Electronic health records and health information exchange

The adoption of electronic health records (EHRs) in the U.S. was greatly accelerated by the HITECH “meaningful use” (MU) regulations, which require that all healthcare institutions either implement these systems or pay penalties. Accordingly, in the past decade, JAMIA has received many more manuscripts focused on the experiences from selecting, customizing, implementing, and evaluating the use of EHRs in various clinical settings, and on exchanging information contained in the EHRs across healthcare institutions. This issue of JAMIA focuses on the latest experiences of using and evaluating EHRs and a health information exchange (HIE). Understanding where EHRs can be improved is an important factor in their continued adoption. Goss (p. 661) proposes a value set for adverse reaction documentation, and Kannampallil (p. 739) describes the association between issuing medication orders for the wrong patient and the number of open charts in a clinician’s monitor. Wright (p. 709) explains how free-text electronic prescriptions can result in communication failure, and Percha (p. 679) proposes an expansion of the radiology lexicon using contextual patterns contained in radiology reports. The importance of customizing EHR systems to clinical workflows in different settings has been extensively documented in the biomedical informatics literature. Veinot (p. 746) describes a process to model clinical information interactions in primary care, and Ramelson (p. 715) reports on an enhanced referral management system. Krousel-Wood (p. 618) compares healthcare provider perceptions on transitioning from a small EHR system into a comprehensive commercial system. Price-Haywood (p. 702) analyzes dose effects of communication between patients and the care team via secure portal messaging, and Reading (p. 759) reports on the converging and diverging needs among patients and providers who are using patient-generated health data. In addition to their role of assisting clinicians in documenting their activities and using the information to provide care, EHR systems have an important role for healthcare quality, management, and biomedical research. Cho (p. 730) reports on how specific eMeasurements can be automatically populated from EHR systems. Holman (p. 694) describes how MU can result in both benefits and burdens for family physicians, Holmgren (p. 654) assesses the relationship between specific EHR systems and MU performance. Additionally, Casucci (p. 670) uses Medicaid data to study effects of chronic disease combinations on 30-day hospital readmissions, an important healthcare quality measure. Fraser (p. 627) discusses barriers to the success of an electronic pharmacovigilance system, and Baron (p. 645) proposes an approach for imputing multi-analyte values in longitudinal clinical data for use in machine learning systems. In an era where healthcare data integration becomes the norm, several HIE approaches are being pursued across counties, states, and nations. Motulsky (p. 722) analyzes usage and accuracy of medication data from HIE in Quebec, Canada, Schmit (p. 635) describes how differences in state laws can adversely impact or facilitate this type of exchange, and Klapman (p. 686) reports on emergency care clinicians’ experiences of HIE across five countries. As this JAMIA issue illustrates, we live in an exciting time in the evolution of EHR systems and HIE. Never before has adoption been so high with an understanding of the multiple aspects of their use and usefulness approached from so many different perspectives.