Dead-on right. It's not the back-end, it's not what brand of software, it's not the brand of tablet... it's the interface.

I'll say it again... most physicians are NOT geeks, with the occasional exception (confession: I actually have a server rack in my house). People may not realize this, but plenty of physicians can't even type, particularly the older ones.

I have a colleague... I'll call him Dr. Smith. He's a GP, and he's literally been practicing for nearly 50 years. That's not a typo... he started in 1960. He's old-school, and anybody (including me) would be happy to have him take care of them... because he takes all his own calls... comes into the ER to see his patients, even in the middle of the night and on weekends. He's also a hell of a nice guy, and a good doc... a real dying breed.

He's computer-illiterate. Completely. You threaten him with "learn this crappy new system or else," and he's going to balk. He'll retire, or drop his privileges and move to the hospital across town like a bunch of his younger colleagues given the same ultimatum.

You think you can force physicians to simply eat sh*t? Who do you think you are... Medicare? You MUST have physician buy-in, and physicians balk at being told "use this crap or else" by some suit who doesn't take care of patients, ESPECIALLY when the UI slows them down, cuts into their productivity, and interferes with their care of patients. I've worked in environments where that was done as a top-down forced implementation (I'm an ex-military doc), and it sucks out loud (it was also reverted to paper in less than 24 hours after the entire facility literally ground to a halt).

How do you like it when some admin weenie comes down to your server room and says "we're implementing this brand-new system. It sucks, it's slow, it crashes, it's full of security holes... but you're going to use it or else." Somehow, I think a similar industry-wide fiat like that directed against IT, posted on Slashdot, would easily generate a 1000-comment thread... in the first 15 mintues.

Doctor Dugan, is it? I have to ask what specialty you practice, and what sort of practice environment you inhabit.

You sound like you're one of those who wants to throw open the health care licensing gates to anybody who wants to take care of a patient. Having seen some of the stunts pulled by my fully-educated colleagues over the years, I'm a bit leery of turning over those keys to just anybody, particularly those with even LESS training and knowledge.

What, exactly, are you proposing as an alternative to the current system?

And spare me the thinly-veiled "profit-driven whores" implication in why physicians didn't adopt EMRs 30 years ago. That isn't why, and you know it. The truth is that the technology sucked even more then than it does now.

It's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR (you can't get ten physicians to agree on damned-near ANYTHING, from what PACS software to use, to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper?) You want to know why physicians dread EMRs?

Well... being one (and a tech geek to boot), I'll tell you:

It's the UI.... that and the cost. If you can make it fast, user-friendly, intuitive, lightweight, and inexpensive, the world will beat a path to your door.

For example, when I was an intern, we were evaulating a hospital-based order-entry system from TDS. It was the old light-pen system, and the damned thing took 14 screens to order an Xray.

I'm now a practicing ER physician... nobody is under greater time pressure than I am, and the EMRs that I've seen so far will slow me down. My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.

Make it faster and easier to use than paper. Make it... you know... an actual upgrade? Not some ugly, unwieldy kludge forced by some data-mining, numbers-obsessed bureaucrat. Doctors generally aren't geeks... they care about ease of use. A system that doesn't make it easier to take care of patients will be universally despised, and resisted by everyone on the medical staff.

Physicians have enough to do, and enough to worry about. Want to have medical staff buy-in? Make the EMR an asset instead of a liability.