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It is sad to see that it is taking so long to get to where we have what could be called high performance electronic medical records. One important aspect must be the ability to exchange information without having to manually enter things. There has been a lot of work done at an international level that is largely ignored by EMR developers, Infoway and CIHI. There has been a strong preference to reinvent the wheel and a lot of time and money has been wasted on the development of rudimentary EMRs that are contributing to physician burnout. My experience has been that when a new EMR is being created the developer is very interested and willing to make modifications. After about 3 years once there is a bit of a user base the developer basically stops listening. Opensource products are an exception as evidenced by the enthusiastic user group meetings that OSCAR has had.
Various organizations have repeatedly produced 'high level' reports that describe some aspects of a desirable solution. The problem is that efforts to hammer out the details are typically deemed to be 'out of scope'. No organization has been willing to put the required effort into mapping out all the details that are required or to provide physicians with the funding to participate in a sustained effort to accomplish this. When efforts have been made to produce comprehensive specifications like the EMR 2 EMR work done in BC the vendors did not see that this could have provided guidance to enhance their products. Instead the vendors prefer to continue with their idiosyncratic products that are largely based on uninformed opinions. Sadly while many physicians complain about how they struggle with their EMRs they do not spend any time complaining to their vendors. Surveys have shown that a large percentage of physicians would not recommend the EMR they are using to others. The few physicians that do complain are marginalized with the often heard vendor statement 'No one else has complained about this'.
Single vendor solutions have been tried before and have failed. I feel that the solution depends on having mandated standards that are detailed enough that EMRs based on those standards would provide the level of performance and interoperability that is expected for health system use. Vendors instead of putting time and effort into designing minimal viable products should instead work on providing services to support EMR users.