The EMR Ontario Is Dreaming Of. Day 3: The Hardest Problem Was Never the Technology
Yesterday I talked about what all this means for our vendors and the doctors who rely on them. But beneath the architecture and the market strategy is a tougher, more human problem. And it’s the one that decides everything.
Let’s talk about Physician Lock-in
Let me say what often goes unsaid. More than nine out of ten Ontario doctors already own, license, and depend on an EMR they have used for years. It is their main source of truth. They are tied to it financially, legally, and by habit. They have shaped it to fit their workflow. In a system running at full speed, sticking with a flawed but familiar tool is not stubbornness. It is rational. Sometimes, it is even necessary for survival.
We have seen what happens when big system changes ignore this. The UK’s National Programme for IT, a top-down effort to modernize the NHS, struggled and was eventually scaled back. This happened mostly because it moved faster than the clinicians it depended on could keep up.
You cannot force your way past a clinician’s muscle memory.
You cannot force your way past a clinician’s muscle memory. Change like this only works when we do it together: clinicians, government, and vendors, all moving as one system.
“Loyalty” is really four different locks
It helps to stop seeing physician attachment as just one big feeling and instead break it down into the four things doctors are really tied to. Each one needs its own solution. Each lock has aa key.
The data lock. Decades of records, much of it scanned and messy, that I am legally and clinically responsible for. The fear is real: if even one chart is lost in the move, I am the one left to deal with it.
The money lock. The EMR is a sunk cost and a monthly expense. Entire practices are built around its financial model.
The workflow lock. I have adapted to what I have. Every extra click in an already tough day is a reason to say no. Here is the trap most people miss: even matching my current workflow is not enough. A switch that only breaks even causes me real pain for no benefit.
The trust lock. I am truly loyal to the system I know, especially since I have no extra time or energy to learn about new systems, whether they are better or not.
Why the obvious historical plays on change usually backfire
If you try to mandate change from the top, history shows you will hit a wall. If you say, “it’s just as good as what you have,” doctors and nurses will not be impressed. If you underestimate the effort needed to switch, and I think my records will not transfer over safely—structured and scanned, originals preserved—the conversation ends before it even begins.
The costs of every previous wave of digital change since the original funding for EMRs have always fallen on the people least able to handle them: the clinicians. We remember. That memory is the real barrier, not the software.
This was never really a technology problem. It never is.
Tomorrow, in Part 4: if that is the wall, here is how we get over it. I will talk about what real success will take. I hope you will come back for it.
