There are soooo many problems with electronic records that it's hard to even summarize. But the biggest few, in my opinion:
1) The software influences the medical workflow and becomes a major distraction to visits. What was completely analog and free-form is now binned, discrete, and made more complex.
2) Desired outcome affects what and how things are recorded, instead of vice-versa. Staff learn what they have to do to get the orders or prescription or billing output that they need, which often doesn't line up with the actual diagnosis.
3) It reduces productivity, causes physician burnout, and put most small practices out of business. (Any practice not large enough to self-host records hire and have full time IT/software staff were basically strong armed into selling out to hospitals or other large org.)
4) It tracks both efficiency and patient satisfaction in the same system as the records and billing, which leads to some pretty perverse incentives on multiple levels. (As much heat as the drug companies over the opiod crisis, I'd argue doctors worried about dinging their patient satisfaction scores were just as responsible, by being afraid to tell too many patients "no".)
It goes on... Just a huge cluster of poorly thought out unintended consequences.
And that's just the medical side of things. The technical, financial, and legal aspects all have similar issues.
Half of this is a good thing. I want my doctor to follow the proper process and checklist everytime, no matter what. There are many one in a million cases that have the same symptoms as the common thing they see daily. The process is how you catch them and treatment. The doctors office is no place for creativity until everything else has been ruled out.
That doesn't mean there isn't room to improve the user interface. However doctors are in the wrong to be so technology backwards
A bit of both. The medical system has long known that doctors are too much "cowboy" and not following useful process. Many doctors resisted hand washing in the late 1800s.
User interaction studies have made great progress. A lot of software ignores that. Likewise we know a lot of ways to write high quality software that are ignored in your typical web app.
However we also know that doctors are human and they fail often. while computer systems do fail, those failures are much easier to fix once and for all.
> What was completely analog and free-form is now binned, discrete, and made more complex.
This sentence makes zero sense. Limiting choices inherently makes things LESS complex. That's why we use frameworks for decision making and risk assessment, rather than just doing everything "analog and free form"; it's the same reason we do "structured training" for complex and difficult tasks, rather than just let people try to figure them out. It's just a completely wrong and backwards statement.
> Limiting choices inherently makes things LESS complex.
"Do you want me to kick you in the face, or the groin?" is a substantially more complex choice than "Do you want me to kick you in the face, or the groin, or not at all?"
Sometimes, limited choices require you to shoehorn something into one of those available choices when it's not actually appropriate. Such is the case with medical record systems at times.
If I limited your choice to answering questions in binary yes/no, do you really think that makes things less complex than a free form & lucid description of an issue/procedure? Perhaps if you are communicating exclusively with a machine..!
1) The software influences the medical workflow and becomes a major distraction to visits. What was completely analog and free-form is now binned, discrete, and made more complex.
2) Desired outcome affects what and how things are recorded, instead of vice-versa. Staff learn what they have to do to get the orders or prescription or billing output that they need, which often doesn't line up with the actual diagnosis.
3) It reduces productivity, causes physician burnout, and put most small practices out of business. (Any practice not large enough to self-host records hire and have full time IT/software staff were basically strong armed into selling out to hospitals or other large org.)
4) It tracks both efficiency and patient satisfaction in the same system as the records and billing, which leads to some pretty perverse incentives on multiple levels. (As much heat as the drug companies over the opiod crisis, I'd argue doctors worried about dinging their patient satisfaction scores were just as responsible, by being afraid to tell too many patients "no".)
It goes on... Just a huge cluster of poorly thought out unintended consequences.
And that's just the medical side of things. The technical, financial, and legal aspects all have similar issues.