October 29, 2015

Medical Record

Believe it or not, electronic health records (EHRs) have been around for nearly 50 years. It is not an entirely happy birthday. Here are the top eight milestones along the EHR journey. 1960s-1970s—Early Adopters: Hospital innovators apply information technology to the use, management, and delivery of medical information. They set out to solve the availability, legibility, and research ability issues with paper records, and to push critical information to clinicians via alerts and reminders. El Camino Hospital (in partnership with Lockheed), Massachusetts General Hospital, the University of Utah (in partnership with 3M and Latter Day Saints Hospital), the Regenstrief Institute, and the Department of Veterans Affairs all develop early EHR systems. 1987—A Stab at Standardization: Health Level 7 is founded to address EHR standardization issues. Specifically, it addresses the ability to share and integrate medical information. 1990s—Ambulatory Expansion: Personal computers and the internet open EHR opportunities within the ambulatory market. The EHR can now address growing healthcare complexity by providing a centralized repository of information that brings together clinicians, processes, departments, and facilities to deliver optimal treatment. In pursuit of this idea, the Institute of Medicine (IOM) sets a goal that all physicians will use EHRs in their practices by 1991. 2001—Sorry, IOM: Only 18% of physicians are using EHRs in their practices, according to the National Center for Health Statistics (NCHS). But computerized provider order entry begins to enter the mainstream, as calls grow to address the IOM reports To Err Is Human and Crossing the Quality Chasm. 2004—The Federal Government Steps In: The original idea of EHRs was powerfully simple: By providing distributed access to patient information (problems, diagnoses, symptoms, and treatments), we could improve patient safety, medical decision-making, and care delivery efficiency. But U.S. healthcare’s response has been anemic. President George W. Bush creates the Office of the National Coordinator for Health Information Technology to ensure most Americans have access to EHRs by 2014. 2010s—Building a Better EHR: The promise of information sharing and instant access to medical information still exists. But serious clinician concerns and credible research point to clinical and workflow problems induced by EHRs and how they present information. In creating massive volumes of data, we have lost access to meaningful information and insight. Business intelligence, rules and workflow technology, big data and predictive analytics arrive to extract meaning from all this data. 2011—Patient Demand Grows: The HITECH Act of 2009 serves as a catalyst for healthcare information technology. According to NCHS, 57% of physicians now use EHRs in their practices. But consumers want more. Seventeen million consumers use mobile devices to access medical information, and two out of three consumers would consider switching to a physician who offered electronic access to their medical records. Today—In Search of Meaningful Use: The push continues to leverage EHRs in delivering safe, quality, efficient, and equitable care; engaging patients; coordinating care; and managing population health. Stage 3 meaningful use criteria, which are currently open for comment prior to required use in 2018, move beyond basic information sharing to focus on improving outcomes. But some detractors believe we haven’t reached a degree of standardization to justify moving beyond the basics. For example, one Stage 2 rule required hospitals to demonstrate that 5% of their patients viewed, downloaded, or transmitted their records post-discharge. A recent modification reduced the requirement to a single patient completing these actions. Perhaps we need to look to tools beyond the EHR to achieve meaningful use of healthcare information technology? EHRs have the potential to put technology at the service of care providers and patients. But while EHR core principles and goals are well established, we are still actively reaching for those ideals—and it may take going beyond the EHR to achieve them.

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