A new paradigm for EMRs--publishing

Nice thoughts. As an internist and CEO of our large internal medicine group on the East coast, I have spent years examining the financial and operational obstacles to EMR. It has obvious potential benefits in many domains of healthcare particularly documentation of outcomes etc etc.
Given that the more affluent single specialty pracitices have adopted these at a far higher rate than the primary care physician there are important barriers to adoption that the pure capital cost analysis do not capture.
Given that in many areas of the country primary care medical practice has degenerated into a volume proposition to stay barely alive financially.
There are large costs associate with the training and re engineering of practice workflows which is an economic hit.(some claim reduction in work force but for the most part this has been marketing smoke and mirrors)
If a physician needs to see 30-40 patients a day to keep his practice financially viable ANYTHING which drops that volume is a painful expense
Most of the "efficient systems" end up being template driven and rarely accurately capture physical finding in a manner that is clinically useful for outcomes analysis.(nicely printed garbage in garbage out)
Lastly, work ergonomics of primary care require visual and emotional contact with the patient rather than a distracted clinician trying to find the control F5 button when the patient is sharing the sorrow of a lost husband etc...these are the subtle issues that are relevant to adoption. It has nothing to do with computer phobia and a system that integrate advertising is an annoyance however if the product is superior can easily be overlooked
don bruce, md

In response to Dr. Bruce's concerns about being able to incorporate the new EMR into a primary-care-practice workflow, the person who largely designed--and used--the EMR that Practice Fusion markets is in fact a primary care physician who is also a computer programmer (in his "spare time"). He made a point of creating an EMR that would reflect and enhance the workflow of a primary care practice. As a friend of his when he was developing the application, I saw firsthand the years of tinkering and creating and debugging and adapting that went into the product. So, it might be easier for PCPs to use than they imagined, even if they are not "techies" (but just average users).