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. 2021 May;60(1-02):32-48.
doi: 10.1055/s-0041-1731784. Epub 2021 Jul 19.

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

John H Holmes  1 , James Beinlich  2 , Mary R Boland  1 , Kathryn H Bowles  3 , Yong Chen  1 , Tessa S Cook  4 , George Demiris  3 , Michael Draugelis  5 , Laura Fluharty  6 , Peter E Gabriel  4 , Robert Grundmeier  7 , C William Hanson  8 , Daniel S Herman  9 , Blanca E Himes  1 , Rebecca A Hubbard  1 , Charles E Kahn Jr  4 , Dokyoon Kim  1 , Ross Koppel  10 , Qi Long  1 , Nebojsa Mirkovic  11 , Jeffrey S Morris  1 , Danielle L Mowery  1 , Marylyn D Ritchie  12 , Ryan Urbanowicz  1 , Jason H Moore  1
Affiliations

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

John H Holmes et al. Methods Inf Med. 2021 May.

Abstract

Background: The electronic health record (EHR) has become increasingly ubiquitous. At the same time, health professionals have been turning to this resource for access to data that is needed for the delivery of health care and for clinical research. There is little doubt that the EHR has made both of these functions easier than earlier days when we relied on paper-based clinical records. Coupled with modern database and data warehouse systems, high-speed networks, and the ability to share clinical data with others are large number of challenges that arguably limit the optimal use of the EHR OBJECTIVES: Our goal was to provide an exhaustive reference for those who use the EHR in clinical and research contexts, but also for health information systems professionals as they design, implement, and maintain EHR systems.

Methods: This study includes a panel of 24 biomedical informatics researchers, information technology professionals, and clinicians, all of whom have extensive experience in design, implementation, and maintenance of EHR systems, or in using the EHR as clinicians or researchers. All members of the panel are affiliated with Penn Medicine at the University of Pennsylvania and have experience with a variety of different EHR platforms and systems and how they have evolved over time.

Results: Each of the authors has shared their knowledge and experience in using the EHR in a suite of 20 short essays, each representing a specific challenge and classified according to a functional hierarchy of interlocking facets such as usability and usefulness, data quality, standards, governance, data integration, clinical care, and clinical research.

Conclusion: We provide here a set of perspectives on the challenges posed by the EHR to clinical and research users.

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Conflict of interest statement

T.S.C. reports grants from ACRIN, NIH, ACR, and RSNA, as well as royalties from the Osler Institute for lectures in 2013, outside the submitted work. D.S.H. reports grants and nonfinancial support from Roche Diagnostics, outside the submitted work. R.A.H. reports grants from Johnson & Johnson, Merck, and Pfizer, outside the submitted work. Q.L. reports grants from NIH, during the conduct of the study; grants from Pfizer and Bayer, outside the submitted work.

Figures

Fig. 1
Fig. 1
Directed acyclic graph illustrating the five entities and activities (facets) that affect the use of the EHR in clinical care and research. The direction of the links indicates the direction of the relationship. For example, standards impact data quality, and standards impact data governance, which in turn impacts data integration. EHR, electronic health record.
Fig. 2
Fig. 2
Venn diagram illustrating the overlap between the five facets as they relate to each other and the central concept, use of the EHR in clinical care and research. Red: EHR usability and usefulness; green: EHR data quality; blue: EHR standards; yellow: EHR and other data integration; black: EHR governance; violet: use of the EHR in clinical care and research.
See this image and copyright information in PMC

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