My maternal grandfather, a retired physician, once took me on a walk around his neighborhood in Rio de Janeiro, Brazil when I was somewhere around five or six-years-old. “I want you to meet a very distinguished gentleman,” he said. In those days, his neighborhood street was cobblestone with high curbs on either side.  Today, we have big trucks with air-conditioned cabins and large, rotating brushes to sweep off our street. Back then, street sweepers were day laborers, most of whom lived in the ‘favelas’ (slums) for which Rio is known. They were transported each morning to their respective locations throughout the city with their large garbage cans on a hand cart, broom, and shovel to sweep the gutters.

As we approached one of these street sweepers, Vovo (grandpa in Portuguese) greeted the middle-age black man by name and the greeting was returned with a smile, “Bon dia, Dr. Abel (my grandfather’s first name).” Vovo introduced me as his grandson and we shook hands. Vovo inquired about the man’s wife and children and they spoke for perhaps 5 minutes or so before we left and the man resumed work. I later learned that he was one of my grandfather’s patients from years earlier.

You will not hear about this in the mainstream media.

Thanks to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 the push for adoption of electronic health records (EHR) began with a vengeance, long before these programs were truly ready. The government adopted a carrot-and-stick approach, rewarding those who jumped onboard and punishing those who did not.

If you ask any physician what they think about HER, be prepared for a profanity-laden reply. The programs are too complicated, requiring more data input than necessary. The screens are too full of extraneous information. The endless point and click to accomplish a simple task is maddening. They abet abuse such as copy/pasting the same patient information over and over. They allow for upcoding simple encounters, a form of fraud to increase reimbursement. Things get missed. They slow physicians down. Even the manufacturers of these programs acknowledge they decrease physician productivity. We are promised improvements as new programs come out, but this seems to never be realized. The recent switch to EPIC at local hospitals is an example.