I enjoyed reading “Yale’s Epic Challenge” in the Winter 2013 Yale Medicine. As a former CMIO who trained in medical informatics and clinical computing at Yale, I know the challenges of EMR implementation are considerable, especially for an organization as large and complex as the Yale Health System. In fact, the term “EHR” is an anachronism; what Yale and others are now implementing are not simply electronic filing systems but enterprise-wide clinical resource and clinician control systems, with all the complexity that implies.

I do hope that Yale has learned well from the trials and tribulations of others’ prior efforts. I still note many difficulties with commercial EHRs, resulting in unintended consequences up to and including patient injury and death.

Finally, I note that the statement [by one of the physicians quoted in the article] that

“EMR use is mandated by federal authorities for everyone who’s in the Medicare and Medicaid arena” is not accurate. While there are reimbursement penalties for non-adopters of HHS-“certified” EHRs in those programs, there are no federal or state requirements for their use.

Responsibility for the choice of EHR adoption and liability for patient safety problems that may result falls fully on the adopters. Health care leadership should remain ever mindful of this.

Scot Silverstein, M.D., FW ’94
Philadelphia, Pa.