As an oncologist, I’ve participated in the 24- to 48-hour EMR training sessions that purport to equip clinicians for new systems. They seldom succeed. The average physician typically invests one to two days in technical orientation and an additional month navigating screens before achieving comfort. Versions differ significantly, even from the same vendor, and transitioning to a new hospital resets the learning process.
One evening in a rural hospital, I observed a patient in distress wait 40 minutes for medication because a locum nurse struggled to locate the correct screen for the dosage. She cycled through six pages before reaching out to the pharmacy. That delay was not a training problem; it was a design flaw, and a patient suffered because of it.
We continuously discuss AI, interoperability, predictive analytics, and clinical decision support, yet the vital tool that clinicians use daily still functions like a 1990s operating system. The CrowdStrike update failure in July 2024 wasn’t a cyberattack, but it still hampered access to medical records, imaging, and fetal monitoring across 759 U.S. hospitals. Over 200 hospitals lost access completely. The incident wasn’t an isolated occurrence; it revealed the fragility of a system that was never designed with resilience or user-friendliness in mind.
Clinicians constantly adapt to new treatments and scientific breakthroughs. EMRs do not evolve alongside them. They are created in corporate laboratories, not in clinical settings. Hospitals acquire budget-constrained versions with stripped-down workflows. Interfaces vary. Labels shift. Buttons relocate. Even similar EMR systems operate like different entities from one health system to another.
The cost of this disorder is substantial:
– **Loss of productivity:** Hours are consumed by tutorials, workarounds, and delayed charting.
– **Safety risks:** Unfamiliar layouts cause misclicks, incorrect dosages, missed alerts, and postponed care.
– **Emotional exhaustion:** Clinicians feel inadequate not because they are, but because the software compels it.
– **Increasing inequity:** Underfunded hospitals receive minimal configurations, causing care to be slower and riskier in communities that can least endure it.
And the industry’s reaction? “That’s just how it is.” This complacency must be eradicated.
Healthcare doesn’t require another feature-laden platform. It requires clarity. Apple thrived not due to having more features, but because it comprehended human hands and attention. Healthcare deserves the same level of consideration.
However, genuine reform cannot arise from vendors alone. EMRs are too intertwined with compliance, billing, and federal regulations to be repaired in a piecemeal fashion. A redesign necessitates a collaborative effort: EMR companies, health systems, and crucially, the Office of the National Coordinator for Health Information Technology (ONC).
A revamped EMR ecosystem should adhere to three fundamental principles:
– **Universal logic:** One menu structure. One navigation language. One uniform set of labels. A nurse or physician should not feel as though they are learning a new dialect with every hospital change.
– **Simplicity over features:** Most EMR features exist to meet billing, audits, and compliance. A clinical tool should prioritize safety, speed, and transparency.
– **Usability as a regulated metric:** If usability affects safety (which it does), then EMR vendors should be publicly evaluated on it. Those evaluations should influence whether their products can be utilized in clinical environments. Usability is not an extra; it is a patient safety concern.
At present, EMRs track codes more adeptly than they monitor care. They were optimized for insurers and auditors, not for clinicians or patients. To enhance outcomes, we require tools developed around the bedside, not the billing office.
We accept this inefficiency only because we’ve made it the norm: “That’s how healthcare operates.” But we have long surpassed the point where another tutorial, another onboarding, or another 40-minute delay for a patient in distress is tolerable.
Every other industry has experienced usability revolutions. Healthcare is the sole sector where the primary work tool becomes more complex the more “advanced” it becomes.
We need our Apple moment.
Because until we design technology around clinicians’ hands, attention, and workflow, rather than insurers’ dashboards, we will continue squandering six weeks of every doctor’s life on tasks that should require six minutes.
*Sriman Swarup is a board-certified hematologist-oncologist and the cofounder of OncoNexus, an AI-driven oncology workflow platform aimed at enhancing efficiency and care delivery. He also leads Swarup Medical PLLC, where he advises on clinical systems design, health equity, and digital health transformation. Practicing in rural Arizona, Dr. Swarup manages over 3,000 patient encounters each year while consulting startups and health systems on innovation and healthcare strategy. He writes about medicine, technology, and healthcare leadership at his website.*