History of Electronic Health Records (EHR)

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Mid 1960's: Lockheed Unveils Clinical Data Management System

One of the earliest data processing systems focused specifically on managing clinical data – now called a hospital information system – is introduced at El Camino Hospital in Mountain View, California. Suggested by: Dr. Seth Flam, DO. Founder and CEO of HealthFusion. (Image created by Cliff.)

 

1965: National Library of Medicine Moves to Computer System

The National Library of Medicine converts the Index Medicus – a comprehensive index of the world's leading biomedical literature – to the computer-based version later called Medline, beginning the shift to electronic rather than paper-based information resources.

 

Late 1960s: “Problem-Oriented Medical Record” Introduced

Physician Larry Weed introduces the idea of recording patient information electronically, aiming to generate a record that would allow a third party to independently verify the diagnosis. Prior to this, a doctor only recorded his diagnoses and the treatment provided.

 

Early 1970s: VistA Initiated to Manage Veterans' Health Data

The predecessor to today's Agency for Healthcare Research and Quality (AHRQ) initiates the concept behind Veterans Health Information Systems and Technology Architecture, VistA. This marks the start of heavy government investments in VistA and clinical IT. (Image created by DonkeyHotey.)

 

 

1972: First Electronic Medical Records System Developed

The Regenstreif Institute develops the first electronic medical record system. Although the technology is widely regarded as a major advancement for medical practices, it does not attract many physicians.

 

Early 1980s: VA Health Information Software Declared Public

The VistA information system is legally declared available for unrestricted use in the public or private sectors. This open-source collaboration marks the evolution of VA health software. Major hospitals in other countries adopt and modify VistA's information-driven care model. (Image created by MC4 Army.)

 

1982: Dragon Systems Pioneers Voice Dictation Software

Early voice recognition prototype evolves into Dragon Dictation, used today by more than 150,000 doctors and caregivers. Its wide adoption illustrates that one early key to success in healthcare IT was a design built around doctors’ existing processes.

 

Late 1980s: Emergence of Low-Cost PCs Spurs Wide Adoption

Lower costs of personal computers (PCs) make it an affordable way to automate core health care functions. Windows-based software emerge soon thereafter. Doctors follow the trend and buy PCs for their offices. While EHRs weren’t widely adopted yet, practice management functions (billing and scheduling) started to move to computers. (Image created by espensorvik.)

 

Early 1990s: Emergence of the World Wide Web

After Tim Berners-Lee established the World Wide Web in 1990, new developments in browser interfaces – such as Microsoft Explorer and Netscape Navigator – make it faster and easier to access information online. People begin to access health information online and the stage is set for web-based EHRs.

 

1994: Clinitec Sells Software to Convert Paper Records to EHRs

Two years after its birth the company is bought by Quality Systems, Inc., a dental software company, which soon merges with Micromed, which provides front- and back-office practice management software. In 2001 Clinitec and Micromed combine to form NextGen Healthcare Information Systems, which becomes NextGen Healthcare. (Image created by Gwyneth Anne Bronwynne Jones.)

 

1995: Eclypsis Corporation (now Allscripts) Founded

The company provides hospitals and other healthcare organizations with EMR, computerized physician order entry, and revenue cycle management software. In 2008 the company acquires physician practice management software company MediNotes. Eclypsis merged with Allscripts in August 2010.

 

1996: Health Insurance Portability and Accountability Act

All software used to manage health insurance claims must follow HIPAA’s new regulations on health record use, disclosure and confidentiality. Software developers accurately predict one consequence of HIPAA will be a shift to electronic health record (EHR), which can greatly aid providers in complying with confidentiality laws. (Image created by Venturist.)

 

1996: Veterans Health Administration Mandates Use of EHRs

The largest integrated health care system in the United States, VHA, mandates use of EHRs throughout all facilities. VHA quality of care shows significant improvement in the wake of these changes. Later research indicates VHA care is better than that administered by Medicare, the government social insurance program administered to Americans 65 and older.

 

1997: Allscripts Begins Focusing on Healthcare IT

The company a year later launches an electronic prescribing solution for physicians, then acquires a series of ambulatory electronic medical record companies. By 2011 the product is used by over 180,000 physicians. Allscripts is now arguably the largest EHR vendor.

 

1999: eClinicalWorks Started by Four Engineers and a Physician

The company quickly becomes a market leader in ambulatory EHR systems, eventually partnering with Sam’s Club and Dell to sell the brand’s EHR and practice management software as turnkey solutions for small practices.

 

Early 2000s: Emergence of Web-based Software

Salesforce.com and other web-based companies emerge, proving that the software-as-a-service (SaaS) model is viable. EHR vendors begin to offer remotely-hosted options, and new purely web-based vendors start to enter the market.

 

2002: GE Acquires MedicaLogic and Millbrook

The acquired solutions are later re-branded Centricity with two applications, Centricity EMR and Centricity Physician Office. Building on the momentum and experience of MediaLogic and Millbrook, Centricity eventually emerges as the brand of 31 healthcare IT solutions that form part of GE Healthcare, a division of General Electric valued at $17 billion today.

 

2004: President George W. Bush Promotes Adoption of EHRs

Demonstrating his commitment to healthcare information technology, President George W. Bush doubles funding for health care IT demonstration projects, raising it from $50 million to $100 million. Additionally, he creates a new sub-Cabinet position of National Health Information Coordinator, and calls for widespread adoption of EHR systems by 2014, referring specifically to standards for electronically transmitting X-rays, lab results and electronic prescriptions. EHRs gain momentum. (Image created by JAXPORT.)

 

2006: CCHIT Certifies Electronic Health Records Systems

Certification Commission for Health Information Technology (CCHIT), a nonprofit aiming to accelerate adoption of secure and interoperable health IT, begins certifying electronic health records systems to help providers choose quality products. Controversy emerges later over CCHIT’s close ties to the board of trustees of Healthcare Information and Management Systems Society (HIMSS), a lobbying agency representing the interests of technology vendors.

 

2007: VA and Kaiser Permanente Create CONNECT

CONNECT- an open-source, cross-agency software system – promotes sharing health records and aims to move the US toward national interoperability. Health giant Kaiser Permanente achieves interoperability with VistA and uses many of its techniques. Suggested by: Hal Amens (Image created by Garfield Anderssen.)

 

2008: Idea of Personal Health Record Reemerges

Growth in the Internet drives the idea of the personal health record (PHR), a record where an individual curates his/her own health data online or via an electronic device. With the development of web technologies, the possibility of storing, exporting, and sharing patient-reported data makes sense. Google and Microsoft release PHR solutions.

 

2009: HITECH Act Passes

Health Information Technology for Economic and Clinical Health (HITECH) Act passes as part of President Obama’s American Recovery and Reinvestment Act (ARRA) of 2009 stimulus package. ARRA encourages the switch to electronic records by providing Medicaid rebates of up to $63,750 and Medicare rebates of up to $44,000. (Image created by AMagill.)

 

2010: Apple’s iPad Spurs Widespread Use of Tablet Computers

The iPad ushers in the reemergence of the tablet era to build on the features of the earlier Tablet PC. Experts predict Gen Y and Z’ers will be eager to engage with personal medical records in part because of the high-tech, interactive format. Physicians start to demand the same simplicity and convenience in the workplace that they enjoy at home with their iPads. (Image created by Sean MacEntee.)

 

2011: ONC-ATCB Certification Program Created

The Office of the National Coordinator of the HITECH Act creates a certification program in response to the need for clarity on what EHRs are capable of meeting meaningful use criteria during the first phase, or Stage 1, of adopting EHRs. Specifically, the ONC announces which that 6 certification bodies, including CCHIT, are approved to verify meaningful use.

 

Mid-2011: HHS Proposes Accountable Care

To help healthcare providers better coordinate care across multiple settings for Medicare patients, new regulations propose creating Accountable Care Organizations (ACOs). Those ACOs that help reduce healthcare costs and meet certain performance standards would be rewarded. This represents a shift away from traditional fee-for-service models of reimbursement (where providers are compensated based on volume of services) toward a focus on prevention and outcomes (or value of services). The EHR will play a key role in capturing patient data for sharing within an ACO. Suggested by: Justin Barnes (Image created by US Army Africa.)

 

The Future: Connectivity Key to Future of Healthcare

As technology evolves, providers will continue to look to software and devices to connect to patients and other providers. This will likely include greater connectivity and collaboration among providers, payers and other healthcare participants. Increased use of social networking and improvements in home-based health monitoring using mobile technology are expected. (Image created by LearnerWeb.)

 
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