Electronic health records offer potential, but not without pitfalls.

For anyone who has sat in a new doctor’s office filling out yet another detailed health history—and who hasn’t?—the idea of electronic health records (EHR) seems compelling. Imagine that a person could provide details once, the information would be available to any doctor who sees him or her, and the record would simply need updating at subsequent appointments. Plus, physicians would be able to make decisions based on comprehensive and timely data.

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Although the benefits are clear, and there is serious talk now about expanding the place of information technology (IT) in health care, the task poses tremendous challenges.

“For years, vendors have sold programs to automate medical records, but they weren’t always looking at the big picture,” said Monica Chiarini Tremblay, who teaches courses in management information systems (MIS) in the Department of Decision Sciences and Information Systems, and who researches medical IT. “Consequently, organizations have software and even hardware systems that won’t interoperate with other organizations’ systems. In addition, ineffectual programs made people feel burned and they may be reluctant to try again.”

Furthermore, many of the EHR vendors were expanding on existing systems that were designed to track financial processes. As a result, the systems did not perform well with clinical data.

Another drawback: vendors sometimes have automated ineffective processes.

“We can’t just throw technology at problems,” Tremblay said. “The processes that are in place need to be studied and optimized before they are automated.”

Additionally, the information held in these systems is very sensitive.

“Policies and procedures need to be in place governing issues such as what do if someone with data access leaves, or what disaster recovery provisions are required,” she said. “Also, there are technical matters including how to control access and minimize breaches. These kinds of subjects need resolution before applying a solution.”

Despite challenges, EHR can work.

According to Tremblay, “Having a clinical decision support system that enables medical practitioners to use the data to make the best possible decisions will improve the quality of care, which is the key goal.”

Also, such a system can reduce costs by, for instance, eliminating repeated tests. And underserved populations—spanning children in foster care to migrant workers—may experience better care by having a continuous medical record that follows them.

In addition, models, including disaster recovery programs, now exist so not all the systems have to be developed from scratch. And, clinical software is getting better, easier to use, and less expensive.

Still investments beyond hardware and software will be necessary. In the case of IT staffs, some universities already offer degrees in medical IT through their public health, nursing, or MIS programs.

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