Thanks for the continuing dialogue. I stand by my comments that the opinion piece that I was commenting on was political in nature. I am not saying at all that all objection to EHRs/EMRs are politically motivated. I absolutely agree that there are products out in the market that you wonder how did they get there in the first place.

During the holidays, I asked my brother-in-law, the pharmacist, how their EMR is going. He rolled his eyes. He told me how their EMR surely did not have a pharmacist on the development team because the medication modules were not intuitive and were missing a number of steps in the pharmacist workflow. He said they were getting upgrades to the modules, but I could tell by the tone of his voice that he wasn't expecting any changes. I don't know the reputation of this particular product outside of a couple of major complaints. I do believe that this product is not the right one for my brother-in-law's clinic (small-budget clinic serving HIV/AIDs patients) because the patient population's medication lists are not being served well by this product. There are, I'm sure, better products that would suit his clinic's needs. As he spoke, I told myself, okay, even if it's not the right product, it's hard to believe that kind of product is on the market.

That's why I've been saying that the next-generation products will either drive those products out of the market or make them better products in the next iteration. I do believe that.

I think you bring up a really good topic about EMRs forcing clinicians to be more accurate record keepers in lieu of providing better care. I don't doubt that happens, but I'm not in a position to say it happens more than it does not. I'd be interested in others weighing in on this topic. As med school graduates come into the workforce, I wonder how they, being weaned on all things electronic and social networking, will interact with their patients. I do believe that EMRs will be a natural part of their workflow. Will they experience the disruption that the current workforce is experiencing?

As far as beta-testing products, maybe this is not a good comparison, but how often is a new, innovative medical procedure beta-tested before being performed in a real-world situation? Honestly, I don't know, but it was the thing that came to my mind as I read the comment about beta-testing. That aside, EMRs/EHRs absolutely should be beta-tested in the development process and in a pilot. I guess they beta-test with the most well-known software company, but there are still a lot of bugs after the software giant releases its products.

The most important comment I do want to end with is that it's critical to offer corrective suggestions and to make noise when something's not working. I applaud you for doing so. The industry needs that critical voice. I hope your voice is heard all the way up to the vendor. That's when and where we'll get things going in the right direction.

Thanks for the feedback. What I object to is your conclusion that criticism of Obama's support for Electronic record keeping is only politically motivated. We do live in a political world, and if you want to get into a debate about how Bush's "trashing of the constitution" and similar actions by our present president are viewed by those on the right and left of the political spectrum, we could talk or write for hours. :>) My concern about EMRs in general is that they, out of necessity, force medical professionals to change their focus--"accurate" record keeping, as defined by the EMR product and those that support it, becomes more important than actual medical care. I believe we have exchanged a higher calling and a higher good for an inferior one. Patients are suffering for it, and primary care physicians are disillusioned. Right now the supposed promises that the EMR supporters tout are not being delivered. The group I oversee (~28 physicians and mid-levels) are using a "leading" product (NextGen) and in the last 4 years our group has literally lost millions in revenue because of it. And the document, that is produced as a summary of a usual visit, when following directions from the company would put anyone with even marginal writing or communication skill to shame. When I use available computer technology for other reasons, e.g. a search engine produced by Google, and see what it can do, it is hard for me to believe that these EMR products have been allowed to enter the market. Physicians with their careers on the line every minute, are being asked or even forced to "beta-test" these products before they are safe or efficient. (I read hundreds of them every month, so this is not just a debate point devoid of experience) So far the folks with the philosophy that good medical care is measured by accurate billing and coding information, and outcomes are best measured by some kind mathematically measureable formula and or percentage of compliance to legal regulations are winning the day. I believe that electronic record keeping could be useful if it is designed in such a way that reflects physicians' thought processes and their priorities for the higher good--their patients' healing and health. I am doing what I can to offer constructive suggestions in the little pond that I am presently swimming in. I hope that before I die things change for the better, because right now, at least in the primary care arena, things look pretty grim and one of the greatest sources of dissatisfaction is the huge roadblock to good patient care presented by the EMR.

You "trust" the docs that say they would never go back to paper records. Do you know what percentage of physicians who have transitioned to an EMR (I decline to call it an EHR, since health is a state of being, not something that can be determined by a narrative of one's history with medical care or a group of test results) give this assessment, and what percentage bemoan how the EMR has increased their expenses, markedly increased their work hours, markedly decreased their ability to see as many and serve as many patients, and generally have seen a negative effect on their ability to focus on patient care and actually deliver it. Most of the docs I talk to say their ability to see patients has been decreased by 25-50% since they converted to an EMR. Do you trust them as well, or do you consider their credibility suspect because they don't fit with your perspective and long range goals? Bush was wrong, and Obama is wrong, about the overall effect on actual patient care, and ultimately patients' health that these over-regulated electronic systems are having.