There are more filing issues with EMR EHR programs that with paper records

Electronic medical record (EMR) systems, defined as "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization," []  have the potential to provide substantial benefits to physicians, clinic practices, and health care organizations. These systems can facilitate workflow and improve the quality of patient care and patient safety. Despite these benefits, widespread adoption of EMRs in the United States is low; a recent survey indicated that only 4 percent of ambulatory physicians reported having an extensive, fully functional electronic records system and 13 percent reported having a basic system. []

Among the most significant barriers to adoption are:

• High capital cost and insufficient return on investment for small practices and safety net providers.
• Underestimation of the organizational capabilities and change management required.
• Failure to redesign clinical process and workflow to incorporate the technology systems.
• Concern that systems will become obsolete.
• Lack of skilled resources for implementation and support.
• Concern that current market systems are potentially not meeting the needs of rural health centers or federally qualified health centers (FQHC).
• Concern regarding negative unintended consequences of technology. 

Recognizing the role that EMRs can play in transforming health care, in 2003, the Institute of Medicine issued a group of eight key functions for safety, quality, and care efficiency that EMRs should support.

• Physician access to patient information, such as diagnoses, allergies, lab results, and medications.
• Access to new and past test results among providers in multiple care settings.
• Computerized provider order entry.
• Computerized decision-support systems to prevent drug interactions and improve compliance with best practices.
• Secure electronic communication among providers and patients.
• Patient access to health records, disease management tools, and health information resources.
• Computerized administration processes, such as scheduling systems.
• Standards-based electronic data storage and reporting for patient safety and disease surveillance efforts.

[1] The National Alliance for Health Information Technology (NAHIT)

[2] DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care -- a national survey of physicians. N Engl J Med  2008 Jul 3;359(1):50-60.

Areas of Current Investigation

Traditionally, the EMR vendor community has created systems that conform only to proprietary database formats, making it difficult for them to send and receive data from other, potentially competing products. The medical informatics community has realized the need for interoperability and thus has created standards for data coding and communication. The Office of the National Coordinator for Health IT (ONC) has funded several major initiatives to harmonize standards and create a certification process for EMRs so that different products can interoperate better and be easily and objectively compared. This will enable decisionmakers to adopt EMRs more easily.

In 2006, the U.S. Department of Health and Human Services (HHS) recognized initial criteria for certification of ambulatory EHR systems as recommended by the Certification Commission for Healthcare Information Technology (CCHIT). The criteria were updated in 2010 (PDF, 2.3 MB). These criteria will help reduce barriers for ambulatory providers to adopt EHR systems by ensuring confidence in purchased products. CCHIT certified products also meet requirements set forth by HHS in final physician self-referral law and anti-kickback statute rules, providing access to external means of implementing EHR systems.

Federal initiatives are under way to drive adoption of interoperable EMRs, including funding of the Agency for Healthcare Research and Quality (AHRQ) Health IT portfolio.  The recent American Recovery and Reinvestment Act (ARRA) of 2009 (PDF, 1 MB ) authorizes $34 billion to be distributed starting in 2011 as adoption incentives through Medicare and Medicaid to qualified providers who adopt and use certified EMRs.  In addition, several States have recently promoted EMR adoption by mandates, initiatives, or funding programs through the disbursement of grants and loans within their States:

• The State of Minnesota is perhaps the most aggressive in promoting the adoption of standards-based electronic health records to support statewide electronic health information infrastructure. Minnesota has done this through a combination of legislative mandates and grants and loans programs.
• Missouri has established a fund for health IT development that is being made available to health care providers. Senate Bill 577 (2007) (PDF, 2.29 MB ) states, "There is hereby created in the state treasury the "Health Care Technology Fund" which shall consist of all gifts, donations, transfers, and moneys appropriated by the general assembly, and bequests to the fund."
• Wisconsin has created a tax credit for health care providers who purchase EMRs in Senate Bill 40 (2007).  Providers can claim up to 50 percent of the cost of the system with a maximum of $10 million a year (PDF, 5.49 MB) .

AHRQ-Funded Projects

AHRQ has funded organizations across the country that are implementing and evaluating electronic medical and health record systems. Some of these include:

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