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Electronic health records: monitoring the return on large investments

Electronic health records: monitoring the return on large investments Highlights doi:10.1136/amiajnl-2013-001966 Lucila Ohno-Machado, Editor in chief This special issue of JAMIA focuses on office settings. Jariwala (seepagee39) New York City. Merrill (see page e131) Electronic Health Records (EHR) systems. describes factors that influence physician’s describes an evaluation model for the Health systems in many countries have use of electronic prescribing (e-prescribing), impact of health information exchange in promoted the implementation of EHR and Thomas (see page e44) reports on public health, and Lee (see page e139)pro- systems in the past few decades, and adequate adoption of controlled substance poses a tool to assist with infectious disease demonstrations of value for public health e-prescribing in a community setting. Also control at a regional level. and research, as well as implications for on this topic, Abramson (see page e52) Finally, the benefits of using EHR for clinical workflows and care improvement describes the safety of e-prescribing systems. research will increase as the barriers to have been previously published. In the However, EHR systems cannot always be utilization are removed and proper incen- USA, however, a substantial government adapted to fit existing workflows. Flanagan tives are devised. Newton (see page e147) initiative to promote the widespread (seepagee59) describes paper- and reports on algorithms and strategies to implementation of EHR systems did not computer-based workarounds to EHR use validate phenotypes for use in cross- happen until 2009. The HITECH act pro- in different institutions. De Lusignan (see institutional research studies, and Weber vided the necessary financial incentives for page e67) and Pinnock (see page e76) (see page e155) draws attention to issues EHR implementation in different settings, report on studies that utilized multi-channel of duplicate records in clinical data ware- which increased public interest in informa- video recording to analyze clinician’suseof houses serving multi-centric studies. tion about key factors for success or EHRs, with the latter article focusing on While most clinical research is still cur- failure, particularly generalizable lessons e-prescribing by primary care clinicians. rently based on data collected by dedi- learned from practical implementations. Rosenbloom (see page e178)and Wachs(see cated clinical trial management systems The articles in this issue discuss and page e183) developed interfaces that facili- (CTMS), there is increasing interest in provide some answers to frequently asked tate EHR utilization in practical settings, integrating CTMS with the information questions related to: (1) EHR usability and Landman (see page e187)providesa originating from the EHR, and a potential issues in clinical care and quality improve- case report of hazards related to software merger of functionalities could be envi- ment; (2) public health implications of updates in clinical workstations. sioned in the long-term. A historical con- EHR and health information exchange The use of EHR systems has been asso- trols database, such as the one described systems across institutions; and (3) use of ciated with healthcare quality improve- by Desai (see page e162), could be among EHR-derived clinical data warehouses for ment in several areas. Bates (see page e85) the first beneficiaries of such integration, research. reports on decreased rates of adverse medi- as its goal is to accelerate studies and Adoption of EHR systems by clinicians cation events with the use of EHR systems, quickly disseminate actionable results by is still highly variable. Commentaries and Flamm (see page e91) reports on bene- drawing on a larger data set for controls. from different stakeholders illustrate fun- fits for pre-operative assessment. However, as Huser (see page e169) points damental reasons for heterogeneous adop- Structured data from EHR systems are not out, dissemination of clinical trial results tion: Middleton (see page e2) reports on always enough: Greenberg (see page e97) is still hampered by poor adherence to AMIA recommendations to improve the combines EHR data with other sources to mandatory clinical trial registration in usability of EHR systems to increase monitor blood pressure control for quality national databases. patient safety and quality of care. improvement for chronic kidney disease These articles illustrate that EHR Cresswell (see page e9) provides an inter- care. Computer-aided diagnosis can also systems present enormous opportunities national perspective on successful health benefit from data derived from EHR as well as important challenges. The field IT implementation and adoption, while systems. Haug (see page e102) and Morillo of biomedical informatics has helped lay Saleem (see page e175) provides the per- (see page e111) propose systems to facili- the foundations of EHR system design, spective of the Veterans Affairs in the tate pneumonia diagnosis that could implementation, and evaluation, as well as USA. Ozkaynak (see page e14) calls for potentially interface with EHR systems in clinical decision support for quality increased flexibility to accommodate the future. Because many clinical decisions improvement, analytics for public health workflow issues in patient-centered care, are based on life expectancy and current and research, and the study of human Bar-Dayan (see page e17) reports on posi- models for predicting five-year survival are factors in EHR adoption. There will be tive return on investment for an EHR problematic, Mathias (see page e118)pro- no backtracking from EHR system use system, and Simborg (see page e21) poses a prognostic index derived from and adoption: much has been accom- discusses some potential future directions. EHR data. plished since the boost in utilization of Research articles address the issue of Public health is another potential benefi- EHR systems that started in 2009, and usability: McClellan (see page e26) describes ciary of EHR adoption, particularly much more is expected to happen within a study on successful EHR system adoption through the electronic exchange of health the next few years. As always, JAMIA will by physicians, while Davis (see page e33) information. Onylle (see page e125) reports continue to be the prime source for infor- reports on marked differences in EHR util- on the population characteristics of a mation on the impact of EHR systems for ization depending on clinical specialty and health information exchange network in clinical care, public health, and research. J Am Med Inform Assoc June 2013 Vol 20 No e1 e1 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the American Medical Informatics Association Oxford University Press

Electronic health records: monitoring the return on large investments

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Oxford University Press
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Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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1067-5027
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1527-974X
DOI
10.1136/amiajnl-2013-001966
pmid
23687172
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Abstract

Highlights doi:10.1136/amiajnl-2013-001966 Lucila Ohno-Machado, Editor in chief This special issue of JAMIA focuses on office settings. Jariwala (seepagee39) New York City. Merrill (see page e131) Electronic Health Records (EHR) systems. describes factors that influence physician’s describes an evaluation model for the Health systems in many countries have use of electronic prescribing (e-prescribing), impact of health information exchange in promoted the implementation of EHR and Thomas (see page e44) reports on public health, and Lee (see page e139)pro- systems in the past few decades, and adequate adoption of controlled substance poses a tool to assist with infectious disease demonstrations of value for public health e-prescribing in a community setting. Also control at a regional level. and research, as well as implications for on this topic, Abramson (see page e52) Finally, the benefits of using EHR for clinical workflows and care improvement describes the safety of e-prescribing systems. research will increase as the barriers to have been previously published. In the However, EHR systems cannot always be utilization are removed and proper incen- USA, however, a substantial government adapted to fit existing workflows. Flanagan tives are devised. Newton (see page e147) initiative to promote the widespread (seepagee59) describes paper- and reports on algorithms and strategies to implementation of EHR systems did not computer-based workarounds to EHR use validate phenotypes for use in cross- happen until 2009. The HITECH act pro- in different institutions. De Lusignan (see institutional research studies, and Weber vided the necessary financial incentives for page e67) and Pinnock (see page e76) (see page e155) draws attention to issues EHR implementation in different settings, report on studies that utilized multi-channel of duplicate records in clinical data ware- which increased public interest in informa- video recording to analyze clinician’suseof houses serving multi-centric studies. tion about key factors for success or EHRs, with the latter article focusing on While most clinical research is still cur- failure, particularly generalizable lessons e-prescribing by primary care clinicians. rently based on data collected by dedi- learned from practical implementations. Rosenbloom (see page e178)and Wachs(see cated clinical trial management systems The articles in this issue discuss and page e183) developed interfaces that facili- (CTMS), there is increasing interest in provide some answers to frequently asked tate EHR utilization in practical settings, integrating CTMS with the information questions related to: (1) EHR usability and Landman (see page e187)providesa originating from the EHR, and a potential issues in clinical care and quality improve- case report of hazards related to software merger of functionalities could be envi- ment; (2) public health implications of updates in clinical workstations. sioned in the long-term. A historical con- EHR and health information exchange The use of EHR systems has been asso- trols database, such as the one described systems across institutions; and (3) use of ciated with healthcare quality improve- by Desai (see page e162), could be among EHR-derived clinical data warehouses for ment in several areas. Bates (see page e85) the first beneficiaries of such integration, research. reports on decreased rates of adverse medi- as its goal is to accelerate studies and Adoption of EHR systems by clinicians cation events with the use of EHR systems, quickly disseminate actionable results by is still highly variable. Commentaries and Flamm (see page e91) reports on bene- drawing on a larger data set for controls. from different stakeholders illustrate fun- fits for pre-operative assessment. However, as Huser (see page e169) points damental reasons for heterogeneous adop- Structured data from EHR systems are not out, dissemination of clinical trial results tion: Middleton (see page e2) reports on always enough: Greenberg (see page e97) is still hampered by poor adherence to AMIA recommendations to improve the combines EHR data with other sources to mandatory clinical trial registration in usability of EHR systems to increase monitor blood pressure control for quality national databases. patient safety and quality of care. improvement for chronic kidney disease These articles illustrate that EHR Cresswell (see page e9) provides an inter- care. Computer-aided diagnosis can also systems present enormous opportunities national perspective on successful health benefit from data derived from EHR as well as important challenges. The field IT implementation and adoption, while systems. Haug (see page e102) and Morillo of biomedical informatics has helped lay Saleem (see page e175) provides the per- (see page e111) propose systems to facili- the foundations of EHR system design, spective of the Veterans Affairs in the tate pneumonia diagnosis that could implementation, and evaluation, as well as USA. Ozkaynak (see page e14) calls for potentially interface with EHR systems in clinical decision support for quality increased flexibility to accommodate the future. Because many clinical decisions improvement, analytics for public health workflow issues in patient-centered care, are based on life expectancy and current and research, and the study of human Bar-Dayan (see page e17) reports on posi- models for predicting five-year survival are factors in EHR adoption. There will be tive return on investment for an EHR problematic, Mathias (see page e118)pro- no backtracking from EHR system use system, and Simborg (see page e21) poses a prognostic index derived from and adoption: much has been accom- discusses some potential future directions. EHR data. plished since the boost in utilization of Research articles address the issue of Public health is another potential benefi- EHR systems that started in 2009, and usability: McClellan (see page e26) describes ciary of EHR adoption, particularly much more is expected to happen within a study on successful EHR system adoption through the electronic exchange of health the next few years. As always, JAMIA will by physicians, while Davis (see page e33) information. Onylle (see page e125) reports continue to be the prime source for infor- reports on marked differences in EHR util- on the population characteristics of a mation on the impact of EHR systems for ization depending on clinical specialty and health information exchange network in clinical care, public health, and research. J Am Med Inform Assoc June 2013 Vol 20 No e1 e1

Journal

Journal of the American Medical Informatics Association – Oxford University Press

Published: Jun 1, 2013

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