by Robert B. Teague, M.D.

As we progress through yet another cycle of sound and fury of EMR hype--not to mention billions of dollars of public largesse--the question remains: Why doesn't anyone use these things?

For those of you with a dim view of human nature, pure petulance and willful obstruction seem to be the easy answer. I don't think so, though. The truth is, for clinical purposes, they don't work.

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All systems produce what they are designed to produce. EMRs, in concept, were designed as back-office automation tools. And for these functions, they sometimes perform admirably. To complicate matters, we can't decide what we want them to do: support patient care, perform public health functions, assure payment or some integration of these.

For clinical purposes, the best we have been able to do is cram the complex cognitive tasks of assessment, diagnosis and prescription into an endless array of drop-down lists. If this actually worked, patients would need no clinicians, as a bunch of drop-down lists and a way to get the prescription would suffice. For clinical purposes, more is needed.

There are four areas that require attention if non-coercive, widespread adoption is to ever occur: connectivity; usability; automation; and value.

I have long contended that if an EMR delivered value to clinicians in performing their work, cost would not be an issue, much less adoptive resistance. Connectivity to all needed clinical data and among all parties involved, a user interface that supports the clinical task, and automation of data collection, analysis and process flows will go a long way toward enhancing the value proposition.

I want the "iPhone" of EMRs, a product that any clinician might stand in line to buy and be willing to pay a premium to use. Something with a value proposition that is so compelling that the price, while important, doesn't drive the ultimate decision.

Hey, wait! It might be an iPhone.

Robert B. Teague, M.D., is principal of RBT Services, a health IT and management consulting firm in Austin, Texas.