Electronic health record (EHR) systems are now a fixture in medical examination rooms and hospital corridors. EHR systems have a wealth of potential capabilities, but they also constitute very complex technology. The federal government has embraced and promoted the transition to these systems with great fanfare and for good reasons. This enthusiasm, however, is not universally shared, and many clinicians complain bitterly about the technology's shortcomings. Before analyzing the legal, ethical, and policy implications of EHR system use, it is important to understand fully what the technology is, what it does, and what it doesn't do. This chapter describes the many features of EHR systems. It also details their benefits and explores their pitfalls and shortcomings.

WHAT ARE EHR SYSTEMS?

EHR System Attributes

In the past, doctors’ medical records were just that – repositories of medical information about each patient. Contemporary EHR systems, however, do much more than serve a record- keeping function. They also help clinicians to manage many aspects of patient care through a variety of technological capabilities. The Institute of Medicine (IOM), the Robert Wood Johnson Foundation, and other experts have identified the following eight elements as “core EHR functionalities”:

1. • Clinical documentation and health information display. EHR systems record and display laboratory test results, allergies, patient medication lists, medical diagnoses, patient demographics, clinicians’ notes, advance directives, and other information.

2. • Results management. EHRs create searchable electronic clinical data repositories, including previous and current laboratory test results, radiology procedure results, and other diagnostic or treatment results. These enhance provider access to needed information.

3. • Computerized provider order entry and management (CPOE). EHR systems enable providers to order prescriptions, diagnostic tests, treatments, and referrals electronically. Providers can also store, retrieve, and modify their orders.

4. • Clinical decision support (CDS). This potentially lifesaving feature generates alerts and reminders for clinicians. Examples are warnings about drug interactions, drug allergies, and appropriate medication doses and prompts relating to preventive and wellness care. CDS thus offers monitoring for potential medication errors or other adverse events. It can also suggest possible diagnoses and treatments and educate doctors about clinical practice guidelines and standard protocols.