Health Information Exchanges (Hikes) that allow ambulatory doctors, clinics, and hospital systems to share data so that we reanalyze duplicate products and services. We then track the physician compliance to measures that were built to help in cost reduction and quality control (analytics). This is not complex to explain or to have understood. Still, if we survey physicians and ask why there are some many ERR products and HE initiatives in the country, the answers would run the gamut and few would agree with the description above.

Even those that would agree would be quick o point that nowhere in that description is there a consideration for the impact the technology (as designed) has on physicians. The Health Information Technology (HIT) industry initially designed products that work as information collection systems and protocol compliance systems. Maybe these are not poorly constructed plans for the first iteration of ERR and HE. However, we need HIT that improves the physician experience and the quality of care that patients receive.

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The biggest issues in the design, configuration, and implementation f ERR and HE technology are that we need to better understand what needs to be built, the difficulty in building these kinds of systems, and that HIT needs to serve physicians in a way that augments their Job and their ability to treat patients. Very few HE or analytics projects start with a modest scope. It is not until the project starts that leadership begins to realize the cost in connecting and maintaining an environment compromised of disparate, divergent, and even competing Information systems.

As the project moves forward, the scope gets smaller and the patience and knowledge of leadership is often tested. Some of the difficult pieces to build such as note capture from ERR to HE are removed. Interactive dashboards become "view only," and sometimes simpler things Like bi-directional Interfaces are deemed unnecessary. In the end, we have systems that are very different from the hopes that were the springboard for the project. Still, there Is so much hope and promise for the future of health Information technology.

From the view of the technologist, the vision and promise that health information is perhaps most effective when it hinges on one simple premise: A health information system should result in better patient care by providing an improved physician experience. The system should be based on and designed to satisfy requirements from physicians, physician staff members, and other care providers. So work in HIT should start with physician requirements.

Those requirements give us the definition of the systems we need to build. Perhaps our greatest miscue in design and build of HIT for physicians is that we do not build them based on the workflow, hand offs, and ability to delegate that practically defines how most physicians in the ambulatory world induct their day. If physicians do not normally perform tasks such as prescription call in and data input for past medical history, why then do most electronic health systems attempt to force them into these roles?

How many systems clearly illustrate they are designed in such a way that it matches and improves the way a physician's office runs; that it respects and augments the workflow that the office currently has? Leaders that seek to implement HIT need to understand the significant configuration and customization work that is often necessary to get these systems to fit how hysteria offices work. They also need to understand that configuration is normally preferred over customization so that the system maintains enough original integrity to accept upgrades, fixes, and other system changes.

In the new COCOA and Meaningful Use healthcare models, physicians are measured on how well they capture certain data. This will determine their compliance to measures that will in turn indicate how well they are performing as a physician and finally how they will be compensated for their work. Somewhere in the process of measuring, racking, and performing analytics, it may behoove HIT builders and owners to ask one simple question, "How have I improved the physician's experience? There are initiatives all around the country to build HIT, but for what purpose? Most HIT vendors, hospital administrators, and HIT managers would argue that they are going to use HIT to lower cost, increase quality, and clinically integrate. Few of them would say we are in the business of using HIT to improve the physicians experience of practicing medicine; that we are here to deliver technology that we help them be ore efficient practitioners and increase their Job satisfaction.

Missing the mark regarding design and the lack of requirements has probably been a significant driver in creating the most significant gap in HIT, the understanding of what we are trying to build. There are three essential technological pieces in the new era of HIT: Systems that feed data such as Errs Systems that receive and exchange data such as HE Systems that perform analytics and reporting on data such as Big Data systems the business of modifying physician behavior- good luck with that.

If the goal is to build technology for data input and analysis, then we have neglected to provide practitioners and their patients with a better overall experience in care. Many HE type initiatives start with a lack of understanding regarding the implications of what we are building and the ramifications of what will happen if we built it. The lofty goals and dreams of many HE initiatives become victim to the harsh reality that many of us have little understanding of ERR to HE capability, cost, necessary processes, and even the technologies.

Often we hear that physicians ask what is in it for them regarding ERR technology. This is a good and fair question. We can supply physicians with information at the point of care and even before they see patients that can assist with diagnosis and treatment. We can build systems that allow physicians to see how well they are performing as far as meeting measures. We can allow them to send tasks to help them meet compliance to members of their staff and track the progress of the work getting done. Adherence to compliance updates sent to cell phones and other technologies are available today.

So we can fix the major problems that physicians and their staff have with ERR and HE technologies. There are problems with design, configuration, process, and even our own knowledge and understanding. We are getting better acquainted with the problems every day. Maybe this will help in the future. When the question is asked why we improved our approach to and implementation of HIT maybe the answer will not center on cost and quality control, but better care for patients and better tools and Job satisfaction for physicians that lead to lower costs and increased quality.