Our practice has been using Vista / CPRS "WorldVista" for a couple years now. And we are now in the process of switching to something else because
- we cannot get Vista to meet federal meaningful use requirements.
- we cannot get adequate tech support to tailor the system to our practice.

And note that while is it public domain, you still need an entity to install it, train your office staff, run servers, etc.

It was far from free. Indeed, now purchasing our second "EHR" has made it an even more costly mistake.

The circulating nurses in my OR are excellent at being circulating nurses, not at being CT scan navigators. It is quite painful to watch a nurse "scroll down to that inflammatory process in the right lower quadrant". It is a task that would take me 1-2 seconds with a mouse, but takes seemingly an eternity for someone not accustomed to interpreting CT scans.

Trust me, moving that task to the surgeon would not come CLOSE to eliminating the job of the circulating nurse. The vast majority of their job has nothing to do with navigating radiographs. But it would speed up the operation (good) and make things MUCH less frustrating for the surgeon (also good).

If it happens to be an uncomplicated operation, an appendectomy might take me 45min best case. It could take 2 hours. I would say it takes at least an hour (at shortest) before the operation starts to examine / interview the patient, get informed consent, evaluate labs, imaging studies. Then there is postoperative care of the patient in the hospital as well as follow-up visits to the clinic later.

As a surgeon, Medicare reimburses a $482.62 "global fee" for a laparoscopic appendectomy in my area (there are no provisions for charging "by the hour.". So it's tough to say how much I make in an hour. But I'd say it is safely below these "reasonable attorney's fees." Not to whine here. I'm not starving.

And FYI, after high school: 4yrs undergrad, 4 yrs med school, 5 yrs surgical residency.