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Electronic Health Records: Origination, Adoption, and Progression

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Public Health Informatics and Information Systems

Part of the book series: Health Informatics ((HI))

Abstract

The electronic health record (EHR) represents the evolution and convergence of technology and administration of medicine. Its advent has significantly changed the landscape in which medical policy and process can be created. As vast amounts of data are gathered in the management of care and administration of health systems, these clinical big data provide opportunities to enhance public health practice. This work delineates core functionalities and primary and secondary uses of EHRs that are aligned with these practices, including uses of EHRs for healthcare, public health, and population health outcomes. From EHRs origins as simple billing and accounting systems, to its adoption as, and progression toward, full-fledged interactive records, the medical, public health, and governmental stakeholders have at times been at odds to ensure their concerns and requirements are adequately represented in implementations. Legislation to promote the adoption of EHRs capable of recording and reporting health data in a standardized, structured, and secure format, and technologies to facilitate the progress towards the goals of EHRs, such as achieving portability, have had varying results. Various milestones to EHR goals are discussed, with respect to legislation, regulation, policies, and the importance of standards and technologies. This work examines some lessons learned from EHR developments and implementations, which also exposes limitations, disparities, and unintended consequences of EHR adoption and progression globally. It concludes with forward looking perspectives on EHRs, a crucial cornerstone of public health informatics and information systems.

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References

  1. Institute of Medicine. Key capabilities of an electronic health record system: letter report. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

  2. HHS Summary of the HIPAA Privacy Rule. Public law 104-191. HHS Office for Civil Rights (OCR). 2013. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html.

  3. Clinical Decision Support|HealthIT.gov. https://www.healthit.gov/topic/safety/clinical-decision-support.

  4. Romano MJ, Stafford RS. Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Arch Intern Med. 2011;171:897–903.

    PubMed  PubMed Central  Google Scholar 

  5. Sittig DF, Wright A, Osheroff JA, Middleton B, Teich JM, Ash JS, Campbell E, Bates DW. Grand challenges in clinical decision support. J Biomed Inform. 2008;41:387–92.

    Article  Google Scholar 

  6. Columbus S. Small practice, big decision: selecting an EHR system for small physician practices. J AHIMA. 2006;77:42–6.

    PubMed  Google Scholar 

  7. Fleming NS, Becker ER, Culler SD, Cheng D, McCorkle R, Graca BD, Ballard DJ. The impact of electronic health records on workflow and financial measures in primary care practices. Health Serv Res. 2014;49:405–20.

    Article  Google Scholar 

  8. Patra D, Ray S, Mukhopadhyay J, Majumdar B, Majumdar AK. Achieving e-health care in a distributed EHR system. In: 2009 11th international conference on e-health networking, applications and services. Piscataway: IEEE; 2010. p. 101–7.

    Google Scholar 

  9. Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. 2012. https://books.google.com/books/about/Physician_Adoption_of_Electronic_Health.html?hl=&id=w4UIuwEACAAJ.

  10. History of Electronic Data Interchange. 2005-2013. http://www.edi-guide.com/edi-history.htm.

  11. About HL7. HL7 International. http://www.hl7.org/about/index.cfm?ref=nav.

  12. Pianykh OS. Digital imaging and communications in medicine (DICOM) - a practical introduction and survival guide. New York: Springer; 2012.

    Google Scholar 

  13. The switch from ICD-9 to ICD-10: when and why. https://icd.codes/articles/icd9-to-icd10-explained.

  14. ICD-10 overview. 2018. https://www.cms.gov/Medicare/Coding/ICD10/index.html.

  15. ICD - ICD-10-CM - International Classification of Diseases, Tenth Revision, clinical modification. https://www.cdc.gov/nchs/icd/icd10cm.htm.

  16. WHO|International Classification of Diseases (ICD) Information Sheet. https://www.who.int/classifications/icd/factsheet/en/.

  17. CDT Products. https://www.ada.org/en/publications/ada-catalog/cdt-products.

  18. Executive Order 13335 - incentives for the use of health information technology and establishing the position of the National Health Information Technology Coordinator. 2004.

    Google Scholar 

  19. Health IT Legislation|HealthIT.gov. https://www.healthit.gov/topic/laws-regulation-and-policy/health-it-legislation.

  20. H.R. 1. - American Recovery and Reinvestment Act of 2009 (ARRA). Public Law 111-5. https://www.congress.gov/bill/111th-congress/house-bill/1/text.

  21. HITECH Act Grants. http://www.hipaasurvivalguide.com/hitech-act-13301.php.

  22. Introduction/meaningful use/CDC. https://www.cdc.gov/ehrmeaningfuluse/introduction.html.

  23. CMS Medicare and Medicaid EHR Incentive Programs Milestone Timeline. In: HIMSS. 2011. https://www.himss.org/cms-medicare-and-medicaid-ehr-incentive-programs-milestone-timeline.

  24. About Health Level Seven International|HL7 International. http://www.hl7.org/about/.

  25. About LOINC – LOINC. In: LOINC. https://loinc.org/about/.

  26. What is SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms)? - Definition from WhatIs.com. In: SearchHealthIT. https://searchhealthit.techtarget.com/definition/SNOMED-CT.

  27. NCPDP.org - About NCPDP. https://ncpdp.org/About-Us.

  28. ICD - ICD-10-CM - International Classification of Diseases, Tenth Revision, clinical modification. 2019. https://www.cdc.gov/nchs/icd/icd10cm.htm.

  29. Overview. 2019. https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html.

  30. CPT® purpose & mission. In: American Medical Association. https://www.ama-assn.org/about/cpt-editorial-panel/cpt-purpose-mission.

  31. David Kindig GS. What is population health? Am J Public Health. 2003;93:380.

    Article  Google Scholar 

  32. How can electronic health records improve public and population health outcomes? HealthIT.gov. https://www.healthit.gov/faq/how-can-electronic-health-records-improve-public-and-population-health-outcomes.

  33. Lurio J, Morrison FP, Pichardo M, Berg R, Buck MD, Wu W, Kitson K, Mostashari F, Calman N. Using electronic health record alerts to provide public health situational awareness to clinicians. J Am Med Inform Assoc. 2010;17:217–9.

    Article  Google Scholar 

  34. Fiks AG, Grundmeier RW, Biggs LM, Localio AR, Alessandrini EA. Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric population. Pediatrics. 2007;120:707–14.

    Article  Google Scholar 

  35. Friedman DJ, Gibson Parrish R, Ross DA. Electronic health records and US Public Health: current realities and future promise. Am J Public Health. 2013;103:1560.

    Article  Google Scholar 

  36. Electronic Health Records as a Resource for Public Health Surveillance. https://www.phi.org/resources/?resource=electronic-health-records-as-a-resource-for-public-health-surveillance.

  37. DeSalvo KB. Public Health 3.0: a call to action for public health to meet the challenges of the 21st century. Prev Chronic Dis. 2017;14

    Google Scholar 

  38. Cantor MN, Thorpe L. Integrating data on social determinants of health into electronic health records. Health Aff. 2018;37:585–90.

    Article  Google Scholar 

  39. Gold R, Cottrell E, Bunce A, Middendorf M, Hollombe C, Cowburn S, et al. Developing electronic health record (EHR) strategies related to health center patients’ social determinants of health. J Am Board Fam Med. 2017;30:428–47.

    Article  Google Scholar 

  40. BioSense Platform|NSSP|CDC. 2018. https://www.cdc.gov/nssp/biosense/index.html.

  41. Gray BH, Bowden T, Johansen IB, Koch S. Electronic health records: an international perspective on “meaningful use”. Issue Brief. 2011;28:1–18.

    PubMed  Google Scholar 

  42. Timmins N. World’s biggest civil technology project comes alive. In: Financial Times. 2006. https://www.ft.com/content/f3cc5876-85e6-11da-bee0-0000779e2340.

  43. Charette, RN. Troubled HealthSMART system finally cancelled in Victoria Australia. In: IEEE spectrum inside technology. 2012. https://spectrum.ieee.org/riskfactor/computing/it/troubled-healthsmart-system-finally-cancelled-in-victoria-australia.

  44. U.S. Department of Health and Human Services. The office of the national coordinator for health information technology. Health IT Dashboard. https://dashboard.healthit.gov.

  45. Mack D, Zhang S, Douglas M, Sow C, Strothers H, Rust G. Disparities in primary care EHR adoption rates. J Health Care. 2016;27:327.

    Google Scholar 

  46. Whitacre BE. The influence of the degree of rurality on EMR adoption, by physician specialty. Health Serv Res. 2017;52:616.

    Article  Google Scholar 

  47. Johnson OA, Fraser HS, Wyatt JC, Walley JD. Electronic health records in the UK and USA. Lancet. 2014;384:954.

    Article  Google Scholar 

  48. Feng Chang NG. Progress in electronic medical record adoption in Canada. Can Fam Physician. 2015;61:1076.

    PubMed Central  Google Scholar 

  49. Stone CP. A glimpse at EHR implementation around the world: the lessons the US can learn. https://www.e-healthpolicy.org/sites/e-healthpolicy.org/files/A_Glimpse_at_EHR_Implementation_Around_the_World1_ChrisStone.pdf.

  50. Srivastava SK. Adoption of electronic health records: a roadmap for India. Healthc Inform Res. 2016;22:261.

    Article  Google Scholar 

  51. Tavares J, Oliveira T. Electronic health record portal adoption: a cross country analysis. BMC Med Inform Decis Mak. 2017;17:97.

    Article  Google Scholar 

  52. Transformation Health and Care in the Digital Single Market. 2019. https://ec.europa.eu/digital-single-market/en/european-policy-ehealth.

  53. ΝEHR. Development of Nationwide Electronic Health Record (ΝEHR): an international survey. Health Policy Technol. 2017;6:124–33.

    Article  Google Scholar 

  54. Pan American Health Organization. Electronic medical records in Latin America and the Caribbean: an analysis of the current situation and recommendations for the region. 2016. http://iris.paho.org/xmlui/handle/123456789/28210.

  55. Registros Médicos Electrónicos - RELACSIS|OPS/OMS. In: Pan American Health Organization/World Health Organization. 2015. http://www.paho.org/relacsis/index.php/areas-de-trabajo/gt10-registros-medicos-electronicos.

  56. Odekunle FF, Odekunle RO, Shankar S. Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region. Int J Health Sci. 2017;11:59.

    Google Scholar 

  57. Alqahtani A, Crowder R, Wills G. Barriers to the adoption of EHR systems in the Kingdom of Saudi Arabia: an exploratory study using a systematic literature review. JHIDC. 2017;11:1.

    Google Scholar 

  58. Epic. Cerner and others moving into expanding global EHR market, says KLAS. In: Healthcare IT News. 2018. https://www.healthcareitnews.com/news/epic-cerner-and-others-moving-expanding-global-ehr-market-says-klas.

  59. Sheikh A, Jha A, Cresswell K, Greaves F, Bates DW. Adoption of electronic health records in UK hospitals: lessons from the USA. Lancet. 2014;384:8–9.

    Article  Google Scholar 

  60. Silverman DC. The electronic medical record system: health care marvel or morass? (surfing the information technology wave). Physician Exec. 1998;24:26–31.

    CAS  PubMed  Google Scholar 

  61. Lance Downing N, Bates DW, Longhurst CA. Physician burnout in the electronic health record era: are we ignoring the real cause? Ann Intern Med. 2018;169:50–1.

    Article  Google Scholar 

  62. Sieja A, Markley K, Pell J, Gonzalez C, Redig B, Kneeland P, Lin CT. Optimization sprints: improving clinician satisfaction and teamwork by rapidly reducing electronic health record burden. Mayo Clin Proc. 2019;94:793–802.

    Article  Google Scholar 

  63. Payne TH. EHR-related alert fatigue: minimal progress to date, but much more can be done. BMJ Qual Saf. 2019;28:1–2.

    Article  Google Scholar 

  64. Collier R. Rethinking EHR interfaces to reduce click fatigue and physician burnout. CMAJ. 2018;190:E994.

    Article  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge the editorial assistance from J. A. Magnuson and Brian E. Dixon. The authors also gratefully acknowledge the guidance on this intellectual work from advisors, Charles M. Heilig and Mark L. Messonnier, as well as the comments on it from several reviewers, including Adi V. Gundlapalli, Sanjeev Tandon, Michael Paul Reid, and Fatima Coronado, at the Centers for Disease Control and Prevention (CDC). This work was supported by CDC Public Health Informatics Fellowship Program (PHIFP) Fellowships (to F.R., and to J.T.P.). The CDC Population Health Workforce Initiative (PHWI) also provided support for this work (to F.R., and to J.T.P.). This work was also supported by a Biomedical Engineering Society (BMES) Career Development Award (to F.R.). The findings and conclusions in this work are those of the authors, and do not necessarily represent the official position of the CDC, or of the Mayo Clinic. The authors declared no conflict of interest.

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Authors and Affiliations

  1. Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Faisal Reza & José Tomás Prieto

  2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Stephen P. Julien

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  1. Faisal Reza
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  2. José Tomás Prieto
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  3. Stephen P. Julien
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Correspondence to Faisal Reza .

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Editors and Affiliations

  1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA

    J.A. Magnuson

  2. Department of Epidemiology, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA

    Brian E. Dixon

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Reza, F., Prieto, J.T., Julien, S.P. (2020). Electronic Health Records: Origination, Adoption, and Progression. In: Magnuson, J., Dixon, B. (eds) Public Health Informatics and Information Systems . Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-030-41215-9_11

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  • DOI: https://doi.org/10.1007/978-3-030-41215-9_11

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