American tax payers have spent billions funding our current healthcare computer systems.

“Cash for Clunkers,” he calls it.

“[The legislation] gave $30 billion,” says technology entrepreneur Jonathan Bush, “to buy the very pre-internet systems that all of the doctors and hospitals had already looked at and rejected.”

And, he’s right. We’re using clunkers. Paid for by the U.S.A.

The reason for this is simple. These government subsidized and heavily regulated software systems were never designed for the physician end-user. They were built to satisfy thousands and thousands of pages of federal regulations. And, they’ve essentially achieved two things: (1) to create privilege for some, and (2) to politicize everything for the rest of us.

I use these software systems every day. I constantly make reasonable requests to health IT for their improvement. But, nothing changes. And, why should it? The success of the product is not intimately tied to the experience of the one using it. It’s backwards economics.

Every medicine I try to order in this one system requires four clicks and three inputed letters to override some illogical electronic “alert” that pops up. The alert message is supposed to be protecting patients. But, it’s another regulation that does nothing of the sort in this system. No physician even pays attention to these alerts anymore. We just click, type, type, type, click, click, and click. Done.

For three years, I’ve been trying to get them to fix this problem. The alerts are like a perpetual beep that never stops. Ultimately, you just ignore it, and the intended purpose is dead.

Well, physicians have been ignoring these alerts for years. Evidently, it’s the same amount of time they’ve been ignoring my request to fix it. You might enjoy my actual message to them this week:

Dear Mark [name changed to protect the innocent],

You must help me, friend.

Either you and I fix this together, or we might as well both throw in the towel and retire. Medicine, all of medicine, depends on you and me. It depends on us now. We are its last frontier.

Mark, I order just one medicine.


Aspirin 81mg by mouth daily.

It’s the most common dose we order these days. It is the only medicine my patient is getting. The only one. For the record, my patient can buy it over-the-counter himself.

I sign off on the medicine, and then, BEEP!

An alert.

Imagine that.

I get an alert.

It’s a DDAD alert, whatever that means. Wonder what it might say…?

It says, “The daily dose of 81 mg is below the usual dose of 324 mg to 4000 mg.”

Click here… type, type, type, click, click, and click, to override.

Mark, we work in dung every day, but this is the worst of it.

Get them to turn this off. All of it. All of the nonsense alerts. Send this message to someone at central authority who might actually care about doing something right. Actually make something better.

I’m going to keep pacing back and forth staring at the screen.



They call physicians like me complainers. Non-conformists. They say improving medical care depends on us doing it their way. If I object, I’m against “quality,” they say.

Yet, their model of data entry has no data proving it’s better. In fact, those that practice within it–along with the patent experience because of it–frequently say otherwise.

Telling you where medical providers hang out at the hospital these days is redundant. You already know. They are in the same centralized room or workspace. Typing and clicking and overriding one illogical alert after another. The patient is somewhere metaphorically far away.

This is our medical system.

The bureaucracy keeps ticking to its own heartbeat, while an apparent flat line awaits.

Hopefully, it will be for the current system and not its patients.