What are electronic health records?

Electronic health records (EHRs) are a paperless method of health information management (HIM). The EHR format is designed to be easily shared between healthcare providers, so EHRs include information from every clinician who has taken part in the patient’s care. If kept on an EHR database, any authorized healthcare staff can access the records in an instant.

Outside the healthcare industry, it’s easy to forget the impact EHRs have had on the United States healthcare system. Great minds in government, healthcare, and tech spent decades developing and promoting EHR technology with the goal of improving patient care. Thanks to these efforts and the many benefits of using electronic health records, they have nearly a 100% adoption rate in the United States.

The History of Electronic Health Records

While electronic health records (EHRs) only recently became the standard method of storing patient health information, their history goes back nearly 70 years. In the 1960s, Lawrence Weed, MD developed the problem-oriented medical record, a complete patient record that gathers information from the patient’s entire care team.

The introduction of Medicare and Medicaid reimbursement in 1965 made accurate record-keeping more important than ever. At the time, only about 73 hospitals had adopted an EMR system due to the extravagant costs of early computers. 

Over the next 15 years, HIM pioneers, many of whom were academic medical centers, worked on developing better EMR systems. Additionally, the federal government began investing in health information technology (HIT) with the Veterans Health Information System and Technology Architecture (VisTA).

In the 1980s, personal desktop computers made HIT more accessible for healthcare providers by reducing both the cost and space required. Healthcare providers of all sizes began using computers to handle scheduling and billing, but they were slow to adopt EMRs.

The Institute of Medicine (IOM) began studying the benefits of EMRs in the mid-1980s. They released their results in 1991. The IOM argued for the adoption of EMRs to prevent medical error, identified common barriers to EMR adoption, and outlined how to convert existing paper records into EMRs.

Healthcare providers gained a new way to access information outside their own servers in 1990 via the World Wide Web. Medical records exchange became faster, and digital versions became optimized for sharing. 

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How Many Providers Use Electronic Health Records?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created guidelines to regulate medical records exchange and protect covered entities who may handle patient medical records. The Department of Health and Human Services (HHS) established penalty tiers for failing to comply with the Security Rule.

In 2004, the same year President Bush supported IOM’s findings and called for the adoption of EHRs, only about 20.8% of office-based healthcare providers used an EHR system. This number rose steadily over the next five years, reaching 42% in 2008. 

In 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) into law, which included the HITECH Act. The HITECH Act budgeted $19.2 billion to help hospitals and healthcare facilities implement EHRs by 2014. Additionally, it allocated incentive payments to healthcare providers that demonstrate meaningful use standards.

This push caused an EHR boom in the United States. Data measuring office-based physicians that utilize EHRs collected by healthit.gov found that in 2017, 79.7% of such physicians utilized a certified EHR technology (CEHRT), 6.2% used an uncertified EHR, and 14.1% did not use any EHR.  

Pie graph about the percent of office-based physicians in the United States that had adopted Electronic Health Records by 2017. 79.9% used certified EHR, 6.2% used uncertified EHR, and 14.1% used none.

Additionally, a 2016 survey by the ONC determined that 96% of hospitals in the United States use CEHRT. There were 5534 active hospitals in 2016 according to Statista. Using these numbers, we can estimate that only 221 hospitals were not using CEHRT that year.

Pie graph about the percent of hospitals in the United States that had adopted certified Electronic Health Record technology by 2017. 96% used a CEHRT and 4% did not.

This information, alongside the rapid expansion of telehealth throughout the COVID-19 pandemic, strongly implies that healthcare technology is here to stay. It’s likely, however, that the EHR adoption rate would be much lower if not for a push from the government. 

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The HITECH Act and Meaningful Use

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was crucial for the success of electronic health records. EHRs work better when more healthcare facilities use them, and the HITECH Act incentivized more healthcare providers than ever to make the costly transition to EHRs. 

Then, the Center for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) divided meaningful use into 3 stages for a gradual introduction. They also created incentive programs for healthcare facilities and providers implementing CEHRT.

While meaningful use may sound subjective, it’s more of a three-stage checklist with guidelines for EHRs and their exchange between the types of requestors. The meaningful use guidelines set the stage for today’s release of information standards. The stages’ goals are as follows:

  • First Stage focused on data capture and sharing, mainly the creation and exchange of electronic health information with patients.
  • Second Stage focused on the more advanced clinical processes, emphasizing the exchange of patient information between providers for care coordination purposes. 
  • Third Stage focused on improving outcomes by further expanding the goals of CEHRT between all requestor types. Additionally, it implemented requirements such as e-prescribing, protected health information (PHI), and other measures to improve patient care. 

Through these stages of meaningful use, the use of CEHRTs was meant to fulfill the 5 pillars of health outcomes outlined by the CDC. The 5 pillars include:

  1. Improving quality, safety, efficiency, and reducing health disparities
  2. Engage patients and families in their health
  3. Improve care coordination
  4. Improve population and public health
  5. Ensure adequate privacy and security protection for personal health information

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The Benefits of Electronic Health Records

In addition to the financial incentives, there are many benefits to using certified EHR technology instead of paper charts. These benefits include:

  1. Create more complete patient profiles and add new information with ease. Additionally, it is easier to make corrections to electronic health records than paper medical records. EHRs also do not require heavy file cabinets filled with thick folders.
  2. Enhance data sharing due to the relative simplicity of electronic release of information compared to paper. The digitization of medical records makes making copies easier, and electronic methods of exchange are significantly faster than sending paper files through the mail. 
  3. Reduce costs and labor for copying and sharing medical records. Electronic files require less time and resources to reproduce than paper records, and that’s not to mention the time spent searching for the files. 
  4. Improve Security for transferring medical records in a time where hackers can make millions of dollars by breaching medical records. Additionally, protecting patient information is also protecting against HIPAA violation, which carries significant penalties.
  5. Improve patient care and experience by reducing duplicate tests and helping healthcare providers diagnose more accurately. Additionally, EHRs empower patients to take an active role in their healthcare and build a personal health record.
  6. Bolster care coordination between healthcare providers by making medical records easy to share. The sooner a referring provider is able to send patient information to a specialist, the sooner the patient can receive the care they need.
  7. Ensure accurate payment from insurance companies by digitally transmitting relevant billing information. If the insurance company needs additional information, sharing the medical records is just as simple. 

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The Disadvantages of Electronic Health Records

Despite the many benefits of using CEHRT, there are some disadvantages that have dissuaded some from transitioning, such as the following:

  • Potential of reduced efficiency due to clunky software and unfriendly user interfaces could lead to wasted staff hours. This also raised concerns regarding issues between EHR systems, as incompatible systems complicate the exchange of information.
  • High costs of implementation and maintenance of an EHR system can be a deterrent for small, private practices that don’t have a large patient base. 
  • Increased chance of human error if the healthcare provider fails to double-check for errors. For example, a doctor could copy a previous note with an error and paste that same error into their notes.
  • Greater size of medical record breaches when a hacker gains access to a server. Despite the powerful security measures protecting EHRs, breaching a server is like stealing a facility’s file cabinets. 

Electronic health records may have their downsides, but these are outweighed by the benefits. As health information technology grows, it will adapt to be more secure and user-friendly. Safeguards will likely also be developed to protect against human error and ensure more comprehensive records. 

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EHR FAQ

What is the difference between an electronic health record (EHR) and an electronic medical record (EMR)? While EHRs are designed for ease of sharing, EMRs are usually no more convenient to transfer than paper records. As such, EMRs are designed to monitor patients within the clinic that created them.   

What information is in electronic health records? EHRs paint a complete picture of a patient’s health over time. They contain the patient’s medical history, imaging, immunizations, test results, and administrative clinical data, medications, progress notes, and more. 

How are electronic health records more secure than paper charts? EHR systems have built-in privacy measures that restrict the amount of information each individual within an institution can access. Additionally, audit trails are automatically logged when records are accessed to track who is viewing them.

How can I electronically request medical records online? If you need to request copies of your medical records or those of your family, the simplest method is to use a trusted medical records retrieval software. Technology drove the development of EHR systems that help healthcare providers save lives, and it can help you too. 

If you would rather handle the request personally, click here to read our guide on requesting medical records.

Where can I download a medical records release form? Finding an authorization form is easy, but you need to be sure that it’s HIPAA-compliant too. Hippajournal has a downloadable medical records release form and a list of everything a compliant form needs.

Additionally, ChartRequest allows patients to keep a signature on file for electronic authorization, and professional users can text or email patients a form to electronically sign if needed. If you need medical records for yourself, a family member, a client, or anybody under your care, create an account today.

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