Electronic health records: monitoring the return on large investments

Abstract

This special issue of JAMIA focuses on Electronic Health Records (EHR) systems. Health systems in many countries have promoted the implementation of EHR systems in the past few decades, and demonstrations of value for public health and research, as well as implications for clinical workflows and care improvement have been previously published. In the USA, however, a substantial government initiative to promote the widespread implementation of EHR systems did not happen until 2009. The HITECH act provided the necessary financial incentives for EHR implementation in different settings, which increased public interest in information about key factors for success or failure, particularly generalizable lessons learned from practical implementations. The articles in this issue discuss and provide some answers to frequently asked questions related to: (1) EHR usability issues in clinical care and quality improvement; (2) public health implications of EHR and health information exchange systems across institutions; and (3) use of EHR-derived clinical data warehouses for research. Adoption of EHR systems by clinicians is still highly variable. Commentaries from different stakeholders illustrate fundamental reasons for heterogeneous adoption: Middleton ( see page e2 ) reports on AMIA recommendations to improve the usability of EHR systems …