While most providers agree that an Electronic Health Record will be an inevitable addition to their office environment, there is still considerable confusion over what key features to look for when choosing a product.

Much of the reason for this can be traced to the wide diversity of concerns individual providers rate as important in their unique environments. For example, a family practitioner may focus on issues related to providing quality service in an expeditious manner while a pediatric specialist may want to focus on clinical guidelines. EHR vendors for the most part have not addressed these issues. Instead, they continue to respond to the medical provider community as a whole who believes there is too little benefit (ROI) to justify the costs of overcoming perceived substantial implementation hurdles. Many of these issues have been widely publicized including:

• Lack of standardization for documenting clinical episodes
• Lack of technology standards
• Considerable investment costs
• Perceived as more difficult to use than paper charts (ie. Gets in the way of providing care)
• Requires the clinician to change how care is provided, changed workflows
• Requires learning new systems and processes
• Concerns of security (access) and Privacy (disclosure)

These concerns are quite valid and should be given serious consideration. For example, just this past month a major health system in the northwest reported the theft of over 365,000 medical record charts from electronic files left unprotected in an automobile. The impact of such disclosures supports concerns that conversion to electronic charts may not be worth the potential costs.

Such reasoning ignores the potential benefits that can be gained by a well-planned EHR implementation. These include:

• Immediate access to the patient chart
• Consistency and standardization in the documentation and delivery of care
• Ensure appropriateness of care by following clinical guidelines, and decision support features
• Support for medical alerts such as drug interactions, allergies, and other potentially harmful treatments
• Reduction in errors, intelligent ordering, electronic prescribing, clearly legible notes
• Reduction in paper work
• Electronic claim, eligibility, referral processing, transcription
• Improved speed and quality of care by supporting office processes rather than interfering with them

Providers can reap secondary benefits as well; such as clinical data warehousing that can be analyzed for trends, improved care, or other commonalities. Ultimately, the electronic record can provide life saving information for patients who are under treatment but are unable to supply information for themselves. 

While support for the EHR is gaining momentum, vendors can assist by ensuring their systems include features that are deemed important by the greater majority of provider organizations. These would include:

• Office integration – The EHR should provide seamless integration with office functions such as scheduling, billing, and so on.
• Support instead of interfere with care delivery – The system should assist the provider in capturing and documenting the care episode. Features and functions should mix seamlessly with traditional processes while adding new or enhanced capabilities such as medical alerts, clinical guidelines, decision support or electronic prescribing.
• System should include capability to provide and support Prevention and Education programs, suggest care plans and support disease management programs.
• System should provide seamless integration with or incorporation of the Order Request function. System should also support the electronic acceptance and display of results. Result reporting should include visual cues for non-typical results.
• Provide a permanent Electronic Record – System should provide both immediate retrieval as well as long term storage of patient information (eg. Archival capability).
• The system should incorporate and assist in the standardization of medical information including medical terminology, coding, and transcription (eg. ICD-9-CM, CPT, SNOMED, NDC etc.). System should also include functions to update this information as it becomes available.
• System should support the communications of electronic data using required standards (eg. HIPAA EDI, HL7 etc.)
• The system should meet all regulatory and legislated compliance standards (eg, GLB, HIPAA, ADA and other)
• The system should provide a way of organize, group and report on records (eg. by family, statistical outlier, Clinical categories, Date/Time, etc.)
• The system should allow for future mobility and accessibility of the record (eg. RHIOs, online healthcare etc.)
• The system should ensure the privacy, accuracy, integrity and safety of the record by demonstrating well formed technical architecture and security from inappropriate access.
• The system should include the ability to produce paper copies and reports from the electronic data.

Simply put the system should provide a clear return on the investment. This is a critical element in gaining the ever-necessary support of the clinician. EHR implementation plans should clearly identify all implementation and operational costs while reasonably quantifying derived benefits.