JAMA: EHRs hold promise, need improvements

Electronic health record (EHR) systems hold much promise for the future of healthcare, but improvements are needed before their benefits can be fully realized, according to two commentaries published in the February 3 issue of the Journal of the American Medical Association.

The "extremely aggressive timeline" of the American Reinvestment and Recovery Act (ARRA) could result in "significant patient safety events" as healthcare practitioners and the organizations for which they work rush to put into place the use of EHRs, write Dean F. Sittig, PhD, of the University of Texas at Houston, and David Classen, MD, of the University of Utah, in one commentary.

The authors propose a five-stage framework to monitor and evaluate EHR implementation to help ensure quality while keeping costs low. Such a framework, which could be overseen by the Office of the National Coordinator for Health Information Technology or another body, they say, would include a mechanism to report safety events and potential hazards associated with EHR use; enhanced certification procedures; physician assessment and testing to ensure safe EHR use; local, state, and national accreditation conducted on site and in person; and a nationwide board to investigate reports of adverse events.

In the other commentary, Aviv Shachak, PhD, and Alejandro R. Jadad, MD, DPhil, of the University of Toronto, suggest a seven-component framework related to the formation and growth of the EHR network.

EHR systems should include tools that enable patients to participate more in their care, international standards for the creation and exchange of health information should be developed, and multimedia components could be used to "reduce ambiguity and enhance performance in complex tasks," the authors maintain. Also, EHRs should be designed to accommodate text messaging and videoconferencing, integrate social networking capabilities, include the ability to assess entire health systems, and strike a balance between privacy concerns and the exchange of information in pursuit of quality and safety in healthcare, they write.