Abstract
The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.
Highlights
Factors that have contributed to the United States' drive for electronic health records systems include a growing, more diverse American population, increasing socioeconomic and health disparities, a significant percentage of Americans who have no health insurance and the lack of socialized medicine or "universal" insurance coverage, a distributed medical system that emphasizes specialization over general practice in predominantly urban areas, poorer per capita health cost-benefit ratios, and a high incidence of medical errors [1,2,3,4,5]
Fifteen more states were funded for such exploratory programs in 2000–2001, and of these 22 states, 16 states would receive further funding to implement Child Health Profiles [9,10]
Rhode Island, Missouri, Oregon, and Colorado were successful at early data linkage projects that created functioning Child Health Profiles (CHP)
Summary
Factors that have contributed to the United States' drive for electronic health records systems include a growing, more diverse American population, increasing socioeconomic and health disparities, a significant percentage of Americans who have no health insurance and the lack of socialized medicine or "universal" insurance coverage, a distributed medical system that emphasizes specialization over general practice in predominantly urban areas, poorer per capita health cost-benefit ratios, and a high incidence of medical errors [1,2,3,4,5]. Key barriers to EHR adoption are cited, including widespread resistance to computerization of clinics and health care agencies, data silo issues, public perceptions of electronic records and privacy issues (as outlined above with genetic testing), legal and regulatory issues, and most importantly, technical issues in linking and managing large-scale health data systems that use different software, hardware, and coding systems and that are continuously evolving [73] They provide many case examples in both storybook and extensive formats, mapping the central domains and functions of public health and clinical services/data collection to scenarios ranging from hazardous materials exposure to chronic hypertension, in the process demonstrating the importance of common messaging standards and data sharing agreements to enhance the mission of public health [73]. The Robert Wood Johnson Foundation [[58], pp. 98–100] provides a summary of the confusion surrounding HIPAA and states' use of EHR, misunderstandings that have needlessly limited states' implementation of EHR
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