Skip to Main Content

INTRODUCTION

Key Points

  • The electronic medical record has been in development for 20 years, and will inevitably replace the paper record, but its adoption has been slow.

  • Despite buy-in from the federal government, industry, and patient advocacy groups, the healthcare industry has lagged behind other industries in computerization of its records.

  • Barriers include technical impediments, inadequate infrastructure, and the conservatism of the healthcare community.

  • Electronic health records (EHRs) are now beginning to diffuse into the acute care health system and adoption is expected to increase rapidly in the next decade.

The electronic medical record will inevitably replace the paper record at some point in the near future. It has been the subject of extensive discussion and attention by industry and government; as of today, however, it remains a largely unrealized concept. The electronic record has been described variously as a computerized medical record, computerized patient record, electronic medical record, and more recently as an electronic health record (EHR). This last term will be used throughout this chapter (Fig. 9-1).

Figure 9-1

There are many equivalent names for a digital medical record.

Any number of federal agencies, including the National Library of Medicine, the Agency for Healthcare Research and Quality, the Department of Defense, and the National Institute of Standards and Technology, as well as industry groups have attempted for over a decade to “jump-start” the development of computerized patient records. In spite of this EHRs are not used in most patient care settings. The technological barriers inherent in integrating EHRs into medical care are negligible compared to the human, behavioral, and organizational ones. Problems falling under the latter category include issues as fundamental as the definition of an EHR, the redefinition of the roles of the consumers of the medical record, and the creation of standards for data and data security (Fig. 9-2).

Figure 9-2

There are a variety of barriers to the adoption of medical records by health care practitioners.

The barriers to the adoption of EHRs range from imperfect software and the lack of standards, to the cost of retooling. A recent Rand Corporation study found that 10–15% of the nation’s office-based clinicians use EHRs in their practice, and that the speed of adoption is likely to increase rapidly as the technology improves and the cost of remaining paper-bound becomes increasingly apparent. In fact, some patients have taken the problem with traditional medical records into their own hands and subscribed to an on-line service permitting an individual to create their own “own-line” medical record.

The 2005 Rand study, entitled “The Diffusion and Value of Healthcare Information Technology” resulted in several key findings. The first is that, while later than many other industries, healthcare is slowly computerizing, and at ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

  • Create a Free Profile