History of Electronic Health Records (EHR)

Mid 1960's Late 1960s 1972 1982

1965 Early 1970s Early 1980s

Late 1980s 1994 1996 1999 2002

Early 1990s 1995 1997 Early 2000s

2004 2007 2009 2011

2006 2008 2010 Mid-2011

TIMELINE:

Mid 1960's: Lockheed Unveils Clinical Data Management System One of the earliest data processing systems focused specifically on managing clinical data – now called a hospital information system (HIS). HIS is introduced at El Camino Hospital in Mountain View, California.

BACK TO TIMELINE

1965: National Library of Medicine Moves to Computer System The National Library of Medicine converts the Index Medicus – a comprehensive index of the world's leading biomedical literature – to the computer-based version later called Medline, beginning the shift to electronic rather than paper-based

information resources.

BACK TO TIMELINE

Late 1960s: “Problem-Oriented Medical Record” Introduced Physician Larry Weed introduces the idea of

recording patient information electronically, aiming to generate a record that would allow a third party to independently verify the diagnosis.

Prior to this, a doctor only recorded his diagnoses and the treatment provided.

BACK TO TIMELINE

 Early 1970s: VistA Initiated to Manage Veterans' Health Data

The predecessor to today's Agency for Healthcare Research and Quality (AHRQ) initiates the concept behind Veterans Health Information Systems and Technology Architecture (VistA).  This marks the start of heavy government investments in VisTA and clinical

IT.

BACK TO TIMELINE

1972: First Electronic Medical Records System Developed The Regenstreif Institute develops the first

electronic medical record system. Although the technology is widely regarded as

a major advancement for medical practices, it does not attract many physicians.

BACK TO TIMELINE

Early 1980s: VA Health Information Software Declared Public The VistA information system is legally declared available for unrestricted use within the public or private sectors. This open-source collaboration marks the evolution of VA health software. Major hospitals in other countries

adopt and modify VistA and its information-driven care model

BACK TO TIMELINE

1982: Dragon Systems Pioneers Voice Dictation Software Early voice recognition prototype evolves into Dragon Dictation, used today by more than 150,000 doctors and caregivers. Its wide adoption illustrates that one early key

to success in healthcare IT was a design built around doctors’ existing processes.

BACK TO TIMELINE

Late 1980s: Emergence of Low-Cost PCs Spurs Wide Adoption Lower costs of personal computers (PCs) make it an affordable way to automate core health care functions. Windows-based software emerge soon thereafter. Doctors follow the trend and buy PCs for their offices. While EHRs weren’t widely adopted yet,

practice management functions (billing and scheduling) started to move to computers.

BACK TO TIMELINE

Early 1990s: Emergence of the World Wide Web After Tim Berners-Lee established the World

Wide Web in 1990, new developments in browser interfaces – such as Microsoft Explorer and Netscape Navigator – make it faster and easier to access information online.

People begin to access health information online and the stage is set for web-based EHRs.

BACK TO TIMELINE

1994: Clinitec Sells Software to Convert Paper Records to EHRs Two years after its birth the company is bought by Quality Systems, Inc., a dental software company, which soon merges with Micromed, which provides front- and back-office practice management software. In 2001, Clinitec and Micromed combine to

form NextGen Healthcare Information Systems,

which becomes NextGen Healthcare.

BACK TO TIMELINE

1995: Eclypsis Corporation Founded The company provides hospitals and other

healthcare organizations with EMR, computerized physician order entry, and revenue cycle management software.

In 2008, the company acquires physician practice management software company MediNotes.

Eclypsis merged with Allscripts in August 2010.

BACK TO TIMELINE

1996: Health Insurance Portability and Accountability Act All software used to manage health insurance claims must follow HIPAA’s new regulations on health record use, disclosure and confidentiality. Software developers accurately predict one consequence of HIPAA will be a shift to electronic health record (EHR), which can greatly aid providers in complying

with confidentiality laws. NEXT

Veterans Health Administration Mandates Use of EHRs The largest integrated health care system in the United States, VHA, mandates use of EHRs throughout all facilities. VHA quality of care shows significant improvement in the wake of these changes. Later research indicates VHA care is better than that administered by Medicare, the government social insurance program

administered to Americans 65 and older.

BACK TO TIMELINE

1997: Allscripts Begins Focusing on Healthcare IT The company a year later launches an electronic prescribing solution for physicians, then acquires a series of ambulatory electronic medical record companies. By 2011 the product is used by over 180,000 physicians. Allscripts is now arguably the largest EHR vendor.

BACK TO TIMELINE

1999: eClinicalWorks Started by Four Engineers and a Physician The company quickly becomes a market leader in ambulatory EHR systems, eventually partnering with Sam’s Club and Dell to sell the brand’s EHR and practice management software as turnkey solutions for small

practices.

BACK TO TIMELINE

Early 2000s: Emergence of Web-based Software Salesforce.com and other web-based

companies emerge, proving that the software-as-a-service (SaaS) model is viable.

EHR vendors begin to offer remotely-hosted options, and new purely web-based vendors start to enter the market.

BACK TO TIMELINE

2002: GE Acquires MedicaLogic and Millbrook The acquired solutions are later re-branded Centricity with two applications, Centricity EMR and Centricity Physician Office. Building on the momentum and experience of MediaLogic and Millbrook, Centricity eventually emerges as the brand of 31 healthcare IT solutions that form part of GE Healthcare, a division of General Electric valued at $17 billion today. BACK TO TI

MELINE

2004: President George W. Bush Promotes Adoption of EHRs Demonstrating his commitment to healthcare

information technology, the President doubles funding for health care IT demonstration projects to $100 million, creates a new sub-Cabinet position of National Health Information Coordinator, and calls for widespread adoption of EHRs by 2014, referring specifically to standards for electronically transmitting X-rays, lab results and electronic prescriptions. EHRs gain momentum.

BACK TO TIMELINE

2006: CCHIT Certifies Electronic Health Records Systems Certification Commission for Health Information Technology (CCHIT), a nonprofit aiming to accelerate adoption of secure and interoperable health IT, begins certifying electronic health records systems to help providers choose quality products. Controversy emerges later

over CCHIT’s close ties to the board of trustees of

Healthcare Information and Management Systems Society

(HIMSS), a lobbying agency representing the interests of technology vendors.

BACK TO TIMELINE

2007: VA and Kaiser Permanente Create CONNECT CONNECT- an open-source, cross-agency software system – promotes sharing health records and aims to move the US toward national interoperability. Health giant Kaiser Permanente achieves interoperability with VistA and uses many of its techniques.

BACK TO TIMELINE

2008: Idea of Personal Health Record Reemerges Growth in the Internet drives the idea of the

personal health record (PHR), a record where an individual curates his/her own health data online or via an electronic device.

With the development of web technologies, the possibility of storing, exporting, and sharing patient-reported data makes sense. Google and Microsoft release PHR solutions.

BACK TO TIMELINE

2009: HITECH Act Passes Health Information Technology for Economic and Clinical Health (HITECH) Act passes as part of President Obama’s American Recovery and Reinvestment Act (ARRA) of 2009 stimulus package. ARRA encourages the switch to electronic records by providing Medicaid rebates of up to $63,750 and Medicare rebates of up to

$44,000.BACK TO TIMELINE

2010: Apple’s iPad Spurs Widespread Use of Tablet Computers The iPad ushers in the reemergence of the

tablet era to build on the features of the earlier Tablet PC. Experts predict Gen Y and Z’ers will be eager to engage with personal medical records in part because of the high-tech, interactive format.

Physicians start to demand the same simplicity and convenience in the workplace that they enjoy at home with their iPads.

BACK TO TIMELINE

2011: ONC-ATCB Certification Program Created The Office of the National Coordinator of the HITECH Act creates a certification program in response to the need for clarity on what EHRs are capable of meeting meaningful use criteria during the first phase, or Stage 1, of adopting EHRs. Specifically, the ONC announces which that 6 certification bodies, including CCHIT, are approved to verify meaningful use.BACK TO TI

MELINE

Mid-2011: HHS Proposes Accountable Care To help providers better coordinate care across settings for Medicare patients, new regulations propose creating Accountable Care Organizations. ACOs that help reduce healthcare costs and meet performance standards would be

rewarded. This represents a shift away from fee-for-

service model toward a focus on prevention – with the

HER playing a key role in capturing patient data for

sharing within an ACO.

NEXT

THE FUTURE: Connectivity Key to Future of Healthcare With the rapid evolution of technology,

healthcare providers will continue to look to software and devices to connect to patients and other providers. This will likely include greater connectivity and collaboration among providers, payers and other healthcare participants.

More expansive use of social networking, and improvements in home-based health monitoring using mobile technology are expected.

THE END

THAT’S ALL! THANKYOUU!