Assessing the potential of national strategies for electronic health records for population health monitoring and research.

Objectives: This report assesses the potential of national strategies for electronic health records for population health monitoring and research.

Methods: This study: (1) Reviewed national strategies for electronic health records in Australia, Canada, England, and New Zealand, through written materials available before January 2006. (2) Identified the potential of national strategies for electronic health records for population health monitoring and research through interviews with 96 experts in the U.S., Australia, Canada, England, and New Zealand. (3) Delineated fundamental issues that must be confronted to maximize the contribution of national strategies for electronic health records to population health monitoring and research.

Results: National strategies for electronic health records reflect the political, healthcare, and market systems of individual countries. National strategies also reflect technical decisions and political judgments. National strategies are evolving, and passing through stages of conceptualization, design, pilot testing, and implementation. Only England has moved to implementation. Population health monitoring and research are secondary to the primary uses of clinical care and management in all national strategies for electronic health records. Only England has conceptualized, designed, and is implementing the use of electronic health records for population health monitoring and research. Canada's strategy includes communicable disease surveillance, but not broader population health monitoring for developing health statistics. This study identifies definitional, numerator, denominator, and overarching issues that must be evaluated in assessing the potential of national strategies for electronic health records for population health monitoring and research. It delineates success factors that increase the potential for those national strategies to contribute to population health monitoring and research. Finally, this study assesses barriers that must be overcome if national strategies for electronic health records can contribute to population health monitoring and research, and especially to health statistics.