Electronic Health Records Their Time Has Come: After Almost Two Decades of Advocacy, the Health Care System Might Finally Be Ready to Take Full Advantage of Information Technology to Improve Quality and Efficiency

Article excerpt

In 1991, when portable computers were the size of sewing machines and the World Wide Web was aborning, the Institute of Medicine proposed a plan for how emerging technologies could be used to improve medical recordkeeping. The plan highlighted the potential of health information systems in general, and computer-based patient records specifically, to support health care professionals as they make decisions at the point of care. It also called for developing a national health information infrastructure. The goal was to achieve ubiquitous use of such patient records by all U.S. health care delivery organizations by 2001.

The goal was overly ambitious. But the proposed plan proved to be an important milestone in the evolution of thinking about patient data and the health information infrastructure needed within organizations and the nation. And such thought is now turning into action. In early 2009, with passage of the American Recovery and Reinvestment Act, the government committed its first serious investment in electronic health records (EHRs) and in developing a national health information infrastructure. The act calls for achieving widespread use of EHRs by 2014, and it provides $36 billion to support the use of EHRs in clinical settings and another $2 billion to coordinate their implementation.

EHRs are much more than computer-based versions of paper medical records or stand-alone data repositories, and their successful implementation is not without challenges. Indeed, the federal government's newly appointed national coordinator for health information technology, David Blumenthal, said in his first public statement that technical assistance is a "critical factor" in advancing EHRs to reduce health risks.

As an illustration of how EHRs and EHR systems may bring about multiple benefits in medicine, consider how two other industries have used similar technologies to provide convenient, efficient, and customer-centered services. In the banking industry, automatic teller machines and online Web sites provide customers with ways to conduct their banking when and where they choose and with confidence that their personal information is protected. Banks also provide alerts to customers about sensitive activity in their accounts and reminders about payment deadlines. These easy-to-use tools depend on a secure, seamless information infrastructure that enables data to cross organizational and national lines. In the online retail industry, companies such as Amazon.com not only offer convenience in shopping but also provide personalized shopping recommendations based on past purchases or selections made by other customers who have shown similar interests. This feature depends on the ability to capture and analyze data on individual and population levels. Amazon also provides a mechanism for used-book sellers to offer their products via its Web site--a process that is possible, in part, because there is a shared format (technically, interoperability standards) for the information presented to customers.

Now consider how data, information, and knowledge could securely and seamlessly flow through health care organizations. As a case in point, begin with a patient who has a chronic condition and is tracked by an electronic record of her health history, including any unusual symptoms, an accurate list of numerous medications, and reminders of when lab work is needed to ensure that the medications are not causing kidney damage. Lab results are forwarded directly to her electronic health record, which is maintained by her primary care clinician. If lab results are outside of the normal range, the physician receives an alert and, in turn, sends the patient an e-mail requesting that she repeat the lab work and schedule an appointment.

During the appointment, the physician has a comprehensive view of the patient's health history and receives a reminder that the recommended protocol for treating her condition has been changed. …