People Aren't Perfect and EHRs Can't Change That

George W. Bush got one thing right and one thing wrong. He was right when he announced that he was "The Decider." He was wrong when he chose where he would get the information on which to base his decisions. He understood that he could never know everything about everything, therefore it didn't really matter if he knew nothing about anything, as long as he could apply his instincts for deciding to knowledge that was supplied and explained by others.

Keep that in mind while we think about healthcare practitioners. Being human, there are two things about which you can be sure:

1. People can't perform an operation flawlessly, in precisely the same way time after time after time; and

2. People can't keep track of (remember) all of the things that hallucinating managers and regulators think that they should.

It's just the way human brains are constructed. It may not be what anyone wants to hear, but it's a fact and no amount of wishing will alter the facts.

So, the worst thing that an EHR can do is to add to the number of procedures that people must perform flawlessly and the number of things that they must remember to do. Being the worst thing possible, that is, of course, exactly what most of them do do (and why some think that they are do-do).

Computer systems will never make good deciders and people will never make good robots.

For an EHR to be useful, it should focus on documenting events, keeping track of work in progress, and alerting people in useful ways when new information becomes available that might require a decision. Then it should present that new information, in context, so that people can make the best decision possible.

When the available information is skewed, biased, incomplete, or just plain wrong, bad decisions will be the result. When information that could be available is not available, the decisions that get made will be a total crap shoot.