Methods Inf Med 2021; 60(01/02): 032-048
DOI: 10.1055/s-0041-1731784
Original Article

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

John H. Holmes
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
James Beinlich
2  Information Technology Entity Services and Corporate Information Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
,
Mary R. Boland
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Kathryn H. Bowles
3  Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
,
Yong Chen
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Tessa S. Cook
4  Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
George Demiris
3  Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
,
Michael Draugelis
5  Department of Predictive Health Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
,
Laura Fluharty
6  Clinical Research Operations, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
,
Peter E. Gabriel
4  Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Robert Grundmeier
7  Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
C. William Hanson
8  Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Daniel S. Herman
9  Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania, United States
,
Blanca E. Himes
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Rebecca A. Hubbard
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Charles E. Kahn Jr.
4  Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Dokyoon Kim
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Ross Koppel
10  Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Qi Long
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Nebojsa Mirkovic
11  Department of Research Analytics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
,
Jeffrey S. Morris
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Danielle L. Mowery
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Marylyn D. Ritchie
12  Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Ryan Urbanowicz
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Jason H. Moore
1  Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
› Author Affiliations
Funding Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number: UL1TR001878. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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.

Supplementary Material



Publication History

Received: 28 December 2020

Accepted: 22 May 2021

Publication Date:
19 July 2021 (online)

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