There is actually a lot of discussion still taking place about what an electronic health record (EHR) actually is. Earlier this decade, a survey taken at a convention of EHR vendors and hospitals estimated EHR adoption at 60%. This information was used by the Bush administration in 2004 to justify formation of the Office of the National Coordinator for Health IT (ONC) and to set the goal of 90% of Americans having electronic health records by 2014. One decade seemed reasonable given the 60% adoption rate. We now know that the adoption rate among hospitals is closer to 10%, with 10-25% currently in planning or implementation stages.
Part of the problem is in the definition. The survey simply asked if care providers had electronic records. But that could mean patient information, a billing and claims system, electronic order entry, or any number of things. The Institute of Medicine released a report in 2003, Key Capabilities of an Electronic Health Record System, that attempted to solve this, and identified the following core functionalities of EHR:
- Health information and data
- Results management
- Order entry/order management
- Decision support
- Electronic communication and connectivity
- Patient support
- Administrative processes
- Reporting and population health management
The 4 in bold might be considered the bare minimum. Administrative processes are certainly important to the operations of a hospital, but these are historically separate systems focused on billing and insurance claims. Oddly enough, evidence has shown that providers that initially adopt electronic billing systems are no more likely to adopt EHR than those without it. Treating electronic billing as a first step, then, doesn’t work.