Technology

I see a lot of people talking about how this is an issue of capitalism through the eyes of who purchases (c-suite) the electronic health record or EHR. This isn't really applicable when it comes to healthcare delivery systems. Every system has c-suite representation from the clinical side. CMO, CNO, CMIO, CNIO, etc. In addition physicians have strong lobbying power within the orgs to ensure that they are listened to.

Ultimately trade-offs need to be made somewhere, and the real issue is that these pieces of software are incredibly complicated. Have you ever stopped to consider how much information might be in your medical chart, for a single doctors visit? Prior to the visit they need to have or collect a bunch of customer data on you - name, date of birth, insurance info, etc. They need to schedule an appointment for you at a location with a specific doctor which means they need a calendaring and scheduling system and all the data that comes along with that. They may need to collect and scan documents about you, or get information from other medical systems. Then when you show up, you interact with more people than just your doctor - you get checked in, they collect a form of payment or the actual payment itself (meaning they need to interface with insurance to understand what to bill), then a nurse or medical assistant takes you back. A bunch of vitals get recorded - height, weight, blood pressure, pulse oximetry. Some of these come from devices which are hooked up to their system. Then the doctor comes in and does any number of things to you- there's a lot of narrative that needs to be collected, pieces of information about why you are there, your history, and so on. They may collect some kind of material from you for which the system needs to at the very least record that it was collected and what a result is (realistically it's interfaced and sometimes the interface includes media such as images). I could keep going on, but I think you get the idea - the amount that needs to go into a system to make it useful to all the various staff at a place of service means that the product is very expensive and difficult to create.

The real issue with capitalism comes in here - it's an issue of very few companies providing good products. It's very difficult to create a competing product in the EHR world because the established giants have been developing for 30+ years. They've poured billions of dollars and man hours into creating software that can manage the extreme complexity of medical care. Even among these giants which do hire clinical professionals to help shape the front end so it's as user friendly as possible, medicine is huge and there are people of all walks practicing - some are great at tech and others not so much. Being able to appease everyone means you need a flexible UX which also means... more money and more man hours. This problem unfortunately can't really fix itself until it's possible to create a complicated system with less resources, which I don't foresee happening anytime soon.