Today’s EMR Knowledge Management Capabilities:

• Knowledge “hardwired” or structured in proprietary modes into applications, not easily updated or shared

• Little or no standardization of HIT vendors on SNOMED, no shared interface terminologies for observation capture, no standard order catalogues

• Most EMRs have a task-interfering approach to decision support, sub-optimal usability, limited surveillance support

• Knowledge-engineering tools typically edit into transaction, no support for provenance, versioning, life-cycle, propagation, discovery or maintenance

• Consequently, clinical systems implementations are under-resourced with adequate knowledge to meet research, safety and quality needs

• Labor of converting knowledge into Clinical Decision Support is vastly underestimated

• Doesn’t bode well for personalized medicine