I have met with CIOs and CMIOs who have spent well over $100 million on name-brand systems-wide EHRs whose productivity in the exam room after more than two years is 20-30% less than it was before they implemented the EHR.  Two of those hospitals are replacing their EHR and expecting different results.

I watch some physicians spend more than half their time with a patient sitting at a keyboard clicking and navigating while the patient sits there.  I watched it happen to me in an exam.  My physician knows what I do and asked me if there was a way to improve his face-time.

That got me thinking about how to do that.  Most hospital EHRs are very broad and complex systems.  They are designed to do a multitude of things that go well beyond the  interactions needed to document what occurs during the exam.  My review of those systems indicates that in many cases their breadth makes it difficult for them to render effective and efficient service during an exam–too many clicks, and difficult navigation.
Most physicians are much more effective writing than typing, selecting options from a slew of drop-down menus, and finding their ways around a maze of screens.

My reference to the term GUI is meant as a placeholder, perhaps I should have called it an ambulatory EMR front-end.  Whatever its label, I believe there are inexpensive solutions that can be implemented alongside large EHRs that can make the doctor more productive.  The fact that nobody is doing this does not mean it cannot be done.

I have seen EHRs that serve ambulatory care providers that are highly effective and do not neutralize the patient-doctor interaction.  I have seen a doctor be fully functional in as little as 30 minutes.  Some physicians use the increased productivity to spend more time with patients, and some use it to see more patients.

I think it is also an important cost and ROI consideration.  If a hospital spends $200 million on an EHR, and their result is a productivity decrease of twenty percent, the total cost of their EHR is substantially higher than $200 million.