Cheryl Conrad no longer seethes with the frustration that threatened to overwhelm her in 2006. As described in IEEE Spectrum, Cheryl’s husband, Tom, has a rare genetic disease that causes ammonia to accumulate in his blood. At an emergency room visit two decades ago, Cheryl told the doctors Tom needed an immediate dose of lactulose to avoid going into a coma, but they refused to medicate him until his primary doctor confirmed his medical condition hours later.
Making the situation more vexing was that Tom had been treated at that facility for the same problem a few months earlier, and no one could locate his medical records. After Tom’s recovery, Cheryl vowed to always have immediate access to them.
Today, Cheryl says, “Happily, I’m not involved anymore in lugging Tom’s medical records everywhere.” Tom’s two primary medical facilities use the same electronic health record (EHR) system, allowing doctors at both facilities to access his medical information quickly.
In 2004, President George W. Bush set an ambitious goal for U.S. health care providers to transition to EHRs by 2014. Electronic health records, he declared, would transform health care by ensuring that a person’s complete medical information was available “at the time and place of care, no matter where it originates.”
President George W. Bush looks at an electronic medical record system during a visit to the Cleveland Clinic on 27 January 2005. Brooks Kraft/Corbis/Getty Images
Over the next four years, a bipartisan Congress approved more than US $150 million in funding aimed at setting up electronic health record demonstration projects and creating the administrative infrastructure needed.
Then, in 2009, during efforts to mitigate the financial crisis, newly elected President Barack Obama signed the $787 billion economic stimulus bill. Part of it contained the Health Information Technology for Economic and Clinical Health Act, also known as the HITECH Act, which budgeted $49 billion to promote health information technology and EHRs in the United States.
As a result, Tom, like most Americans, now has an electronic health record. However, many millions of Americans now have multiple electronic health records. On average, patients in the United States visit 19 different kinds of doctors throughout their lives. Further, many specialists have unique EHR systems that do not automatically communicate medical data between each other, so you must update your medical information for each one. Nevertheless, Tom now has immediate access to all his medical treatment and test information, something not readily available 20 years ago.
Tom’s situation underlines the paradox of how far the United States has come since 2004 and how far it still must go to achieve President Bush’s vision of a complete, secure, easily accessible, and seamlessly interoperable lifetime EHR.
“What we’ve essentially done is created 24/7/365 access to clinicians with no economic model for that: The doctors don’t get paid.” —Robert Wachter, chair of the department of medicine at the University of California, San Francisco
Poor EHR system usability results in laborious and low-value data entry, obstacles to face-to-face patient communication, and information overload, where clinicians have to wade through an excess of irrelevant data when treating a patient. A 2019 study in Mayo Clinic Proceedings comparing EHR system usability to other IT products like Google Search, Microsoft Word, and Amazon placed EHR products in the bottom 10 percent. Electronic health record systems were supposed to increase provider productivity, but for many clinicians, their EHRs are productivity vampires instead. Researchers have found that doctors spend between 3.5 and 6 hours a day (4.5 hours on average) filling out their patient’s digital health records, with an Annals of Internal Medicine study reporting that doctors in outpatient settings spend only 27 percent of their work time face-to-face with their patients. In those visits, patients often complain that their doctors spend too much time staring at their computers. They are not likely wrong, as nearly 70 percent of doctors in 2018 felt that EHRs took valuable time away from their patients. To address this issue, health care providers employ more than 100,000 medical scribes today—or about one for every 10 U.S. physicians—to record documentation during office visits, but this only highlights the unacceptable usability problem. Furthermore, physicians are spending more time dealing with their EHRs because the government, health care managers, and insurance companies are requesting more patient information regarding billing, quality measures, and compliance data. Patient notes are twice as long as they were 10 years ago. This is not surprising, as EHR systems so far have not complemented clinician work as much as directed it. “A phenomenon of the productivity vampire is that the goalposts get moved,” explains University of Michigan professor emeritus John Leslie King, who coined the phrase “productivity vampire.” King, a student of system–human interactions, continues, “With the ability to better track health care activities, more government and insurance companies are going to ask for that information in order for providers to get paid.”
Robert Wachter is chair of the department of medicine at the University of California, San Francisco. Christopher Michel/Wikipedia
Robert Wachter, chair of the department of medicine at the University of California, San Francisco, and author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, believes that EHRs “became an enabler of corporate control and outside entity control.” “It became a way that entities that cared about what the doctor was doing could now look to see in real time what the doctor was doing, and then influence what the doctor was doing and even constrain it,” Wachter says. Federal law mandates that patients have access to their medical information contained in EHR systems—which is great, says Wachter, but this also adds to clinician workloads, as patients now feel free to pepper their physicians with emails and messages about the information. “What we’ve essentially done is created 24/7/365 access to clinicians with no economic model for that: The doctors don’t get paid,” Wachter says. His doctors’ biggest complaints are that their EHR system has overloaded email inboxes with patient inquiries. Some doctors report that their in-boxes have become the equivalent of a second set of patients. It is not so much a problem with the electronic information system design per se, notes Wachter, but with EHR systems that “meet the payment system and the workflow system in ways that we really did not think about.” EHRs also promised to reduce stress among health care professionals. Numerous studies have found, however, that EHR systems worsen clinician burnout, with Stanford Medicine finding that 71 percent of physicians felt the systems contributed to burnout.
In 2024, the average cost of a health care data breach was $9.97 million. The cost of these breaches will soon surpass the $27 billion ($44.5 billion in 2024 dollars) provided under HITECH to adopt EHRs.
2025 may see the first major revision since 2013 to the Health Insurance Portability and Accountability Act (HIPAA) Security Rule outlining how electronic protected health information will need to be cybersecured. The proposed rule will likely force health care providers and their EHR vendors to make cybersecurity investment a much higher priority.
$100 Billion Spent on Health Care IT: Was the Juice Worth the (Mega) Squeeze?
The U.S. health care industry has spent more than $100 billion on information technology, but few providers are fully meeting President Bush’s vision of a nation of seamlessly interoperable and secure digital health records.
Many past government policymakers now admit they failed to understand the complex business dynamics, technical scale, complexity, or time needed to create a nationwide system of usable, interoperable EHR systems. The entire process lacked systems-engineering thinking. As Seema Verma, former administrator of the Centers for Medicare and Medicaid Services, told Fortune, “We didn’t think about how all these systems connect with one another. That was the real missing piece.”
Over the past eight years, successive administrations and congresses have taken actions to try to rectify these early oversights. In 2016, the 21st Century Cures Act was passed, which kept EHR system vendors and providers from blocking the sharing of patient data, and spurred them to start working in earnest to create a trusted health information exchange. The Cures Act mandated standardized application programming interfaces (APIs) to promote interoperability. In 2022, the Trusted Exchange Framework and Common Agreement (TEFCA) was published, which aims to facilitate technical principles for securely exchanging health information.
“The EHR venture has proved troublesome thus far. The trouble is far from over.” —John Leslie King, University of Michigan professor emeritus
In late 2023, the first Qualified Health Information Networks (QHINs) were approved to begin supporting the exchange of data governed by TEFCA, and in 2024, updates were made to the APIs to make information interoperability easier. These seven QHINs allow thousands of health providers to more easily exchange information. Combined with the emerging consolidation among hospital systems around three EHR vendors—Epic Systems Corp., Oracle Health, and Meditech—this should improve interoperability in the next decade.
These changes, says HIMSS’s Tom Leary, will help give “all patients access to their data in whatever format they want with limited barriers. The health care environment is starting to become patient-centric now. So, as a patient, I should soon be able to go out to any of my healthcare providers to really get that information.”
HIMSS’s Christina Grimes adds that the patient-centric change is the continuing consolidation of EHR system portals. “Patients really want one portal to interact with instead of the number they have today,” she says.
In 2024, the Assistant Secretary for Technology Policy / Office of the National Coordinator for Health IT, the U.S. government department responsible for overseeing electronic health systems’ adoption and standards, was reorganized to focus more on cybersecurity and advanced technology like AI. In addition to the proposed HIPAA security requirements, Congress is also considering new laws to mandate better cybersecurity. There is hope that AI can help overcome EHR system usability issues, especially clinician burnout and interoperability issues like patient matching.
Wachter states that the new AI scribes are showing real promise. “The way it works is that I can now have a conversation with my patient and look the patient in the eye. I’m actually focusing on them and not my keyboard. And then a note, formatted correctly, just magically appears. Almost ironically, this new set of AI technologies may well solve some of the problems that the last technology created.”
Whether these technologies live up to the hype remains to be seen. More concerning is whether AI will exacerbate the rampant feeling among providers that they have become tools of their tools and not masters of them.
As EHR systems become more usable, interoperable, and patient-friendly, the underlying foundations of medical care can be finally addressed. High-quality evidence backs only about 10 percent of the care patients receive today. One of the great potentials of digitizing health records is to discover what treatments work best and why and then distribute that information to the health care community. While this is an active research area, more research and funding are needed.
Twenty years ago, Tom Conrad, who himself was a senior computer scientist, told me he was skeptical that having more information necessarily meant that better medical decisions would automatically be made. He pointed out that when doctors’ earnings are related to the number of patients they see, there is a trade-off between the better care that EHR provides and the sheer amount of time required to review a more complete medical record. Today, the trade-off is not in the patients’ or doctors’ favor. Whether it can ever be balanced is one of the great unknowns.
Obviously, no one wants to go back to paper records. However, as John Leslie King says, “The way forward involves multiple moving targets due to advances in technology, care, and administration. Most EHR vendors are moving as fast as they can.”
However, it would be foolish to think it will be smooth sailing from here on, King says: “The EHR venture has proved troublesome thus far. The trouble is far from over.”
This article appears in the August 2025 print issue as “Electronic Health Records Are Hobbling Health Care.”