EP446: Hey, Let's Not Talk About EHRs, With Spencer Dorn, MD, MPH, MHA

Spencer Dorn, MD, MPH, MHA — a gastroenterologist, academic practice leader, and clinical informaticist at UNC — joins Stacey Richter to talk about EHRs (electronic health records) without really talking about EHRs. The real subject is Kranzberg's First Law of Technology: technology is never good, bad, or neutral on its own. Whether an EHR ends up empowering clinicians or burying them in information, extending human connection or eroding it, depends almost entirely on how it's implemented — the workflows, training, staffing, and people around it — not on the software itself.

WHAT YOU'LL LEARN

✅ Why Dr. Dorn insists there's no intrinsic property of technology, including EHRs, that determines whether it helps or hurts — outcomes depend entirely on implementation, per Kranzberg's First Law of Technology

✅ Why the same EHR system deployed in two different places can produce wildly different results depending on workflow, training, staffing, and change management, not the software itself

✅ How EHR-embedded information can just as easily empower clinicians as overwhelm them, and why that outcome sits on a continuum rather than being a binary

✅ Why "optimizing the EHR" is often the wrong framing, and why reframing conversations around optimizing the patient-doctor encounter or clinician teamwork gets closer to the real goal

✅ How EHR deployments can either extend or diminish human connection between doctors and patients, and between clinicians working together

WHY THIS MATTERS

It's tempting to praise or blame a piece of healthcare technology as if the software itself carries some inherent verdict — good, bad, or neutral. Kranzberg's First Law of Technology says otherwise: technology is never neutral, but it's also never predetermined. The same EHR system can empower one care team and overwhelm another, and the difference almost always comes down to workflow design, training, staffing, and the people implementing it, not the code. For anyone evaluating or purchasing healthcare technology, the real question isn't whether the tool is good — it's whether the surrounding people and processes are set up to make it good.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

06:15 Breaking down Kranzberg's Laws of Technology.

08:16 How do EHRs go right?

12:49 "EHRs empower us with information, yet they also overwhelm us with information."

16:00 How do EHRs bring healthcare workers closer together?

19:35 The Digital Doctor by Robert Wachter.

21:33 "The whole point of healthcare is to help people live healthier, happier lives."

22:41 How the same EHR deployed in different places can be more or less efficient.

25:51 Why the problem is not necessarily the EHR but actually operational.

28:51 How technology has also changed our expectations on timing and value.