Electronic health record: Difference between revisions
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The electronic health record (EHR) is defined as a "computer-based systems for input, storage, display, retrieval, and printing of information contained in a patient's medical record."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Computerized+Medical+Records+System |title=MeSH Descriptor Data|author=National Library of Medicine |accessdate=2007-10-23 |format= |work=}}</ref> In the future it is hoped that EHRs across different health care systems will be able to exchange patient information in regional health information organizations (RHIOs); however, this goal has been elusive.<ref name="pmid17670775">{{cite journal |author=Miller RH, Miller BS |title=The Santa Barbara County Care Data Exchange: what happened? |journal=Health affairs (Project Hope) |volume=26 |issue=5 |pages=w568–80 |year=2007 |pmid=17670775 |doi=10.1377/hlthaff.26.5.w568 |issn=}}</ref> | The electronic health record (EHR) is defined as a "computer-based systems for input, storage, display, retrieval, and printing of information contained in a patient's medical record."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Computerized+Medical+Records+System |title=MeSH Descriptor Data|author=National Library of Medicine |accessdate=2007-10-23 |format= |work=}}</ref> In the future it is hoped that EHRs across different health care systems will be able to exchange patient information in regional health information organizations (RHIOs); however, this goal has been elusive.<ref name="pmid17670775">{{cite journal |author=Miller RH, Miller BS |title=The Santa Barbara County Care Data Exchange: what happened? |journal=Health affairs (Project Hope) |volume=26 |issue=5 |pages=w568–80 |year=2007 |pmid=17670775 |doi=10.1377/hlthaff.26.5.w568 |issn=}}</ref> | ||
==Successful implementations== | ==Uses== | ||
===Clinical care=== | |||
====Successful implementations==== | |||
The United States Department of Veterans Affairs has successfully implemented an electronic health record system, "''VistA''", across a very large health care system.<ref name="pmid12810119">{{cite journal |author=Brown SH, Lincoln MJ, Groen PJ, Kolodner RM |title=VistA--U.S. Department of Veterans Affairs national-scale HIS |journal=International journal of medical informatics |volume=69 |issue=2-3 |pages=135–56 |year=2003 |pmid=12810119 |doi= |issn=}}</ref><ref name="pmid11309758">{{cite journal |author=Fletcher RD, Dayhoff RE, Wu CM, Graves A, Jones RE |title=Computerized medical records in the Department of Veterans Affairs |journal=Cancer |volume=91 |issue=8 Suppl |pages=1603–6 |year=2001 |pmid=11309758 |doi= |issn=}}</ref> | The United States Department of Veterans Affairs has successfully implemented an electronic health record system, "''VistA''", across a very large health care system.<ref name="pmid12810119">{{cite journal |author=Brown SH, Lincoln MJ, Groen PJ, Kolodner RM |title=VistA--U.S. Department of Veterans Affairs national-scale HIS |journal=International journal of medical informatics |volume=69 |issue=2-3 |pages=135–56 |year=2003 |pmid=12810119 |doi= |issn=}}</ref><ref name="pmid11309758">{{cite journal |author=Fletcher RD, Dayhoff RE, Wu CM, Graves A, Jones RE |title=Computerized medical records in the Department of Veterans Affairs |journal=Cancer |volume=91 |issue=8 Suppl |pages=1603–6 |year=2001 |pmid=11309758 |doi= |issn=}}</ref> | ||
==Failed implementations== | ====Failed implementations==== | ||
* Kaiser - Hawaii<ref name="pmid16269467">{{cite journal |author=Scott JT, Rundall TG, Vogt TM, Hsu J |title=Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study |journal=BMJ |volume=331 |issue=7528 |pages=1313–6 |year=2005 |pmid=16269467 |doi=10.1136/bmj.38638.497477.68}}</ref> | * Kaiser - Hawaii<ref name="pmid16269467">{{cite journal |author=Scott JT, Rundall TG, Vogt TM, Hsu J |title=Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study |journal=BMJ |volume=331 |issue=7528 |pages=1313–6 |year=2005 |pmid=16269467 |doi=10.1136/bmj.38638.497477.68}}</ref> | ||
* Limpopo (Northern) Province, South Africa<ref name="pmid12702622">{{cite journal |author=Littlejohns P, Wyatt JC, Garvican L |title=Evaluating computerised health information systems: hard lessons still to be learnt |journal=BMJ |volume=326 |issue=7394 |pages=860–3 |year=2003 |pmid=12702622 |doi=10.1136/bmj.326.7394.860}}</ref> | * Limpopo (Northern) Province, South Africa<ref name="pmid12702622">{{cite journal |author=Littlejohns P, Wyatt JC, Garvican L |title=Evaluating computerised health information systems: hard lessons still to be learnt |journal=BMJ |volume=326 |issue=7394 |pages=860–3 |year=2003 |pmid=12702622 |doi=10.1136/bmj.326.7394.860}}</ref> | ||
==Adverse effects== | ====Adverse effects==== | ||
Implementation of the electronic health record has been associated with medication errors<ref name="pmid15755942">{{cite journal |author=Koppel R, Metlay JP, Cohen A, ''et al'' |title=Role of computerized physician order entry systems in facilitating medication errors |journal=JAMA |volume=293 |issue=10 |pages=1197–203 |year=2005 |pmid=15755942 |doi=10.1001/jama.293.10.1197}}</ref> increased hospital mortality.<ref name="pmid16322178">{{cite journal |author=Han YY, Carcillo JA, Venkataraman ST, ''et al'' |title=Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system |journal=Pediatrics |volume=116 |issue=6 |pages=1506–12 |year=2005 |pmid=16322178 |doi=10.1542/peds.2005-1287}}</ref> Some of these problems may be due to computer interfaces that are not intuitive to use.<ref>{{cite web |url=http://www.useit.com/alertbox/20050411.html |title=Medical Usability: How to Kill Patients Through Bad Design (Jakob Nielsen's Alertbox) |accessdate=2007-10-23 |author=Nielsen, Jakob |authorlink= |coauthors= |date=April 11, 2005 |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | Implementation of the electronic health record has been associated with medication errors<ref name="pmid15755942">{{cite journal |author=Koppel R, Metlay JP, Cohen A, ''et al'' |title=Role of computerized physician order entry systems in facilitating medication errors |journal=JAMA |volume=293 |issue=10 |pages=1197–203 |year=2005 |pmid=15755942 |doi=10.1001/jama.293.10.1197}}</ref> increased hospital mortality.<ref name="pmid16322178">{{cite journal |author=Han YY, Carcillo JA, Venkataraman ST, ''et al'' |title=Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system |journal=Pediatrics |volume=116 |issue=6 |pages=1506–12 |year=2005 |pmid=16322178 |doi=10.1542/peds.2005-1287}}</ref> Some of these problems may be due to computer interfaces that are not intuitive to use.<ref>{{cite web |url=http://www.useit.com/alertbox/20050411.html |title=Medical Usability: How to Kill Patients Through Bad Design (Jakob Nielsen's Alertbox) |accessdate=2007-10-23 |author=Nielsen, Jakob |authorlink= |coauthors= |date=April 11, 2005 |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | ||
===Quality management=== | |||
===Research=== | |||
The electronic health record can provide data for health research. One issue is protecting the privacy of patients.<ref name="pmid17600094">{{cite journal |author=Uzuner O, Luo Y, Szolovits P |title=Evaluating the state-of-the-art in automatic de-identification |journal=Journal of the American Medical Informatics Association : JAMIA |volume=14 |issue=5 |pages=550–63 |year=2007 |pmid=17600094 |doi=10.1197/jamia.M2444}}</ref><ref name="pmid17823086">{{cite journal |author=Szarvas G, Farkas R, Busa-Fekete R |title=State-of-the-art anonymization of medical records using an iterative machine learning framework |journal=Journal of the American Medical Informatics Association : JAMIA |volume=14 |issue=5 |pages=574–80 |year=2007 |pmid=17823086 |doi=10.1197/j.jamia.M2441}}</ref> | |||
==References== | ==References== | ||
Revision as of 11:56, 26 October 2007
The electronic health record (EHR) is defined as a "computer-based systems for input, storage, display, retrieval, and printing of information contained in a patient's medical record."[1] In the future it is hoped that EHRs across different health care systems will be able to exchange patient information in regional health information organizations (RHIOs); however, this goal has been elusive.[2]
Uses
Clinical care
Successful implementations
The United States Department of Veterans Affairs has successfully implemented an electronic health record system, "VistA", across a very large health care system.[3][4]
Failed implementations
Adverse effects
Implementation of the electronic health record has been associated with medication errors[7] increased hospital mortality.[8] Some of these problems may be due to computer interfaces that are not intuitive to use.[9]
Quality management
Research
The electronic health record can provide data for health research. One issue is protecting the privacy of patients.[10][11]
References
- ↑ National Library of Medicine. MeSH Descriptor Data. Retrieved on 2007-10-23.
- ↑ Miller RH, Miller BS (2007). "The Santa Barbara County Care Data Exchange: what happened?". Health affairs (Project Hope) 26 (5): w568–80. DOI:10.1377/hlthaff.26.5.w568. PMID 17670775. Research Blogging.
- ↑ Brown SH, Lincoln MJ, Groen PJ, Kolodner RM (2003). "VistA--U.S. Department of Veterans Affairs national-scale HIS". International journal of medical informatics 69 (2-3): 135–56. PMID 12810119. [e]
- ↑ Fletcher RD, Dayhoff RE, Wu CM, Graves A, Jones RE (2001). "Computerized medical records in the Department of Veterans Affairs". Cancer 91 (8 Suppl): 1603–6. PMID 11309758. [e]
- ↑ Scott JT, Rundall TG, Vogt TM, Hsu J (2005). "Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study". BMJ 331 (7528): 1313–6. DOI:10.1136/bmj.38638.497477.68. PMID 16269467. Research Blogging.
- ↑ Littlejohns P, Wyatt JC, Garvican L (2003). "Evaluating computerised health information systems: hard lessons still to be learnt". BMJ 326 (7394): 860–3. DOI:10.1136/bmj.326.7394.860. PMID 12702622. Research Blogging.
- ↑ Koppel R, Metlay JP, Cohen A, et al (2005). "Role of computerized physician order entry systems in facilitating medication errors". JAMA 293 (10): 1197–203. DOI:10.1001/jama.293.10.1197. PMID 15755942. Research Blogging.
- ↑ Han YY, Carcillo JA, Venkataraman ST, et al (2005). "Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system". Pediatrics 116 (6): 1506–12. DOI:10.1542/peds.2005-1287. PMID 16322178. Research Blogging.
- ↑ Nielsen, Jakob (April 11, 2005). Medical Usability: How to Kill Patients Through Bad Design (Jakob Nielsen's Alertbox). Retrieved on 2007-10-23.
- ↑ Uzuner O, Luo Y, Szolovits P (2007). "Evaluating the state-of-the-art in automatic de-identification". Journal of the American Medical Informatics Association : JAMIA 14 (5): 550–63. DOI:10.1197/jamia.M2444. PMID 17600094. Research Blogging.
- ↑ Szarvas G, Farkas R, Busa-Fekete R (2007). "State-of-the-art anonymization of medical records using an iterative machine learning framework". Journal of the American Medical Informatics Association : JAMIA 14 (5): 574–80. DOI:10.1197/j.jamia.M2441. PMID 17823086. Research Blogging.