1. Status of a US National EHR
• US trails many other countries
• US EHR IT spending < other industries
• Impact on overall costs is unclear
• EHR will improve health outcomes
• Benefits ultimately outweigh the costs
• ETA remains indeterminate

2. EHR vs. EMR
• EMR = application that shares patient
information within one health care entity
• EHR = allows for health records to be
shared across multiple establishments

3. EHR vs. ATM & RAND Study
• ATM: initiated online banking revolution
• EHR: can similarly transform health care
• RAND: EHR will improve quality > reduce costs

4. EHR History
• Originated in late 1960’s
• Pioneers Weed, Barnett, & Warner
• VA adapts EHR circa 1970s
• IOM interest begins in earnest during 1990s

5. Objectives of EHR
Primary and Secondary Uses of an Electronic Health Record
Primary Uses Secondary Uses
Patient Care Delivery Education
Patient Care Delivery Regulation
Patient Care Delivery Research
Financial & Other Admin Processes Public Health and Homeland Security
Patient Self-Management Policy Support

6. Dissenting View
• Increase provider reported services
• Slow down patient provider interactions
• Fail to improve provider to patient ratios
• Persistent errors
• Spending will not decline
• Inconsistent quality

7. World EHRs
• Australia, Canada, et al have interoperability standards
• US does not yet have mandated standards
• CCHIT is standardizing EHR functionality
• HITSP is developing standards for interoperability
• France, Sweden, et al collaborating to exchange EHI
• Canadian EHR = many interoperable EHRs

8. VA EHR & EHR/HIE Workgroup
• VA EHR > 1,000 VA healthcare facilities
• EHR / HIE Interoperability Workgroup:
 15 states, 19 EHR vendors, & 18 HIE vendors
 ~ 50% of the US population

9. EHR/HIE Interoperability Workgroup
States EHRs HIEs
California Alere Wellogic Alere Wellogic
Colorado Allscripts ApeniMED
Florida Cerner dbMotion
Georgia Data Strategies GE
Illinois DeFran Systems GSI Health
Kentucky Dr. First Harris
Maryland eClinicalWorks HealthUnity
Michigan eMDs ICA
Missouri Epic InterSystems
New Jersey ePocrates Med3000
New York First Medical Solutions MedAllies
Oregon GE Medicity
Utah Greenway Mirth
Vermont McKesson Misys Open Source Solutions
Virginia MDClick OmniMD
NextGen Optum
Nortec Software Orion
Sage RelayHealth
Siemens

10. Challenges
• Dearth of funding
• Lack of medical staff support
• Inefficiency
• Difficulty creating a migration plan
• Cost

11. Summary
• US trails other countries
• US EHR IT spending < other industries
• Unclear if EHR will lower health care spend
• Health outcomes will be improved
• EHR benefits ultimately outweigh the costs
• ETA remains uncertain