Deep Dive: Where EHRs Went Wrong

The AI Clinic: Deep Dive #4 | Subscribe

Every week, we take a closer look at the AI tools and trends shaping the future of healthcare. As artificial intelligence fundamentally changes the workplace, staying ahead of the curve isn't optional — it's essential for those who want to excel in their roles.

This week, we're looking at Electronic Health Records (EHRs). Following Oracle’s recent announcement about entering the EHR space, I’ve been thinking about the healthcare industry’s relationship to EHRs and why such a valuable tool is so widely disliked in our industry.

Like many things in tech, our story starts with Steve Jobs.

In August 2007 at a special event introducing the aluminum iMac, Tim Cook, Steve Jobs, and Phil Schiller sat down to take questions from the media. In responding to a reporter, Steve Jobs gave one one of his many classic quotes:

"Our goal is to make the best personal computers in the world and to make products we are proud to sell and would recommend to our family and friends. We want to do that at the lowest prices we can, but I have to tell you there's some stuff in our industry that we wouldn't be proud to ship - that we wouldn't be proud to recommend to our family and friends. We can't do it. We just can't ship junk."

This philosophy from Jobs drove Apple to create products that transformed how we interact with technology. Jobs championed a movement that turned computers from byzantine objects requiring deep expertise, to simple accessories ready to go within 5 minutes of opening. While other companies packed features and 'specs' into their products, Apple focused on making technology feel natural and intuitive. The result? Products that didn't just work - they delighted users.

Now look at healthcare technology. Electronic Health Records (EHRs) impact millions of clinicians and patients daily. Yet these systems, which manage critical health information and have a massive impact on clinician workflows, fall far short of basic usability standards. 70% of doctors cite EHR frustration as a major factor in burnout.

Jobs would be appalled. Healthcare software should set the highest standards for quality and user experience. Instead, we've accepted systems that turn doctors into data entry clerks and reduce patient interactions to a series of clicks and checkboxes. We've normalized "shipping junk" in an industry that has the means and motivations to do better.

We must ask ourselves. As the AI wave poises to reshape how work is done in most industries, how should the healthcare industry utilize AI tools and methodologies to hit "redo" on how EHRs function?

The False Promise

When Electronic Health Records (EHRs) gained mass adoption, they promised to revolutionize healthcare. Digital records would reduce errors, streamline workflows, and give doctors instant access to patient histories. The reality? Doctors now spend more time with computers than patients. A 2023 Mayo Clinic study shows physicians waste up to 6 hours daily clicking through poorly designed interfaces.

Where It All Went Wrong

How did we reach this point? A perfect storm of misaligned incentives. The 2009 HITECH Act pushed healthcare organizations to rapidly adopt EHR systems before the technology was mature. EHRs were given the business instead of earning the business and a few large vendors came to dominate the market, stifling innovation as hospitals invested millions in difficult-to-replace systems.

The result? A healthcare system where billing requirements drive workflows, administrative needs overshadow common sense solutions, and regulatory compliance matters more than user experience. As these systems grew more complex, technical debt accumulated, making meaningful improvements increasingly difficult. Small companies with better ideas couldn't compete, leaving us stuck with systems that actively hinder rather than help healthcare delivery.

Built for Billing, Not Care

Walk into any modern medical practice and you'll find a common sight: physicians hunched over computers, clicking through endless screens of their Electronic Health Record system. These systems weren't built with doctors in mind - they were designed for insurance companies and billing departments. Every click, every dropdown menu, every checkbox serves primarily to document care for payment rather than to deliver it effectively.

Consider a typical psychiatrist's day. Before discussing a patient's mental health concerns, they must click through diabetes screening alerts - not because it's clinically relevant, but because the system demands it. Emergency room doctors make an astounding 4,000 clicks per shift, each one pulling their attention away from critical patient care.

Data Without Insight

Basic clinical tasks that once took seconds now require elaborate workflows, forcing physicians to navigate through layers of menus and alerts just to find critical information. It's death by a thousand clicks.

Even worse, while these systems capture massive amounts of data, they make it nearly impossible to find what actually matters. Crucial patient history gets buried in endless scrolling notes. Important clinical details disappear beneath billing codes and regulatory documentation. Doctors report spending hours hunting through cluttered interfaces for vital information that should be immediately accessible.

The Autonomy Tax

Medicine once relied on doctors combining knowledge, experience, and judgment to treat patients. Now they're forced to navigate dropdown menus and checkbox options that can't capture the nuance of clinical decision-making. Different specialties get forced into standardized workflows that don't match their needs. Alert fatigue has become so severe that a 2022 JAMA Internal Medicine study found primary care physicians receive 77 EHR notifications daily - one every six minutes.

These technical failures extract a heavy human toll. Seventy percent of doctors cite EHR frustration as a major factor in burnout. Many spend their evenings catching up on documentation during what's grimly termed "pajama time." Young doctors now spend more time learning EHR systems than studying medicine. Most tragically, the doctor-patient relationship suffers as physicians stare at screens instead of making eye contact, their natural conversation flow constantly interrupted by software demands.

The Bitter Truth

We've created a healthcare system where technology doesn’t seem to serve anybody. Every poorly designed interface, every unnecessary click, every minute spent wrestling with software represents time stolen from patient care.

Jobs understood that technology should enhance human capability, not replace human judgment. He knew that good software feels natural, almost invisible. Instead, we've accepted systems that turn highly trained physicians into data entry clerks and reduce complex patient care to checkbox exercises.

The cost isn't just measured in time or money - it's measured in physician burnout, deteriorating patient relationships, and a healthcare system increasingly lost in the maze of menus and clicks it takes to get anything done. Until we demand better, we'll continue paying this price.

The Path Forward

In 1997, Steve Jobs returned to Apple and found a company shipping dozens of mediocre products. His first move? Cutting the product line by 70%. "Focus means saying no," he said. Jobs understood that great products require ruthless prioritization and an unwavering commitment to quality.

Twenty-five years later, healthcare technology remains stuck in the same trap Jobs found at Apple - trying to be everything to everyone, and ultimately serving no one well. We've built systems so bloated with features that they've lost sight of their core purpose: helping doctors care for patients.

This isn't just about bad software. Every hour physicians waste on EHRs represents dozens of patients who receive rushed care. Every doctor who quits medicine due to technology frustration represents thousands of patients who lose access to care. Every minute spent clicking through meaningless alerts is time not spent listening to patients' stories.

We deserve better. Our doctors deserve better. Most importantly, our patients deserve better.

Until we stop accepting mediocrity in healthcare technology, we'll continue driving good doctors out of medicine and eroding the human connections at the heart of good care. As Jobs reminded us - we can't keep shipping junk. The cost is simply too high.

That's it for this week! I’ll be working behind the scenes on some ideas for what an EHR “for the future” should actually look like. Have a great rest of your week and we’ll talk again on Friday.

-Patrick

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