ABSTRACT
Over the last 10 years the governments of Australia, [1] Belgium, [2] Canada, [3] Denmark, [4] the United Kingdom [5] and most recently the United States, [6] have all made long-term, multibillion dollar investments in health information technologies, including electronic health records. Although the definition of electronic health records might vary across countries, most systems are widely accessible across a health care network and provide a computer-based user interface that replaces the paper chart. The primary goal of these initiatives in health information technologies is to transform the collection, display, transmission and storage of patient data with the aim of improving health. A secondary goal is to use patient data to improve the system of health care delivery. The rationale for these investments stems from numerous concerns of quality and safety related to paper-based systems, which include problems with legibility, access limited to a single provider at a single location, difficulties with aggregating information from multiple records, and problems maintaining confidentiality of records and accurate backup copies. [7] Comprehensive, well-implemented electronic health records with advanced clinical decision support interventions have potential to reduce errors with medications [8] and to increase the quality, efficiency and reliability of information transfer. [9,10]
Despite progress in the use of electronic health records, [11] their adoption has resulted in larger than expected challenges in day-to-day clinical processes. [12] For example, processing electronic information can reduce the productivity of clinicians and increase their workloads, [13-15] and other disruptions of workfl ow can result in safety concerns owing to loss of attention and situational awareness. [16] Thus, clinicians may perceive that the costs of electronic health records (e.g., in time or money, or from required changes in workfl ow) outweigh direct benefi ts to themselves, whereas patients and payers appear to benefi t more readily. [17] Clinicians require assurances that electronic health records will deliver the features and functions they need and that the regulatory environment will support them.
