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SUMMARY of the Electronic Health Record (EHR) DEVELOPMENT

1960’s- Hospital Information Systems (HIS) were developed primarily to process financial transactions and serve as
billing and accounting systems.
- A few HISs emerged that documented and processed a limited number of medical orders and nursing care
- Vendors of computer systems began to enter the healthcare field and market software applications for
various hospital functions.

1970’s – Nurses assisted in the design and development of nursing applications for the HISs
- Computer based management information systems (MIS) were contracted by large community health
services to be developed.
- Primarily this public MISs provided statistical information whereas homehealth agencies provided billing
and other information required for reimbursement of patient services (Medicare, Medicaid, etc)
- NOTE: HISs are information systems use in HOSPITALS whereas MIS are information systems use OUTSIDE
the HOSPITAL (e.g. community health)

1980’s – Computer-based record systems (CPRs) became subsystems of the HIS.

- This move aided in the development of individualized computer based patient record systems, e.g. in form
of clinical information systems (CIS) specific to nursing practice, laboratory information systems, radiologic
information systems, etc.)
- Many mainframe HISs emerged with nursing subsystems (order entry emulating Kardex, results reporting,
vital signs and narrative nursing notes)

NOTE: A hospital information system (HIS), variously also called clinical information system (CIS) is a comprehensive,
integrated information system designed to manage the administrative, financial and clinical aspects of a hospital.
It can be composed of one or a few software components with specialty-specific extensions as well as of a large variety of sub-systems in
medical specialties (e.g. Laboratory Information System, Radiology Information System).

CISs are sometimes separated from HISs in that the:

CIS - concentrate on patient-related and clinical-state-related data (electronic patient record)
HIS- keep track of administrative issues.
The distinction is not always clear and there is contradictory evidence against a consistent use of both terms.

1990’s –post 2000

The CPRI was founded in 1992-a unique organization representing all stakeholders in healthcare, focusing on clinical
applications of information technology. It initiates and coordinates activities to facilitate and promote the routine use
of computer-based patient records (CPRs).
A CPR project evaluation was established in 1993 with four fundamental criteria:
A. Management
B. Functionality
C. Technology
D. Impact
The criteria also provided the foundation for the Nicholas E. Davies Award of Excellence Program. The program is
founded on the belief that healthcare organizations benefit when collective experiences and lessons learned are
shared. It is intended to award and bring to national attention excellence in the implementation of CPRs. During its
10 year existence, the Davies program has had four criteria revisions and seen its terminology updated from CPR to
EMR and today’s HER.

REMEMBER: EHR/EMR/CPR is similar terms referring an evolving concept defined as a systematic collection of electronic health
information about individual patients or populations. But these terms have distinctions. EMR is existing in a single agency or hospital exclusive for
the utilization of that agency and its affiliates. When EMRs of agencies are shared and are stored in a single server database as what exists today
(thanks to advanced networking) it is known as EHR. EPR or Electronic Patient Record may be also used interchangeably with these terms.
It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected
enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form,
including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, and billing
Its purpose can be understood as a complete record of patient encounters that allows the
1. automation and streamlining of the workflow in health care settings
2. increases safety through evidence-based decision support, quality management, and outcomes reporting
3. serve as database of all patients’ informations.

 Reduction of cost
 Improve quality of care
 Promote evidence-based medicine
 Record keeping and mobility


 Costs
Governance, privacy and legal issues
 Privacy
 Liability and Accountability (streamlined by the HIPAA and other regulatory and compliance agencies)
 Long Term Preservation of Records
 Standards
 Customization