imaging report in my inbox and want to do something about the result, say look at the previous scan the patient had six months ago, let the patient know it was okay, add a new diagnosis to the problem list, arrange or check the date of the followup visit, send a copy with a question or comment to a specialist, look back at what the blood work showed, prescribe or stop a medication, or check a reference website like UpToDate what the best treatment is for what the scan shows – how many clicks does it take to do any of those things, and can I still see or at least get back to the report I just received as I do any of those things? Why don’t I have every single option for what to do with the result right there on the same screen as the result itself?
That’s the essence of our frustration.
Even more basic, and I have lamented about this before, can I read the scan, lab report, consultation note or whatever it is, in one view without scrolling, enlarging, clicking or standing on my head?
If you have only fifty reports to go through every day, and each one takes even just over a minute instead of fifteen seconds to go through, like a paper report used to require, it may not sound like a big deal, but that means about 40 minutes more per day, hardly ever built into your clinic schedule, for that task alone.
Documenting a physical exam with abnormal findings in a structured way, not free texting or speaking, can involve innumerable clicks to get to the findings you need.
For example, click on ENT, then EAR, then scroll down to TUNING FORKS, then scroll to WEBER, scroll to LATERALIZED LEFT, go back to RINNE, and scroll down to POSITIVE or NEGATIVE LEFT and try to remember if bone conduction greater than air conduction is positive or negative because that’s not the terminology you use.
What if the physical exam could be documented by pinching your fingers to zoom in on a touch screen with a body and just pointing to the body part in question and having all the options literally at your fingertips?
If video games can do it, why can’t EMRs?
Just look at these two pictures, courtesy of Bangor ER physician Dr. Jonnathan Busko, and imagine…
https://www.linkedin.com/pulse/dont-let-your-ehr-tail-wag-patient-care-dog-jonnathan-busko
*(It’s) “The Economy, stupid”, is an American idiom from the 1992 Clinton-Bush presidential campaign, a phrase coined by Bill Clinton’s campaign manager James Carville to keep the candidate focused on the most important issue(s).
A Country Doctor Writes: 
ITs have only one goal-to keep themselves in business by constantly designing and redesigning programs.. The EHR is a cash cow-the goose that lays the Golden Egg.