Much has been made of the introduction of Electronic Health ( or Medical ) Records as a means of controlling health costs and improving quality.  Despite the medical community’s quick embrace of technology to treat disease, physicians have been reluctant to adopt medical records to the same degree as other technologies.  Many have characterized physicians as stodgy curmudgeons, stubbornly clinging their antiquated, overstuffed records in the face of rapidly evolving times.  The reality is that you cannot throw a stone in a hospital or medical meeting without hitting a physician with the latest version of the iPhone, reviewing the latest online reviews of apps, laptops, or professional software.  To the contrary, physicians are some of the most easily captured consumers for personal technology and conveniences in the marketplace.  
As a physician, I can tell you that the commodity most cherished by every doctor is his or her time.  Idle time means not only one less patient seen or procedure completed, but one more dinner at home or school recital that is missed.  My happiest days are one where one clinical task flows seamlessly to the next—no waiting for an operating room to become available or records to be faxed.  Yes, the holy grail of a physician’s workday is one that is busy, productive and ends at a reasonable hour.
So why would so many practices resist adoption of medical records to the point that the government has to not only pay a practice to buy one, but also penalize one that doesn’t?  If you ask them, they will say that a complete paper chart is a more efficient use of time than a complete electronic chart and I have to say that I agree.  One can peruse an organized paper chart and identify relevant information in the same amount of time for a desktop to boot up.  The other reason is that many of the day-to day tasks of follow up or delegated to nurses or clinical staff and their mental care algorithms imbedded by their physician supervisors.  EHRs return some of these follow-up tasks back to the physician, which takes time, and thus less revenue and fewer recitals.  
Mind you, I am thankful for EHRs I do not miss the days of going to the microbiology lab and looking through the logbook for my patient’s culture results.   It is a wonder to view X-rays on a computer screen, though I slightly miss annoying the file room clerk by incessantly pressing the call button at the front desk.   But alas, these revolutionary features are no longer a wonder of technology, but an expectation in an i-everything world.
What physicians need is a smarter EHR.  A system that does more than collects and organizes information.  It needs to know what information I want as soon as log in.   A system that knows how I like to treat patients, my patterns and my particulars.  It needs to know when a patient is sicker than the other.  It also needs to remember treatment plans when my nurse is on vacation or takes another job.  It also needs to communicate with my staff, my referrings and my patients.  It also needs to minimize my time in from of a computer.  

Sure, a smarter EMR makes my life easier, but how is it good for patients?  A smarter EHR ensures compliance by standardizing care and thus minimizes errors.  Sound medicine requires a human element, but a smarter EHR can keep me updated on new treatments, and remind me or my staff when straying from our usual standards.  The Smarter EHR operates proactively for the patient.

The current crop of EHRs was designed to collect and organize data into one place.  To do this they had to be heavily structured and expensive.  It is time for a flexible, smarter and yes, inexpensive EHR that actually  helps caregivers take care of patients.