The overarching potential of the EHR
Why the EHR has so much more (unrealised) potential than the paper record
Dave Pao
2 min read
November 2023
‘A gradual but profound transformation of health care into a practice that begins with, flows through, and ends with a computer.’
- Linda Hunt et al. (2017)
Unlike the paper record, the Electronic Health Record (EHR) is an entire system. It is the information backbone of any modern healthcare ecosystem. Given its primary purpose to manage patient data, the EHR is the single most important software system underpinning the delivery of clinical care.
Pioneered in the 1970s, the EHR was rolled out more widely in the 1990s. In the UK today, every GP practice, and almost every outpatient clinic and third sector care provider, use EHR to some degree even if they are not yet fully ‘paperless’. In the USA, 96% of hospitals use an EHR system.
The core property inherent to the digital medium—that data are infinitely shareable without degradation—has expanded the scope of the EHR almost unimaginably beyond that of its paper predecessor. This expansion positions the EHR as an overarching software system that—in an ideal world—connects patient data to all clinicians, social care, pharmacies, laboratories, radiology, administration, finance, logistics, epidemiology, policymakers and clinical research (and many others).
Far beyond an individual patient’s health, therefore, EHR data additionally inform: other individuals’ health, including relatives and partners; population health, including disease surveillance and intervention; service provision, including capacity planning and audit; local, regional, national and international health policy; clinical research; as well as our fundamental understanding of disease.
This overarching role of the EHR is illustrated in the future digital landscape shown in the image below, reproduced from a Nuffield Trust report that discusses the transformation of healthcare through digital technology (Imison et al., 2016). The trapezoidal dotted area represents the EHR backbone connecting patient, professional and organisational stakeholders.
However, the report's conclusion is not optimistic: 'Healthcare lags a decade or more behind most other disciplines in the transition from paper to digital.'
Hunt, L. M. et al. (2017). Electronic Health Records and the Disappearing Patient. Medical Anthropology Quarterly, 31 (3), pp.403–421.
Imison, C. et al. (2016). Delivering the benefits of digital health care. London Nuffield Trust.
Available at: https://www.nuffieldtrust.org.uk/sites/default/files/2017-01/delivering-the-benefits-of-digital-technology-web-final.pdf
