Shared Accountability for Sustainable Clinical Technology Success
Who Owns the EHR?
A Companion Guide to “Working to the Top of Your License”
By Gary Wietecha, MD, Chief Medical Officer, Med Tech Solutions
Introduction: The Question Behind the Question
“Who owns the EHR?” sounds like a question about org charts and budget lines. It is really a question about accountability—and in most healthcare organizations, the honest answer is “no one; and, therefore, it’s everyone’s problem.” When the system underperforms, clinicians blame IT, IT blames the vendor, leadership blames adoption, and the vendor points back to configuration. Each party is partly right, which is exactly why nothing improves.
The electronic health record is the single most expensive and most universally used piece of technology in a modern practice, yet it routinely operates at less than half its potential. The root cause is rarely the software. It is the absence of a shared accountability model—a clear, mutually understood agreement about who is responsible for what, where ownership cannot be handed off, and how the parties hold one another to their commitments.
In this guide, you’ll learn more about
- Reframing the EHR success as a problem of distributed ownership rather than centralized control.
- Technology either amplifies existing dysfunction or augments excellence, and the deciding factor is whether accountability is genuinely shared or merely diffused.
- The ten principles that follow give leaders, informatics professionals, and clinical teams a common language and a practical structure for owning their clinical technology together—and for finally breaking the cycle of automated dysfunction.
It is written as a companion to “Working to the Top of Your License”—just as every clinician should work at the full scope of their training, every stakeholder should own the full scope of their accountability for the systems that shape that work.
