History of EHRs in healthcare technology

Electronic health records (EHRs) have transformed modern healthcare delivery.

From optimizing healthcare providers’ workflows to improving patient data management, EHRs are behind the integration of both essential administrative and clinical data. EHRs support evidence-based decision-making, quality management, and clinical outcomes data collection.

However, EHRs haven’t always been around. So, when did healthcare start using electronic health records?

The Mayo Clinic in Rochester, Minnesota, was one of the first large health systems to use electronic health records in the 1960s. At first, due to their cost, the government exclusively employed them in collaboration with health organizations. 

Let’s take a stroll down memory lane to look at the history of electronic health records and how they’ve evolved over the decades. 

The primary purpose of EHRs is to improve the quality, safety, and efficiency of patient care. This purpose is achieved by digitizing and centralizing patient health information. The advent of EHRs revolutionized healthcare delivery from the cumbersome and paper-based systems of the past. 

EHRs are the evidence-based tools clinicians need to make informed decisions about patients’ care. This integration of clinical decision support was not feasible with traditional paper records.

The history of EHR has evolved from fragmented, paper-based records to efficient and streamlined provider workflows. 

Just some of the benefits of EHRs today include:

The history of electronic health records has been a transformative journey spanning several decades. 

The path began with humble beginnings in the 1960s to widespread adoption in the 21st century. The EHR evolution reflects technological innovation, clinical needs, and regulatory developments in healthcare.

In 1968, Dr. Lawrence Weed introduced one of the first and most successful attempts to streamline and improve the keeping of patient records. 

The problem-oriented medical record (POMR) was developed to help physicians make more accurate clinical decisions and is still used by some healthcare organizations today. 

The POMR includes 5 key elements:

These early efforts initiated by Dr. Weed were limited by the technology of the time but set the stage for future developments.

The EHR evolution continued in 1972, when the very first iteration of what we now know as an EHR came to the fore. 

With the help of Clement McDonald, The Regenstrief Institute in Indianapolis developed its EHR program. McDonald set out to both improve patient care coordination and reduce medical errors with the design of the database. 

The Veterans Administration (VA) began developing its Decentralized Hospital Computer Program (DHCP), later known as VistA, around the same time the Regenstrief system emerged. 

The VA’s system eventually became fully integrated, allowing for the full spectrum of capabilities:

Without the capability to transmit all that information rapidly, securely, and affordably, EHRs remained few and far between for the next 20 years.

The 1980s witnessed an increase in healthcare system automation due to the decrease in the price of personal computers. This significant technological progress laid the groundwork for modern EHRs, particularly when Microsoft Windows was introduced on a large scale in 1983.

The need for data interchange in healthcare stimulated the creation of Health Level 7 (HL7), a set of international standards for the transfer of clinical and administrative data. HL7 develops electronic standards to ensure that the components of an EHR (such as a health organization’s billing and clinic information) can communicate more easily. It was during the 1980s that research showed that reminders incorporated into EHRs could decrease healthcare costs. 

Publications describing systems like QMR, DXPLAIN, and ILIAD also appeared in this decade. These systems represented major progress in the development of computerized diagnostic decision support tools. They were more sophisticated than earlier attempts at medical expert systems.

By the 1990s, EHR development and the rise of internet-based systems were fully underway. 

After scrutinizing the cumbersome use of paper health records, The Institute of Medicine (IOM) cited EHR adoption as one of the key factors for improving patient care in 1991. 

The IOM published influential reports on the importance of EHRs in reducing medical errors. The emergence of internet-based EHR systems allowed for easier data sharing, and the concept of the Computerized Physician Order Entry (CPOE) gained traction. 

With the rise of the internet came less need for extensive on-site infrastructure. The extended data-sharing capabilities improved both provider-to-provider and provider-to-patient communication. As a result, patient engagement increased as individuals gained unprecedented access to their health information.

New vendors entered the market around this time, offering off-the-shelf solutions to suit various budgets and needs. This dual approach led to a diverse EHR landscape by catering to different healthcare settings and requirements.

EHRs became more sophisticated and began to demonstrate their potential for improving patient care and healthcare efficiency. At this time in EHR history, they became more affordable, even for small practices. 

The Health Insurance Portability and Accountability Act (HIPAA) was introduced in 1996 as a response to the growing concerns surrounding electronic medical information. HIPAA established crucial patient privacy protections and data security standards, and, in response, EHR vendors rushed to ensure compliance with these new regulations. 

HIPAA laid the groundwork for future EHR developments, emphasizing the importance of data protection in healthcare IT. This period set the stage for the rapid EHR adoption and further innovations that would follow in subsequent decades. 

According to the Centers for Disease Control and Prevention, the use of EHR saw a steep increase from 34.8% in 2007 to 71% in 2012. 

In 2004, President George W. Bush created the Office of the National Coordinator for Health Information Technology, which outlined a plan to ensure that most Americans had electronic health records within the next 10 years.

This decade saw technical, physical, and administrative safeguards appearing in all new EHR products. Some common protections included automatic data backups and log-offs, data encryption, audit trails, and access control.

However, as of 2010, hospital-owned outpatient clinics only had a 54.5% adoption rate of EHRs. And only 29% of independently-owned clinics were using EHRs. The EHR evolution was certainly underway, but widespread acceptance was slow. 

Adoption rates of EHRs have surged, with 88% of United States office-based physicians using EHRs in 2021. This figure represents a 110% increase from 2008.

Today's EHRs have evolved far beyond simple digital recordkeeping systems. They now serve as sophisticated, interconnected platforms that play a vital role in various aspects of healthcare:

The US EHR Cloud Computing Market is expected to grow at a compound annual growth rate (CAGR) of 11.58% from 2022 to 2027. The future of EHRs is also heavily leaning towards artificial intelligence (AI).

Specifically, AI-driven clinical decision support will analyze patient data, medical records, and research to provide personalized treatment recommendations and predict patient outcomes. Advances in natural language processing (NLP) will further automate the creation of clinical notes and reports to free up physician time.

Predictive analytics and the use of cloud-based EHR systems for improved accessibility and scalability are going to become the norm. This tech will help healthcare providers be better equipped to identify potential health risks and intervene proactively. 

This shift toward preventive care, together with the increased use of cloud-based EHR systems, will not only improve patient outcomes but also contribute to more cost-effective healthcare delivery in the future.

Throughout the decades, the EHR evolution has transformed from basic digital records to comprehensive, interconnected systems that play a crucial role in modern healthcare delivery. This evolution has been driven by technological advancements, changing clinical needs, and regulatory developments, all aimed at improving patient care, enhancing efficiency, and promoting better health outcomes. 

As we look to the future, the integration of artificial intelligence, cloud computing, and predictive analytics promises to further revolutionize EHRs, paving the way for more personalized, proactive, and efficient healthcare delivery.

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