Evolution of the Electronic Health Record

Evolution of the Electronic Health Record By Belinda Martorelli 11 January 2012 The beginnings of a standardized electronic health record system started in the 1960’s. They were mostly written accounts of the patients’ complaints’. As the systems developed, the records followed a business format, with the information being more useful for the financials and statistics. (Johns, Merida L. (Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition. It was reported by Summerfield and Empey that “at least 73 hospitals” were using computerized systems for patient’s records and there were “28 projects” underway to store and retrieve clinically relevant information. Over time other systems were created such as the CHCS – Composite Health Care System – used by the Department of Defense, COSTAR – the Computer Stored Ambulatory Record- used worldwide, and DHCP – De-Centralized Hospital Computer Program cultivated by the Veteran’s Administration – used nationwide, to name a few. Electronic Health Records, National Institutes of Health National Center for Research Resources, Overview, April 2006, The MITRE Corporation) The Institute of Medicine (IOM) saw new technologies in the mid 1980’s that they wished to implement in Electronic Health Records (EHR) to reduce duplicate records and increase accuracy. In 1991, a committee was created to make a report and recommendations. That first report was titled “The Computer-based Patient Record: An Essential Technology for Health Care”.

The results of this report spoke about the characteristics, features and purposes of the electronic record. (Johns, Merida L. (Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition. ) Early in 1999, a report came out that revealed between 44,000 and 98,000 American hospital patients died due to medical errors. Embracing information technology was a priority along with other factors that needed improvement in the American Healthcare System. Other reports focused on patient safety and the quality of care they received. Johns, Merida L. (Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition. ) The next important report the IOM produced, in 2003, dealt with the standardization of EHRs to improve patient safety. They created an 8-point list of what EHRs could do. 1. Administrative processes 2. Decision support 3. Electronic communication and connectivity 4. Health information and data 5. Order entry/management 6. Patient support 7. Reporting and population health management 8. Results management (Johns, Merida L. Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition. Source: adapted from Kohn 2000. ) There was a study done in 2009 reporting the set-up of health information technology, with limited success, in the industry. The IOM and the National Research Council spoke about the shortfall of implementing the technology, creating a “healthcare IT chasm”. (Johns, Merida L. (Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition. Source: adapted from Kohn 2000. Some of the challenges to having EHR’s can be system crashes, slow response time and lack of communication between disciplines. Purchasing a system “off the shelf” can be problematic. It may not be an exact fit. It can also be cost prohibitive. Buying components to meet the facilities needs might perform better. The Personal Health Record (PHR) is controlled by the patient. It contains information about their diseases, hospitalizations, surgeries and any other pertinent facts that affect the patient. Its’ location can be on a flash drive, their computer or on the Web.

It can list demographics like occupation, health related plans and their current health status along with a living will, organ donation choices and a durable power of attorney. (Johns, Merida L. (Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition. ) References: Electronic Health Records, National Institutes of Health National Center for Research Resources, Overview, April 2006, The MITRE Corporation Johns, Merida L. (Ed. ) (2011) Health Information Management Technology, Illinois: Chicago, Third Edition.