In 2009, during the depths of the Great Recession, President Obama and the US Congress passed a law that accelerated the adoption of electronic health records (EHRs) as part of a stimulus package. Digitizing hospitals’ paper-based charting systems seemed like a sure-fire way to increase the efficiency of clinicians’ workflows.

The decade since has seen massive adoption of EHRs by American hospitals. But instead of the promised gains in efficiency, we got buggy software, physician burnout, and new barriers between clinicians and patients.

If you don’t have time to read three long-form articles (they’re all really good), the succinct lyricism of ZDoggMD hits all the major points:

As I see it, here are the two major problems with current electronic health record systems:

1. Terrible UI, designed by committee, that tries to cater to everyone and satisfies no one. (Except the administrators, or so I hear, but I bet even they hate it.)
2. Lip service to inter-operability by major EHR vendors, when really their business moat relies on the exact opposite. If your current EHR can’t easily talk to a competitor’s EHR, then your switching costs are astronomical (literally shutting half the hospital down, and bringing on dozens of IT support staff, for months), and so you’re locked in as a customer for years.

Five years after that video by ZDoggMD, and more than a decade after Obama signed that bill, instead of learning from the American experience, Canadian healthcare authorities are buying these turnkey systems wholesale from the same companies.

The alternatives: countries like Taiwan and Estonia have shown us that we can do better.

My vision:

1. To address the interoperability problem, we need a federally mandated EMR communication standard (we don’t even have to write one, FHIR already exists). You could make provincial healthcare funding contingent on this, since “portability” is enshrined in the Canada Health Act, but I’m not a politician.
2. To address the UI problem, we need an open health app ecosystem built on:
   a) A central database managed by provinces,
   b) API hooks into hospital and clinic EMRs, and
   c) Actual competition between vendors to provide the best user experience.

The result: I’m not scrolling through garbage UI at 3am that makes me cross-eyed and more likely to mis-prescribe dangerous medication.

The future of medicine is data. This has to happen, but we have to make it happen.