Building boats and EHRs

Imagine that you want a boat. You tell someone to build or buy you a boat, and tell them to send you a bill. What would you get? A kayak? A windsurfer? A boat for waterskiing? A sailboat. A party boat? A cruise ship? A submarine? A battleship or destroyer? You probably would not get what you want. Very likely you would end up with something expensive - that you cannot use.

Before you build or buy a boat, you need a defined goal and a process:

• Define the parameters. Who will use the boat? What does the boat have to do?  Carry passengers? How many? Carry freight? How much?  How far? How fast? Ocean? Lake? River? 
• Identify the constraints.  How long does it have to last? How much is it worth and how much can you spend? What are the legal implications? Where will it be stored and how will it be transported and maintained?
• Find people who know how to build or buy THAT kind of boat.
• Have the boat experts work with the prospective boat users (who may not be the purchasers or owners) to plan or find the boat.
• THEN you can build or buy a boat that will meet the needs of the users and you won’t be stuck trying to pull a waterskier with a kayak.

The same applies in medicine. If you are the leaders of a medical institution and want an electronic health record, you cannot simply pay someone to write it or buy it. You need to start by asking the users to define what it is do and how it is to do it.