What I believe about EMRs and Medical Information

I matriculated into medical school relatively late in life (at the age of 34) back in '84.  Purchased my first computer with all of our savings (more than $5,000 - can you believe they cost that much then?). My wife threatened to do nasty things to my gonads unless that investment paid off.  Twenty five years later it has (thank goodness).  Here's what I've learned in the interim:

1. First and foremost, unless information systems are aligned with human, bacterial and viral interactions they will never fulfill their promise of providing the "RIGHT information at the RIGHT time to the RIGHT people.
2. Second, unless the patient is the primary user of the information system it will have trouble delivering a return on investiment. This is what is meant by patient centered approach to care.
3. Third, the power of any electronic health or medical record is proportional to the number of other clinical information systems (hospitals, other doctor's offices, pharmacies, etc.) to which it is seamlessly linked.
4. Fourth; until physicians begin to think like patients they will have trouble communicating and improving the health of their patients.
5. Fifth; until we change the reimbursement formulas, we will never bend the cost-curve of medical care in the United States.
• Incidentally, this is a corollary of #4
  

So those are the main things that I've learned after 25 years of attempting to push the envelope in medical care.  Of course there are many other lessons but those pale in comparison to these 5.

Now there are equally several big lessons that I've learned in other areas of my life but I'm not sure I want to share those with the world now.