Reflections on rapidly changing health care landscape:  More and more folks are thrown into the fraying safety net.  More and more budget cuts impact this net. Greedy insurance companies skim the cream, and leave the crumbs for those trying to actually deliver services.  The already wealthy, serving the wealthy can easily afford the expensive EHR records that can artificially produce data indicating quality is available only from the elite private practices. (Appears that no one seems to understand statistics and epidemiology well enough to see through the data manipulation.)

In a nut shell- If the very poor, illiterate, non-English speaking, and homeless population are systematically excluded from the denominator of the data presented, and only the health outcomes of the educated employed insured are presented - Imagine what an effective health care delivery system it will appear that you are a part of!

However when you look past the veneer and scrutinize the drivel that passes for medical history from these EHR's and the differential diagnostic mediocrity hiding under the multi box check lists - and then sit down with the (hand written) medical records of those of us who are still standing in the trenches with the afore mentioned "excluded" population, what you might realize is that better actual medicine is practiced without the dumbed down scripts of EHR.