Daniel Essin, MA, MD

The typical EHR depends on the assumption that everything is predictable. But that's never the case.

The goal of a lifetime medical record won't be realized as long as EHR vendors ignore theory and use proprietary representations of an encounter note.

Babies learn to recognize and differentiate objects, so why can't today's EHRs recognize and differentiate data?

The government has committed over $20 billion to incentivize the use of today's EHRs and …not one dollar to explore an alternative.

Today's EHRs are little more than glorified data collection devices, making meaningful clinical use difficult or impossible without more information.

Trust is an essential element of medicine. Trust is also an important consideration when dealing with computers, data, and information.

Those in healthcare get so excited about the data, especially "big data," that they come to believe that data elements have some intrinsic value, but they don't.

The NSA appreciates the importance of context. Do you? Does the EHR at your medical practice?

Plainly put, the "data" in an EHR, especially the coded values, are not and cannot be informative in the way a narrative record can.

Interoperability is the healthcare buzzword of the moment, but let's look at the word, what it means, and what we are truly trying to achieve in health IT.

Medicine needs a conceptual framework that addresses, in a coherent, coordinated way, the wide variety of requests that arise as we care for patients.

Chances are your medical practice uses e-mail every day. But here's how it works and how to find the right fit for your office's operations.

Physicians have medical information in their mind, but the EHR cannot access it, so the unhappy task of extracting data from information falls on providers.

If your goal is to be the best doctor you can be, limit your personal interaction with the EHR to only those things that serve that goal.

Some EHRs succeed in medical practices while others fail. There may be a root cause for the failure, but the solution is not easily embraced.

Usability remains a matter of personal preference, so the debate over the best tablet can shed light on how we determine the best EHR system for our own use.

Einstein was right when it came to EHRs: Insanity is doing the same thing over and over again and expecting different results.

The goal of medicine is to heal people, not to mass-produce them.

Each physician must decide whether to comply with the spirit, or merely the letter, of the rules of EHR use. That is a grassroots decision.

Many of today's EHRs have inherited both strengths and weaknesses of early design concepts, so perhaps it is time for a new role model.

Until the day when medicine if fully understood, today's EHRs will struggle to make sense out of data that is ambiguous and imprecise.

Physicians looking for lower healthcare costs and CPOE need only turn to Amazon for the blueprint to success.

Building things that others can use as tools of their trade requires an in-depth understanding of their work and how they do it as well as subject matter expertise.

If EHRs must evolve, then evolution needs time, opportunity, and freedom to make mistakes and suffer the pitfalls. Unfortunately, the government halts that freedom.

Whether you are a short-order cook or a physician, it's all about workflow in getting your daily work successfully completed.

It is time to stop repeating the worn out rhetoric that existing EHRs …are going to come to the rescue of medicine, patients, or healthcare costs.

Healthcare reform and the regulatory push for EHRs involve elaborate plans predicated on the future being a repetition of the past - but your future will not repeat the past.

Health IT can be improved by building applications with the goal of getting the real work done in the shortest possible time and with the least effort.

HIPAA may protect patient information, but it has come at the cost of direct patient care.

Physicians, by nature, multi-task. EHRs, by their nature, force physicians to single-task, therefore slowing them down.