I hate seeing thick patient charts. They're unweildy, and if you're carrying a stack of them they tend to slide around. Sometimes crap pops ut of them. The pages are held together by brass fasteners, and constantly flipping through pages eventually tears pages. Then you have to use tape to fix the tears. And punch them back through those brass fasteners.

And the absolute worst part is that thick charts are still common. Especially with new patients. Why? Because when a patient moves from one office/hospital to another, and if the new office doesn't use the same exact EMR system as the previous place the digital records can't get transferred over. Not as a digital record anyway. Do you know what happens in that instance? Those records are printed. They don't always get printed at the new office or old office. Sometimes, they're printed at a "Health Information Exchange" which is basically a third party office that prints up digital records. These companies exist solely because they have multiple EMRs and will print all the electronic information to paper. And then mail off stacks of paper. Sometimes giant stacks of paper.

Now, I know what you're thinking. If you can install multiple instances of EMR software on a given system, why can't you just convert files over? Because the systems don't talk to each other! Each system uses its own file system. Its very own proprietary system. Now, I'm betting almost all of you use Word. Some of you may use OpenOffice or Google Docs to make .doc files, if not Word. Years ago there used to be this thing called "WordPerfect." It's actually still around. WordPerfect was the word processing software for a long time. It was incredibly popular for one reason - it was available for every operating system. Didn't matter if you were running Windows/DOS, Apple IIe/MacOS, *nix, AmigaOS. You could find a copy of WordPerfect. And it stored its files as .wp. The problem with WordPerfect was that it was part of a closed system. Something that Microsoft capitalized on. They allowed Word to open .wp files. Not only that, but they allowed Word to open up all sorts of non-MS word processing files. It's why Microsoft Office is the dominant Office suite, and will probably continue to be for a long time. Everything can open a .doc/.xls/.ppt/etc. Now .doc files weren't proprietary to Microsoft. Even WordPerfect made .doc files, but the formats were not the same. By making .doc a standard, Microsoft put itself ahead of its competitors. Not by making a more stable product, but by making a better product.

And that's what really ticks me off about EMRs. Not one vendor, not one company is standing up and going, "Hey. I'm gonna make this file system completely open." I have no idea why! It's not a security thing. Anyone with a text editor can open up any EMR file and read the contents. In between all the funky characters is going to be the patient information. It's not an ease of use thing. None of this is easy to use, all the systems are clunky. It's like we're back in the 80s when Apple decided they were going to take over the computing world with their broken, closed system.

So really, any developers for EMRs out there? I have a bone to pick with you. It'll probably be your own humerus bone, too. Because I will be beating you, your officers, your board, my board and my PI if I don't get satisfactory answers.