So in your case the SW is a poor fit. That feels underwhelming from a package that is used widely and presumably should have the flexibility to adapt to the requirements of very different customers.

Yes, all major inpatient EHRs do have the flexibility to adapt to those requirements. But that level of customization is itself a huge effort, and many hospitals lack the resources to do it well. The other problem is that hospital administrators and IT staff often give in to internal pressure from clinicians to customize every little thing even when it doesn't actually improve productivity or care quality. Sometimes it's better for humans to adapt to the software rather than vice versa. "Vanilla is the best flavor."

As a clinician, I wholeheartedly agree that adapting myself to the software is usually better than spending tons of money to try to make the software fit me, but at the same time the software really should fit the general norm of practice style.

This is more about unnecessary complexity. Medicine is hierarchical and like any hierarchy those at the top should be giving orders that leave lots of leeway for those who have to make them happen. EHRs often push all that onto the physician who never learned how to do that and really shouldn’t.

It’s like the old story about a green lieutenant in the army. Commander says, Lieutenant Smith, I want a flagpole on our parade ground. The dumb lieutenant tells their sergeant precisely how to do it. The smart lieutenant says, “Sergeant, the commander wants a flagpole right here. Make it happen.”

Whenever a question arises (and it will), the sergeant with a dumb lieutenant has to go back and clear every step. The smart lieutenant’s sergeant doesn’t have to call until they encounter something they don’t know how to do or can’t approve on their own authority.

> That feels underwhelming

That could be the motto of basically every EHR system!