As I've said before, I think one of the core flaws in the typical process of EMR development is that the programmers do not actually use the software--they are not physicians/nurses/etc. Let's contrast this with the development of word processing software--practically every programmer is also a potential user of the software, and so when something during the execution of the software is "off", the programmer will likely spot it him/herself, and go in and correct it. Or if indenting something took an unusually large amount of mouse clicks, then they would catch on to this and fix it. An even better example might be the programming of an IDE (ie software for programming software). While I may have the occasional gripe about NetBeans or similar software, modern IDEs (with the possible exception of Apple's XCode) are incredible pieces of software.
With EMR development, the programmer does not actually use the software, at least not in a real life kind of way. Instead, they often rely on the advice of consultant physicians. But this one degree of separation from use is very significant in my opinion. While the physician knows the "it would be nice if it [did such-and-such]" things, the programmer knows the underlying data structures and what the EMR IS and IS NOT capable of doing. While reconciling these two things (what is desired vs what is possible) can be done between two people, it is very inefficient. When the programmer and the physician are the same person, this process is exceedingly more streamlined.
Moreover, the small things that a physician may find wrong with an EMR may just get ignored, because the process of explaining to the programmer why some part of the UI is annoying to use may be too much effort. EMRs should actively solicit feedback from ALL users, not just paid consultants. There should be an easy-to-access menu option that a user can select to provide such feedback--a suggestion box. FEEDBACK, FEEDBACK, FEEDBACK is what is needed.
