Introduction

Medical care worldwide is a costly enterprise. It is most expensive in the U.S., where 16% of gross domestic product (GDP) goes to health care costs. Even the typical Western European country spends 9% of their GDP on health care—a huge amount (OECD, 2006). Paradoxically, the country that spends the most on health care, the U.S., does not have the healthiest population. Most industrialized nations have avoided this dilemma, in part, by implementing electronic medical record (EMR) systems. These systems have other benefits: reducing medical errors, facilitating the electronic transfer of patient records across facilities, and improving the efficiency of clinicians.

 
However, the story from individual physicians is quite different. They complain of forced changes to established and successful work flows, long training times, and excessive time spent serving the computer rather than providing care to patients. The rush to automate the clinical environment has met significant resistance from clinicians, resulting in some major implementation failures.
 
 
Our own experiences with physicians reveal some critical usability aspects of their working environment and the systems they use. We discuss those insights here within the broader context of EMR implementations. Finally, we suggest directions for EMR designs that better accommodate the needs of physicians.

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