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Electronic health records

Bishoy Morris explains what the fuss surrounding new electronic records is all about

You know that room in your hospital, labelled medical records. Try to pop in one day and capture a mental image of it; there is a good chance that you will never see it again. Those old heaps of manila files enclosing barely legible handwritten medical records may soon give way to a versatile successor: electronic health records (EHRs).

An EHR provides electronically maintained information about an individuals lifetime health status and health care, which replaces or supplements the paper medical record.1 The software, however, is intended to support patient care and reduce cost, time, and errors, rather than just to be a digital copy of an existing paper record.2

The US Institute of Medicine has recently defined eight core functions of an EHR system (box).3 Even an EHR with only these basic functions makes a paper record look primitive, bulky, and inefficient. EHR software programs will be designed to do many tasks beyond traditional records. They will interact with doctors and patients to facilitate communication. They will have built-in systems to support clinical decision making that will send you reminders of your patients scheduled appointments or annual mammograms, give you up to date practice guidelines, and may identify a serious drug interaction between the two you have just prescribed online.34

Patients will also benefit from EHRs; they will have online access to their own medical records and will even see what doctors have written about their condition. The EHR will have user friendly tools to educate patients about their conditions and help them keep track and improve control of chronic conditions, such as diabetes or asthma.3

Patients are likely to be treated by different doctors in their lifetime; from the local general practitioner in your home town, where you received your vaccinations as a child, to the big hospital where you have bypass surgery 40 years from now. Each doctor will keep a separate medical record focusing on the most recent encounter with the patient. An EHR will gather all these bits together to create the big picture: an easily accessible longitudinal electronic record that can be safely and easily shared between all your healthcare providers. It will be easily accessible wherever and whenever it is needed, establishing continuity of care.5 EHRs are also more likely to be legible, accurate, and secure.67

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Once EHR systems are operational they will revolutionise health care, but their implementation faces a few obstacles. The initial cost of installing EHRs can be millions of dollars for a hospital and many thousands for a single practitioner. These huge startup costs have made healthcare providers reluctant to buy EHRs even though they can save money in the long term through better coordination and fewer errors.89

Privacy and security of electronic patient records are pertinent issues; no one wants their sensitive health data to be floating around in cyberspace.10 Accessibility and security of digital data is a constant conflict, but eventually a point of equilibrium acceptable to all parties will be reached.11 However, EHR technology is maturing rapidly. Medical, industrial, and public sectors are reacting to this by providing guidelines, providing solutions, and giving feedback on issues that arise.12

The potential benefits of EHRs are so compelling that politicians and governments are pushing strongly for their adoption. Last year President George Bush announced a plan to ensure that most Americans have electronic health records by 2014.1314 This year, officials at the White House said that they were seeking to double funding for the effort to $100m (54m; a78m),13 saying improved procedures for record keeping and prescriptions could reduce the $1.6 trillion US annual healthcare bill by up to 20%.

In the United Kingdom, the four phase NHS Care Records Service, which will digitise more than 50 million patient records, will be completed in 2010.5 A summary of all records will be held on a national database, known as the Spine, to ensure that particularly important patient information is always accessible.15 This is part of the national programme for information technology in the NHS, for which the government has set aside 2.3bn over the next three years.16

Bishoy Morris, final year medical student, Assiut University, Egypt
Email: bishoyso@yahoo.com


studentBMJ 2005;13:89-132 March ISSN 0966-6494

1. Health Canada. E-health thesaurus. Ottawa: Health Canada. www.hc-sc.gc.ca/ohih-bsi/res/thesaurus/thesaurus_alpha_e.html (accessed 10 Feb 2005).
2. Marietti C. Will the real CPR/EMR/EHR please stand up. Healthcare Informatics Online 1998 May. www.healthcare-informatics.com/issues/1998/05_98/cover.htm (accessed 10 Feb 2005).
3. Board on Health Care Services, Institute of Medicine. Key capabilities of an electronic health record system: letter report (2003). http://books.nap.edu/books/NI000427/html Accessed 10/1/2005 (accessed 10 Feb 2005).
4. Payne TH. Computer decision support systems. Chest 2000;118(suppl):S47-52.
5. National Programme for Information Technology in the NHS. NHS care records service. www.npfit.nhs.uk/programmes/nhscrs (accessed 10 Feb 2005).
6. Department of Health. Information for health: an information strategy for the modern national health service 1998-2005. London: DoH, 1998.
7. Hippisley-Cox J, Pringle M, Cater R, Wynn A, Hammersley V, Coupland C, et al. The electronic patient record in primary care--regression or progression? A cross sectional study. BMJ 2003;326:1439-43.
8. Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003;114:397-403.
9. Adler KG.Why its time to purchase an electronic health record system. Fam Pract Manag 2004;11:43-6.
10. MacDonald R. Commentary: a patients viewpoint. BMJ 2001;322:283-7.
11. Mandl KD, Szolovits P, Kohane IS. Public standards and patients control: how to keep electronic medical records accessible but private. BMJ 2001;322:283-7.
12. Joint Computing Group of The General Practitioners Committee and Royal College of General Practitioners Good practice guidelines for general practice electronic patient records (version 3). London: JCG, 2003.
13. The White House. Transforming health care: the presidents health information technology plan. Washington, DC: The White House, 2004. www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html (accessed 10 Feb 2005).
14. McGee MK. Eleven-member commission, sworn in Monday, has until Oct. 31 to create a plan for electronic health records. InformationWeek 2005 Jan 11. http://informationweek.com/story/showArticle.jhtml?articleID=57565
15. National Programme for Information Technology in the NHS. The national spine. London: Department of Health. www.npfit.nhs.uk/programmes/nhscrs/spine (accessed 10 Feb 2005).
16. National Programme for Information Technology in the NHS. NHS national programme for information technology implementation costs. London: Department of health. www.npfit.nhs.uk/news/131004 (accessed 10 Feb 2005).