This document discusses the implementation of electronic health records (EHRs) in the United States. It defines EHRs and outlines past attempts at implementation, including efforts by the Bush and Obama administrations. The benefits of EHRs include improved quality of care and data sharing between physicians. However, there are also drawbacks such as high costs, decreased workflow efficiency, and privacy concerns. The document proposes solutions such as revising EHR definitions and providing clearer guidelines to address current issues surrounding implementation.

1. Is the United States Ready for the
Implementation of Electronic
Health Records?
Shamaree Cromartie
HIMA 5060
December 5, 2012

2. Electronic Health Records
Definition
• The HITECH Act provided the first federal definition for EHRs.
“an electronic record of health related information on an
individual that is created, gathered, managed, and consulted
by authorized health care clinicians and staff”. 2,8
• The American Health Information Management Association’s
E-HIM Workgroup defines EHRs as “a longitudinal electronic
record of patient health information generated by one or
more encounters in any care delivery setting. Included in this
information are patient demographics, progress
notes, problems, medications, vital signs, past medical
history, immunizations, laboratory data and radiology reports.”
2,8

3. Attempts of Implementation of
EHRs in the United States
• Institute of Medicine issued report in 1991 calling for EHRs.
• Bush Administration- Office of National Coordinator for Health
Information Technology (ONCHIT) in 2004 in order to improve
the nation’s health information technology, including EHRs, by
2014. 4,7
• Was unable to get Congress to pass the appropriation to support
the efforts of ONCHIT.
• Obama Administration- The Health Information Technology for
Economic and Clinical Health (HITECH) Act of 2009, a part of
the American Recovery and Reinvestment Act of 2009, has
provided $20 billion in incentive payments to speed up the
adoption of EHR.

4. Benefits of EHR
• Improve quality of care
• Reduces medical errors
• Increases sharing of data between physicians
• Improve health of the community
• Overall organization of the healthcare delivery improved
• Patients adhering to medical guidelines
• Supports surveillance activities

5. Drawbacks to EHRs
• Expensive
• High start up and ongoing maintenance costs
• Decreases workflow
• Physicians spending too much time figuring out system, which
shortens patients’ visits
• Privacy
• Patients worried that information will not be safe
• 2014 deadline too optimistic
• Physicians are rushing and ending up with systems that are
dissatisfied with
• Criteria unrealistic
• Guidelines are not clear and could end up with systems that are
not compatible

6. Solution
• Revise HITECT definition of EHR or use the one from the
American Health Information Management Association’s E-
HIM Workgroup
• Provide clearer guidelines so systems will work together and
physicians will not have to pick and choose from the criteria
given to meet “meaningful use” criteria
• Incorporate training of systems in already existing meetings
for physicians to learn

7. References
• Hsiao CJ, Decker SL, Hing E, Sisk JE. Most physicians were eligible for
federal incentives in 2011, but few had EHR systems that met
meaningful-use criteria. Health Aff (Millwood). 2012;31(5):1100-
1107. doi: 10.1377/hlthaff.2011.1315.
• Menachemi N, Collum TH. Benefits and drawbacks of electronic
health record systems. Risk Manag Healthc Policy. 2011; 4:47-55.
Doi: 10.2147/RMHP.S12985.
• Simon SR, McCarthy ML, Kaushal R, et al. Electronic health records:
Which practices have them, and how are clinicians using them? J
Eval Clin Pract. 2008;14(1):43-47. doi: 10.1111/j.1365-
2753.2007.00787.x.
• Tomes JP. Avoiding the trap in the HITECH act's incentive timeframe
for implementing the EHR. J Health Care Finance. 2010;37(1):91-100.
• Tejero A, de la Torre I. Advances and current state of the security
and privacy in electronic health records: Survey from a social
perspective. J Med Syst. 2012;36(5):3019-3027. doi:
10.1007/s10916-011-9779-x.