Critical Issues for Electronic Health Records

This report is based on an expert workshop, hosted by the Nuffield Trust and Wellcome Trust in November 2007. This brought together an international group of health leaders, policy-makers and academics to identify priorities for research, strategy and implementation of electronic health record systems (EHR).

"Critical Issues for Electronic Health Records" augments the workshop findings with further comment from the authors and identifies key requirements for successful EHR systems implementation, integration and maintenance worldwide.

This report will be of interest to all those engaged in researching and implementing EHR systems, as well as those concerned with developing public policy in this important area.

Seven key requirements for successful systems implementation, integration and maintenance were identified.

1. A clear ‘vision’ of the role of EHR and related information and communications technology (ICT)-aided healthcare interventions, supported by sub-component plans capable of assuring engagement of five key stakeholder groups: patients (including informal caregivers), the public (including citizens/media/public representatives), professionals (including health practitioners and health informaticians/technologists); managers, administrators and regulators; and technology suppliers (including application vendors, systems integrators etc.)
2. Clear and consistent communication of EHR content and meaning. This includes terminologies, classifications and standards to assure interoperability without loss of meaning, including relevant contextual content.
3. Systems that are able to aggregate, assess and manage the current base of knowledge and then ...
4. deliver that knowledge through decision support in a timely manner at the point of care. This is seen as critically important for both clinicians and patients (including their informal care-givers).
5. Systems that develop and support relevant workforce education and training.
6. Systems that support innovation in healthcare by enabling access to reliable data for research in the core sciences, as well as facilitating continuous improvements in healthcare quality.
7. Strategies for harnessing both experiential learning and opportunities to obtain evidence of the impact on quality, efficiency and safety.

All of the above assume that an information and communications infrastructure will be there to offer secure delivery of relevant information and knowledge on a right- and need-to-know basis. It is likely that this agenda will require another 20 years to reach maturity in a number of nations or regions of the world.

Achieving these objectives requires information governance policies and strategies that are informed by a sound understanding of the multiple types, functions and uses of patient data and the long-term implications of record linkage, as well as by stakeholder consultation. Such strategies must be sufficiently flexible to respond to changes in clinical need and risk.

EHRs are embedded within complex sociotechnical and organisational systems. Successful realisation of the vision of EHR will require considerable change and strategies that fail to approach implementation as appropriate for complex adaptive systems will be less likely to be successful.

Contributors: Claudia Pagliari organised the workshop, Don Detmer facilitated the discussions and Peter Singleton acted as rapporteur. All contributed to the preparation of this report.