electronic health record business plan

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How to Implement an Electronic Health Records System

Table of Contents

Electronic health record (EHR) systems are essential for maximizing profits and delivering a modern standard of care to patients. However, the implementation phase is among the most arduous stages of the electronic medical record (EMR) adoption journey. This phase is where the most problems occur and where shortcuts could lead to catastrophic issues later on. Here’s how to make sure your medical practice avoids a crisis scenario when transitioning to a new EHR system.

Editor’s note: Looking for the right EMR system for your business? Fill out the below questionnaire to have our vendor partners contact you about your needs.

What is EHR implementation?

EHR implementation refers to the integration of medical records software into a healthcare organization’s workflow. Steps in this process include selecting and preparing the EHR software, ensuring compliance with privacy and security regulations, training the organization’s care team and troubleshooting any issues that arise. Taking the time to implement an EHR solution thoughtfully will help smooth the transition and benefit your practice, patients and staff.

While some providers may be concerned about the costs and time associated with EHR systems, their implementation is vital to improving patient care and efficiency within a medical practice. EHR systems have been shown to increase the quality of care, patient outcomes and safety, as well as enhance communication between patients and providers. EHR systems also streamline the scheduling and patient data management processes, thus freeing valuable time for healthcare workers to focus on other tasks.

How long is the implementation process?

The EHR implementation timeline varies based on several factors, including the complexity of the chosen system, the size of your practice and the location of the server (cloud-based versus on-site). As a general estimate, a healthcare organization can set up a new EHR system within a year. EHR implementation for smaller practices (or modifications of an existing system) may take six to nine months, and cloud-based systems may take weeks, rather than months, to set up.

How do you implement an EHR system?

To successfully implement an EHR system in a timely manner, follow the steps below.

1. Plan your EHR implementation road map.

The first step of implementing an EHR system is to create a checklist of all the tasks that need to be completed. Carefully consider who — healthcare providers, managers, IT staff or patients — will need to complete which responsibility.

Critical tasks include stakeholder recruitment, budget planning, scheduling implementation, data transfer, training and live testing, and the establishment of go-live activities and metrics for success. Collaborative project management software , such as Google Sheets and Trello, can be especially helpful for developing a road map. Read our project management app reviews for additional product recommendations.

2. Define your budget.

The exact cost of EHR implementation will depend on both the chosen software’s features and the size of your organization. Hardware and network upgrades, vendor training and consultant fees, data backups and storage, and cost per employee can all affect your total expenses. Your budget will likely dictate the EHR solution you choose to implement. What can you realistically afford? [Read related article: How to Choose Medical Software ]

You also should consider the initial loss in productivity that comes in the early stages of EHR implementation. Providers and staff will need dedicated time for training, which may come out of their patient care hours, and they may require additional time beyond that to further adjust to the new system. Once the platform is fully implemented, however, your organization will benefit from a more streamlined workflow and overall increased productivity.

3. Configure the EMR system.

Once you’ve determined a road map, identified your budget and purchased the software, the next step in setting up a new EHR solution is doing a system configuration, which is essential to accurately represent the details of your medical practice and your patients’ information within the software. That means programming the location(s) of your practice and the providers who will be using the platform.

You also need to design your practice’s clinical workflow, which includes the creation of clinical templates. Templates are required to meet Meaningful Use and Physician Quality Reporting System standards outlined by federal regulations. Following those rules is critical to ensure your practice does not incur Medicare payment penalties.

During the system-configuration phase, your EHR will be integrated with your practice management (PM) system if it’s not already. Also, any data stored within your old system will be migrated to the new one in this phase. You will need IT assistance for this.

“An important component of putting a complete PM and EHR system in place is conducting a data import from the legacy system to the new system,” Adam Siegel, a senior product manager at MedBridge, told Business News Daily. “A new software system will not automatically convert patients from one system to another. This is a complex process that must be facilitated by technical experts.”

4. Begin enrollment and credentialing.

Enrollment and credentialing, which detail how you are paid, depend partly on the responsiveness of the payers. At best, changing payer enrollment from one PM system to another will take a couple of weeks or, at worst, a few months. It’s imperative that you build enough time into the implementation process in case the enrollment-and-credentialing step takes longer than expected.

“Enrollment and credentialing is critical for accurate and consistent payment from insurance companies,” Siegel said. “The process can be drawn out depending on payer responsiveness and if the practice is represented as a group or individual providers.”

Getting this step right is crucial to ensuring smooth operations for your future revenue-cycle management, including the receipt of accurate, consistent and timely payments from insurance companies. Still, you won’t want it to push back your “go live” date, which would hinder your medical practice’s operations. Careful planning is vital. [Check out medical billing and collection tips from the pros.]

5. Optimize the workflow.

Outline each step of your organization’s current workflow. Then, ask the following questions:

• Is it necessary?
• Does it add value for the patient?
• Is it being done in the right order and by the right person?

For certain processes done by a physician, ask the following questions:

• Does this require a physician’s skills or training?
• If not, can someone else complete this task?

By optimizing your workflows before EHR implementation, you can increase the likelihood of a smooth rollout and minimize inefficiencies in the use of the system.

6. Train your team.

Even the best software is useless if staff aren’t trained on how to use it properly. Training will vary based on your practice’s specific workflows, the different roles of your staff members and their preferences for how to engage with the new system. There are several ways to bring your team up to speed, but the key is to begin training a short time before the new EHR solution goes online so staffers retain as much of the information as possible.

“Training is best done within a couple weeks of the go-live date,” Siegel said. “This ensures that new workflow and process will be fresh in the minds of the staff. … Staff interact with their [practice management] and EHR systems constantly, and it’s important that they adopt the new system and look for ways to use it as efficiently as possible.”

Training options include self-paced learning and on-site training. Self-paced distance learning, which is the most affordable and simplest method, involves reading user guides and watching instructional videos. On-site, instructor-led training is a comprehensive, in-person teaching program.

Of course, on-site training costs more, since a professional integrator must travel to your practice to teach your staff, but in-person training can provide your team with one-on-one time with an experienced instructor who knows the ins and outs of the new system. Siegel recommended less-robust training methods for smaller practices with fewer staff and on-site training for large practices or hospitals.

7. Troubleshoot the system and mitigate risk.

EHR software is complex and far-reaching, so be prepared to engage in troubleshooting and risk mitigation. As Siegel put it, “The implementation process as a core principle involves stopping revenue through one channel and restarting it through another.”

Naturally, this is a delicate and risky thing to do. Here are a few suggestions to protect yourself against some of the potential issues surrounding implementation:

• Choose a system with a user-friendly interface. An EHR system can either streamline or hinder operations in your medical practice, depending on how you use it. To ensure your new solution has the desired effect, make sure the platform’s user interface is intuitive and simple to learn. This will help make the transition easier for your staff and increase the effectiveness of your system, without depressing productivity.
• Include your staff in the decision-making process. The best way to determine how prepared your staff is to adapt to the new system is to include them in the decision-making process before you select a product. Do they find certain interfaces friendlier than others? What does their preferred workflow look like? What kind of training would they find most helpful? These questions can help you choose a system with your team in mind and make adoption of the new software much easier for them. Involving each department in your practice during the decision-making process provides invaluable insight for making a final purchase and gets long-term buy-in from your team members.
• Integrate all software with your new PM/EHR system. “Many practices use additional software products to provide the full spectrum of solutions needed to run an efficient modern medical practice,” Siegel said. “This starts with integrating any additional systems with the new PM and EHR software. Products like appointment-reminder systems and interfaces with lab and imaging systems are critical to practice efficiency and shouldn’t be overlooked during the conversion process.”
• Assess your practice honestly before implementation begins. Providing an honest and accurate assessment of your medical practice’s current finances, workflow and capabilities is a major part of executing a successful implementation. Through this assessment and the development of clearly stated goals, a practice’s administration can more effectively set and track metrics of success for the new system.

“A practice should have a clear understanding of how their complete practice will operate on the new system by the time they sign the contract and begin the implementation process,” Siegel said.

Once the software is configured and your team is trained, run through different online and offline workflows to see what issues, if any, arise. Take the time to troubleshoot and resolve those hiccups before your full rollout.

What are the benefits of a fully implemented EHR system?

At the end of the implementation process, your practice will have a fully functioning, modern EHR system that will hopefully improve both the quality of the healthcare services you provide and your practice’s profitability. Most practices implement new software only once or twice, and if it’s done right, the rewards are exceptional.

Here are some of the benefits your practice should see:

• A more optimized day-to-day workflow and friendlier user experience
• More efficient, timely and comprehensive medical care for patients
• More complete documentation of patient visits and rendered services
• Greater patient satisfaction due to decreased wait times and simplified billing
• More efficient scheduling and increased appointments, as well as reductions in no-shows and cancellations
• Increased revenue and medical claims accepted by payers on the first submission, as well as a reduction in the amount of aging accounts receivable in collections
• Improved connectivity with labs, hospitals and specialists that work with your practice

“By visualizing a modern medical practice and putting in place the right tools to manage it, a practice can put themselves in a grounded position of system optimization and excellence in performance poised for future growth,” Siegel said.

What is the best EMR and EHR software?

These platforms rank among our picks for the best medical software :

• DrChrono: The introductory tiers for this EMR platform are feature-rich and low-cost, making it a great choice if you’re new to medical software. You’ll also get free setup assistance, so the implementation process will be much easier. You can learn more in our detailed DrChrono review .
• AdvancedMD: This vendor operates on an a la carte model, meaning you can pick just the EMR and PM services you need. This flexibility can streamline implementation and save you money, since you aren’t paying for unnecessary features. Read our AdvancedMD review for more information.
• CareCloud: The tools within the CareCloud system are arranged logically, and the platform’s interface is highly user-friendly. The software is easy to use right from the start, and its extensive customizability further lowers any remaining learning curves. Read our CareCloud review to see if this EMR platform might be right for you.
• athenahealth: A major function of medical software is to generate analytics reports that you can use to make smart decisions for your practice. athenahealth excels in this area, and a company representative always reaches out to new users for one-on-one consultations. Our athenahealth review further explains how this vendor goes out of its way to serve healthcare organizations.
• Kareo: For user-friendly software at a competitive price, Kareo is a great choice. Its dashboard is notable for resembling a social media feed and thus feels familiar, and everyone in your practice can customize their dashboards. Learn more in our comprehensive Kareo review .

What lies on the other side of implementation

Your EHR implementation journey will almost certainly result in more organized workflows, larger revenue and happier patients. It’s no wonder, then, that about 80 percent of healthcare offices have adopted EHR systems. The overwhelming popularity and prevalence of this technology suggest it’s time for your practice to get on board if it hasn’t already. And with this guide, doing so should be a breeze.

Max Freedman and Sean Peek contributed to this article. The source interview was conducted for a previous version of this article. 

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It’s Time for a New Kind of Electronic Health Record

• John Glaser

We need to shift from reactive to preventative care.

Well before the Covid-19 pandemic struck, electronic health records were the bane of physicians’ existences. In all too many cases, EHRs seemed to create a huge amount of extra work and generate too few benefits. The pandemic has made the deficiencies of these systems glaringly apparent. This article discusses how EHRs should be transformed so they become an indispensable tool in keeping individual patients and patient populations healthy.

In these difficult times, we’ve made a number of our coronavirus articles free for all readers. To get all of HBR’s content delivered to your inbox, sign up for the Daily Alert newsletter.

The Covid-19 pandemic presents the U.S. health care system with a mind-boggling array of challenges. One of the most urgent is coping with a simultaneous glut and dearth of information . Between tracking outbreaks, staying abreast of the latest information on effective treatments and vaccine development, keeping tabs on how each patient is doing, and recognizing and documenting a seemingly endless stream of weird new symptoms, the entire medical community is being chronically overwhelmed.

• John Glaser is an executive in residence at Harvard Medical School. He previously served as the CIO of Partners Healthcare (now Mass General Brigham), a senior vice president at Cerner, and the CEO of Siemens Health Services. He is co-chair of the HL7 Advisory Council and a board member of the National Committee for Quality Assurance.

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Electronic Health Records

An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports   The EHR automates access to information and has the potential to streamline the clinician's workflow.  The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

EHRs are the next step in the continued progress of healthcare that can strengthen the relationship between patients and clinicians.  The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.  

For example, the EHR can improve patient care by:

• Reducing the incidence of medical error by improving the accuracy and clarity of medical records.
• Making the health information available, reducing duplication of tests, reducing delays in treatment, and patients well informed to take better decisions.
• Reducing medical error by improving the accuracy and clarity of medical records.

For information about the Medicare & Medicaid EHR Incentive Programs, please see the link in the "Related Links Inside CMS" section below.

For industry resources on EHR, please see the links in the "Related Links Outside CMS" section below.

Related Links

• HHS/Office of National Coordinator Health IT Web Site
• Health Level Seven (HL7)
• Promoting Interoperability (PI)

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April 12, 2024

23 min read

Patient Care

EHR explained: A guide to electronic healthcare systems

When effectively implemented, EHR systems can automate processes, enhance engagement, improve outcomes, and boost margins.

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At a glance.

• EHRs are accessible by authorized healthcare providers involved in a patient’s care, allowing them to view and share crucial data like demographics, medical history, vital signs, lab results, care plans, and more.
• When implemented well, EHRs can automate key processes, enhance patient engagement, improve health outcomes, and boost operational margins, allowing healthcare professionals to focus more on patient care than administration.
• Making the right investment in an EHR that focuses on automation and reducing workflow friction can save independent practitioners time and money.

What is an electronic health record? In this article, we go deep into the world of EHR systems, unraveling the complexities and showcasing how these digital tools can help healthcare practices. With over 75% of office-based clinicians and 96% of hospitals in the United States using an EHR system, according to HealthIT.gov , the shift from traditional paper records to digital platforms is nearly ubiquitous. Yet, despite their widespread adoption, EHRs are often a significant source of frustration for healthcare providers.

EHRs are often badly designed and don’t integrate with other systems, leading to wasted time and unnecessary friction. Providers often feel frustrated because their EHRs promised them flexibility and efficiency — but what they’ve got is rigid and inefficient.

However, when effectively implemented, EHR systems can automate key processes, enhance patient engagement, improve health outcomes, and boost operational margins. In sum, they allow healthcare professionals to focus more on patient care and less on administrative tasks. 

Let’s learn how to make an informed decision about your practice’s EHR.

What is an EHR?

An EHR is a digital version of a patient's medical record. Think of it like a comprehensive online chart that securely stores and organizes a patient’s important health information, usually in reverse chronological order, including:

• Demographics: Examples include the patient’s name, address, date of birth, gender, contact information, insurance information, and emergency contact details.
• Medical history: Past illnesses, surgeries, immunizations, and family medical history. It can also contain their social history, habits (tobacco, alcohol, drug use, etc.), growth chart, and developmental history (children).
• Medications: Current and past medications, dosages, and allergies.
• Lab results: Blood work, X-rays, imaging scans, pathology reports, and specialized testing such as pulmonary function tests and genetic testing. 
• Vital signs: Blood pressure, temperature, heart rate, heart rate, respiratory rate, oxygen saturation, and height and weight.
• Medical encounters: Doctors' notes and progress reports. These include the chief complaint, history of present illness, physical examination, diagnosis, assessment and plan, hospital admission documentation, referral information, and consultation notes. 
• Orders and prescriptions : Detailed instructions including medications, physical or occupational therapy, post-operative or procedure care instructions, and follow-up including emergency instructions.
• Procedures: Surgical and medical procedures, rehabilitation therapy details.
• Risk factors: Lifestyle factors (smoking, alcohol consumption), occupational hazards, environmental exposures.
• Care plans: Chronic disease management plans, preventive care recommendations, behavioral health treatment plans.
• Other information : Digital images of the patient; flowsheets from operations, procedures, or stays in the emergency room or intensive care unit; informed consent forms; EKG or EEG tracings; digital radiology or pathology images; digital output from medical devices such as pacemakers or cardiac assist; medication or chemotherapy protocols; clinical research protocols; and any relevant patient-specific information. 

EHRs are accessible by authorized healthcare providers involved in a patient's care, who can view and share crucial data instantly and securely. They streamline communication, promote coordinated care, and reduce the risk of errors due to incomplete or outdated information. EHRs can combine large databases of patient information to follow healthcare trends, develop new treatments, and innovate healthcare delivery. These features were especially beneficial during the COVID-19 pandemic.

History of EHRs

The history of EHRs and EMRs began in the 1960s, but there were challenges around technology limitations and lack of standardization. EMRs and EHRs were also so expensive that primarily the government used them in partnership with health organizations. In the early 1990s, widespread EHR adoption was further delayed due to physician reluctance because of a lack of any real incentive. 

The early 2000s saw the introduction of government incentives in the United States, like the Medicare and Medicaid EHR Incentive Programs . These incentives encouraged healthcare providers to implement EHR systems, which led to a surge. By 2020, nearly 90% of hospitals and 75% of office-based physicians in the U.S. had adopted at least a basic EHR system.

However, the widespread adoption of EHRs led to concerns about patient privacy and data security. As a result, several laws and regulations were established to protect patient data and ensure proper use of EHRs. 

Some key examples of these regulations include:

• Health Insurance Portability and Accountability Act (HIPAA) : A U.S. law enacted in 1996 to protect patient information. Its Privacy Rule covers the use and disclosure of patient-identifiable information — referred to as protected health information (PHI) — by individuals and organizations called covered entities (CEs).
• Health Information Technology for Economic and Clinical Health Act (HITECH Act): This U.S. law expands HIPAA and imposes stricter data security and breach notification requirements.
• General Data Protection Regulation (GDPR): This European Union regulation addresses the processing of personal data, including health information. It also empowers individuals with control over their data.

These regulations outline various requirements for healthcare providers using EHRs, including:

• Implementing appropriate security measures to protect patient data
• Obtaining patient consent for sharing information
• Reporting data breaches to authorities and affected individuals
• Providing patients with access to their EHR data

As a result of improved safety and security, EHRs now help physicians determine optimal patterns of care while preserving privacy. EHRs have also changed the dynamics of the doctor-patient relationship with better communication and documentation.

What information is included in an EHR record? 

An EHR solution is a dynamic and secure information hub accessible across different healthcare providers. 

We’ve covered the core elements of an EHR, such as medical history, medications, labs, vital signs, and clinical notes. But there’s more to the story, as recognizing health is more than just a history of electronic medical records.

EHR records can also contain the following information for full patient context: 

• Social determinants of health (SDOH): EHRs increasingly capture factors like income, housing, and education to provide a holistic view of potential health risks and to promote targeted interventions.
• Imaging and scans: EHRs often integrate digital versions of X-rays, MRIs, and other diagnostic images to create a readily accessible visual library of patients' health.
• Patient-reported outcomes (PROs): PROs include subjective experiences, like how patients feel about their own health. Typically captured through surveys or questionnaires, this data can personalize treatment plans and empower shared decision-making. PROs are increasingly recognized as valid outcomes including quality of life and physical functioning.
• Genomic data: As genetic testing becomes more prevalent, EHRs may house genetic information to pave the way for personalized medicine. This might include genetic risk assessment and preventive care based on individual predispositions.

What are the different types of EHRs? 

Ehr software.

There are 3 major types of EHR software : software as a service (SaaS), on-premise (also known as enterprise), and custom.

Cloud-based EHRs

In this EHR model (also known as a SaaS solution), your practice accesses the system via the Internet. You do not need servers and other infrastructure on-site.

Typically, a SaaS solution has lower upfront costs but requires a monthly or annual subscription, making it suitable for smaller practices or those with limited IT resources. 

SaaS EHRs have some customization, but are not as customizable as on-premise EHR software.

On-premise EHR software

Choosing an on-premise EHR solution means you buy the software product from an EHR supplier and install it on your own servers. 

You need to invest upfront in software, servers, and local network connectivity — plus ongoing maintenance. However, this type of EHR software generally does not require a subscription fee.

Most on-premise EHR software can be used immediately, but your practice will probably need to customize clinical content, templates, reports, or other functions to fit your needs and workflows.

Hybrid EHR systems

This hybrid method combines elements of both on-premise and cloud-based models. 

Typically, some data is stored locally, while other information is hosted in the cloud. A hybrid option offers greater flexibility and personalization than a true SaaS model, but still needs local IT management and support.

For example, a hybrid approach for your practice may look like building custom interfaces, templates, and reports into a flexible enterprise on-premise EHR.

EHR storage

There are also 3 main EHR data storage options:

On-site EHR data storage

On-site data storage means your enterprise or custom EHR system will store all data on your in-house servers. This allows your practice to closely monitor privacy and security, and helps you keep control of your EHR data. However, this option can be costly, so this is typically a more practical solution for large practices. 

On-site data storage requires you to develop a plan to regularly back up your systems in case servers fail. You will also need to adopt a high-availability plan — access to an EHR at all times is critical to patient care.

EHR data hosted remotely on dedicated servers

Many EHR suppliers allow you to store data off-site on dedicated servers. Your practice effectively rents external space instead of needing an in-house server room. 

This way, you remain in control of your data without needing to buy, house, and maintain local servers. Medium and large practices benefit the most from a remote hosting option — especially if there’s a challenge with setting up and maintaining in-house servers.

Cloud-based EHR data storage

Cloud-based data storage is most common for SaaS EHRs. 

It’s often cheaper to store your EHR data in the cloud than local or dedicated remote servers. Cloud-based storage also enables your providers and patients to access data from anywhere with an internet connection.

Because cloud-based storage typically has lower upfront costs, it’s a wise choice for smaller practices. A monthly or annual fee is required. You should also check the data ownership provisions of the cloud storage contract to ensure you’re in control of your data — in case you decide to switch EHR systems down the road.

What are the benefits of an EHR for patients? 

The EHR concept has transformed healthcare practices, both by streamlining workflows and by improving data management. But what about the patient experience? 

• Portability: Because patients’ medical information is securely stored online and accessible through any internet-connected device, EHRs are certainly more convenient than paper records. Instant access empowers informed decision-making, whether that’s discussing treatment options with doctors or seeking urgent care while traveling. Readily available information simplifies tasks like insurance claims, referrals, and administrative processes. This reduces stress and allows patients to focus on what truly matters: getting well and staying healthy.
• Convenient access: EHRs often come with patient portals, offering 24/7 access to medical records. For instance, patients can view lab results, refill prescriptions, schedule appointments, and even securely message their doctor with questions or concerns. In turn, patients experience a more continuous and convenient communication experience.
• Improved care: Easy data sharing enables specialists, emergency room doctors, or pharmacists to instantly access patients’ complete medical history. This means informed treatment decisions and avoiding medication conflicts. No more starting from scratch each time patients seek care — their health story travels with them.
• Proactive health management: EHRs enable healthcare professionals to identify potential health risks early. This is possible throughaActivities such as preventive screenings and interventions targeted to patients’ specific needs, based on trends and patterns in their EHR data. 

One of the key benefits we've mentioned — convenient access — is vital in strengthening the patient-provider relationship. This is how.

How can EHRs strengthen the relationship between patients and providers?

A strong patient-provider connection relies on more than just efficient information flow. 

Here's how EHRs — when used thoughtfully — can bridge the gap and cultivate trust with patients:

Shared stories, not just charts: Accessible EHRs allow patients to actively review their medical history, lab results, and even progress notes alongside you. This fosters trust and often means they’re more confident to ask questions, discuss concerns openly, and collaborate in treatment decisions. Improved documentation may include examples such as before and after photos, radiology or pathology images, and graph representations of data such as blood glucose or blood pressure readings.

“ EHRs — when used thoughtfully — can bridge the gap and cultivate trust with your patients.  ”

From transactions to partnerships: Medical consultations shouldn't feel like rushed transactions. Patient portals built into EHRs are an excellent way to communicate with patients to answer questions, address concerns, and securely share educational resources. This ongoing dialogue builds trust, ensures you hear them, and empowers patients to be active participants in their health journey.

Empathy through knowledge: Healthcare professionals who already understand the context of a patient's situation are able to engage in deeper, more nuanced conversations. This demonstrates empathy and genuine interest in their unique experiences — ultimately strengthening the bond and create ongoing trust in your expertise.

It’s important to remember that the technology that delivers EHRs should enhance, not replace, human connection. 

Look beyond the data and see the person with a story. Use EHRs to build bridges and cultivate patient trust. By doing so, you'll not only improve outcomes but also create a more rewarding experience for your team and your patients.

How EHRs affect independent providers

Independent providers face the challenges of operating within tight budgets, limited resources, and keeping pace with rapid technological advances. 

With this in mind, it’s interesting to consider whether EHRs, despite their transformative impact on healthcare, help or present new obstacles for independent providers.

Cost implications

The first consideration is cost. 

For independent healthcare providers, the financial burden is substantial. This includes the upfront costs of software, hardware, and training, along with the ongoing cost of maintenance. These expenses may strain the resources of independent providers, so careful budgeting and resource allocation is essential.

Nonetheless, incentive payments from Medicare and Medicaid EHR incentive programs are available to eligible independent providers, providing some financial relief.

Interoperability challenges

Ensuring continuity of care is vital, as it ensures all providers have access to up-to-date and comprehensive patient information for informed decision-making and improved patient outcomes.

This is why sharing patient records can become problematic if independent providers use their own EHR. Using the same EHR facilitates access to any patient’s records, ensuring seamless continuity of care. 

How EHRs help independent providers 

Despite the challenges they pose, EHRs offer several benefits that can positively impact independent providers and their practices:

Streamlined workflows

Unlike larger healthcare institutions, independent providers often have smaller teams with limited administrative support. 

EHRs can streamline workflow processes by automating tasks such as appointment scheduling, charting, and billing. This allows independent providers to manage their practice more efficiently with fewer resources. EHRs may allow independent physicians to access large data resources including local and national trends, clinical studies, and pharmacologic formularies.

Enhanced patient engagement 

Independent providers rely heavily on building strong relationships with their patients. 

EHRs provide tools such as patient portals and secure messaging systems. These allow providers and staff to engage directly with their patients, answer questions, provide educational resources, and involve them more actively in their healthcare decisions.

Customization for individual care 

Independent providers often specialize in niche areas of medicine or serve specific patient populations. As such, providers can customize their EHRs to meet the unique needs of these practices. For instance, tailor templates, workflows, and decision support tools to align with specialized areas of expertise and provide more personalized care to patients.

Compliance with regulations

Independent providers must comply with the same regulatory requirements as larger healthcare organizations, such as HIPAA for patient privacy and security. EHRs designed specifically for independent providers incorporate built-in compliance features and updates. This helps providers maintain regulatory compliance without additional burden or complexity.

EHR pros and cons

Let’s turn now to some of the key EHR advantages and disadvantages.

CMS.gov describes an ideal EHR with “the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.”

But what else does an EHR bring to the table?

Improved efficiency: EHRs eliminate the need for manual data entry or searching for records, reducing errors and saving time for both providers and patients. This allows providers to spend more time focusing on patients and less time worrying about technology.

Decreased waiting times: Options like telehealth enable patients to connect with their doctor virtually for consultations, medication reviews, or follow-up visits — saving them valuable time and travel. For instance, Tebra’s Telehealth equips patients with secure messaging, provider unique URLs, group appointments, and virtual waiting rooms so you can deliver the effortless experience patients expect.

Easier medication management: Alleviate frustration on all sides with faster, easier ePrescriptions that give patients a transparent view of their medication orders and providers a better way to document medications, and manage refills, changes, and cancellations. EHRs can also flag potential drug interactions based on a patient's complete medication history to ensure medication safety and reduce adverse effects.

Enhanced accuracy and accessibility: Patient information is readily available from anywhere with an internet connection, which mitigates the risk of lost or misplaced records. Moreover, electronic health records can help to reduce errors by using features such as drop-down menus and automated checks.

Better care coordination: Real-time data sharing across different healthcare providers ensures informed treatment decisions and can reducethe risk of medication conflicts.

A survey by the Center for Connected Medicine (CMM) involving technology executives from U.S. hospitals and health systems reveals that nearly a third acknowledge their data-sharing efforts are insufficient, even within their own organizations. Less than 40% of these technology executives state that they are successfully sharing healthcare data with other health systems.

Personalized care: Data analysis can identify potential health risks and tailor preventive measures or treatment plans to individual needs. 

Patient engagement: Secure patient portals can empower patients to review their records, schedule appointments, and communicate with providers to promote active participation in their care.

Maximize revenue: Maximize reimbursements and earn positive performance-based payment adjustments.

Research and innovation: De-identified EHR data can contribute to research initiatives and lead to advancements in healthcare and improved population health.

Further Reading

Initial cost and implementation: Transitioning from paper records to EHRs can involve significant upfront costs and training.

Potential for workflow disruption: Learning and adapting to new EHR systems can initially disrupt established workflows and impact productivity levels.

Potential for health disparities: Unequal access to technology or digital literacy skills might create barriers for certain populations; potentially exacerbating existing disparities.

Privacy and security concerns: EHR platforms give your practice a secure, care-focused means of maintaining PHI (protected health information), such as patient records.

Under HIPAA, EHR data is considered PHI because of the amount of sensitive demographic information collected and stored in EHR platforms. To safeguard this data, you need robust security measures in place and adhere strictly to regulations like HIPAA.

HIPAA regulation mandates that healthcare providers comply with national privacy and security standards to safeguard PHI. This includes any demographic information that can be used to identify a patient — such as names, dates of birth, Social Security numbers, insurance information, phone numbers, and full facial photos. It’s vital for EHR providers to be HIPAA compliant to protect clients’ healthcare data from security incidents and to avoid government fines.

EHR vs. paper records

Paper based records — what can go wrong.

While paper records have stood the test of time, they come with significant limitations and vulnerabilities that can create serious challenges in healthcare settings.

Here's a closer look at some of the potential issues:

Accuracy and security

Medication mistakes: Handwritten notes are susceptible to errors and misinterpretations — potentially causing incorrect diagnoses and medication issues.

Alterations: Paper records can be physically altered, added to, lined out, or erased, leading to issues for medical liability. Digital records eliminate these concerns and ensure a more secure method of documentation, because even digital records that are erased can be retrieved.

Unauthorized access: Because paper records are physically accessible to anyone who can get into the storage area, they pose a serious risk to patient privacy and confidentiality.

Limited audit trails: Tracking paper-based record changes is difficult, hindering accountability and making it hard to identify potential fraud or tampering.

Accessibility and efficiency

Limited accessibility: Retrieving specific information can be time-consuming and inconvenient.

Sharing challenges: Sharing information with other healthcare providers or specialists becomes tedious and cumbersome, potentially delaying diagnoses and treatment.

Loss and damage

Misplacement: Physical documents can easily be misplaced, lost, or stolen. Missing information and disrupting patient care can be common.

Damage: Prone to tears, spills, fires, and natural disasters, paper records can become illegible or even destroyed, resulting in permanent data loss.

Deterioration: Over time, paper and ink degrade, making records difficult to read or even unusable, hindering access to crucial historical information.

The issues with paper records, from potential medication errors to limited accessibility, necessitate a more efficient and secure solution. Let's dive into the top EHR software systems and their features.

Top EHR software systems and their features

Some of the common EHR software systems on the market today include:

Practice Fusion

Practice Fusion is a cloud-based EHR that consolidates provider and staff responsibilities with a comprehensive system. It promises to organize patient information before, during, and after the visit.

Features include:

• Automatic updates
• Chart on any device
• Integrated policy support
• Free patient portal
• Flexible billing
• Task management
• Scheduling 

Epic’s cloud-based EHR system is well suited for large healthcare systems, such as multi-hospital systems and institutions.

Expect features like:

• Customized patient charting 
• Prompts for billing codes 
• Flowsheets, templates, and free-text options
• SmartTexts for frequently used phrases or data
• Detailed reports 

eClinicalWorks

eClinicalWorks provides scheduling and check-in through documentation, labs, prescribing, billing, and follow-up, as well as:

• Virtual assistant capabilities
• Patient safety and compliance dashboards
• Enhanced prescribing of controlled substances
• Patient check-in tools
• Billing features

Tebra is a cloud-based EHR, specifically designed for independent practices. Its all-in-one solution combines patient engagement and practice management into an easy-to-use EHR software system. 

Beyond this, Tebra's EHR software is packed with essential features designed to streamline your practice’s operations and enhance patient care:

• Calendar integration with online scheduling: Empower your patients to book directly with you on 50-plus sites including Google, Facebook, and more. Offer immediate, 24/7 online booking anywhere patients find your practice. 
• Automated appointment reminders: Tebra’s appointment reminders enable patients to confirm their scheduled appointments via email, text message, or phone call.
• Comprehensive patient records: Get a full picture of the patient, improve clinical accuracy, increase patient safety, and reduce operating costs and administrative tasks.
• Efficient note charting: Pre-built templates, text shortcuts, and note duplication all speed up note charting — while still letting you capture the depth of detail you need.
• eLlab ordering: Integrated electronic lab ordering automates manual workflows and enables you to send and manage lab orders and results directly in the Tebra platform.
• Digital charge capture creation: View your frequent codes, make notes and comments, track status, and send superbills in just a few clicks.
• Patient communications: Simplify and improve the check-in process by sending patients their intake forms ahead of their appointments, saving time for both patients and staff.
• MACRA/MIPS management : Quality dashboard and guided workflows to easily track your performance on MACRA and MIPS quality measures .
• Simple point and click templates: Save time and increase convenience with customized templates tailored to suit your providers' clinical note preferences.
• PDMP and EPCS monitoring: Electronically send new and existing patient prescriptions with EPCS to the patient’s preferred pharmacy in just a few clicks.

Now that we've explored some of Tebra's key features, it's time to dig deeper. Specifically, how can these features translate into real-world improvements for small practice operations?

How can a great EHR system help small practice operations? 

Independent practices face tight budgets, limited resources, and the pressure to deliver high-quality care. EHR companies with exceptional, fit-for-purpose EHR systems can help overcome all of these challenges and more.

If you're a small practice owner considering an EHR solution, the first step is exploring a list of EHR systems tailored to your specific needs and budget. This will help you compare features, pricing, and functionalities to find the perfect fit for your practice.

Small practice efficiency challenges 

Reduced reliance on dedicated IT staff: It’s common for smaller practices to lack the resources for dedicated IT personnel. Cloud-based EHRs with intuitive interfaces minimize the need for extensive IT support and give staff more time to focus on patient care.

Scalability for fluctuating patient volume: Varying patient loads can be hard to manage, so flexible subscription models and modular functionality in EHRs allow practices to adjust their system seamlessly as needs evolve.

Automated reminders and follow-ups: Automations, such as medication refill prompts, help reduce patient no-shows and improve adherence, which maximizes efficiency with limited staff.

EHR system financial advantages

Decreased administrative costs: Automation saves time and reduces the need for additional administrative staff — equalling practice-wide cost savings.

Improved insurance coding and billing: Accurate and standardized documentation facilitates faster and more accurate insurance claims processing and improved cash flow.

Additional EHR benefits for specific specialties

Psychiatry: Track patient progress, manage medication adherence, and leverage secure messaging for confidential communication.

Dentists: Manage dental charts, track treatment progress, and integrate digital X-rays for improved diagnosis and communication with patients.

Urgent care: Optimize patient flow with efficient registration, triage tools, and streamlined documentation for faster diagnoses and treatment.

How should private practices choose an EHR?

Trent Carter, founder and nurse practitioner at Curednation , has some key advice for choosing the right EHR for private practices:

Assessing practice needs: Understand the unique workflows of the practice to identify areas where an EHR can enhance efficiency. Choose a system that can adapt to the evolving needs and potential growth of the practice.

User-friendly interface: Opt for an EHR system with an intuitive interface to minimize the learning curve for staff to reduce both training time and potential disruptions.

Integration capabilities : An EHR that seamlessly integrates with existing systems and technologies ensures a cohesive and connected healthcare environment.

Cost considerations: Beyond the initial investment, consider long-term costs — including maintenance, support, and potential upgrades.

Vendor reputation: Explore user reviews and testimonials to gauge the experiences of other practices with similar needs. Also, assess the EHR vendor's quality of customer support and ongoing assistance.

EHR features checklist

Choosing the right EHR system is crucial for making your operations run smoothly and enhancing patient care. 

At Tebra, we know that common pain points in EHR systems include elements like excessive clicking, data transfer hassles, and lack of specialty-specific features. 

“ Choosing the right EHR system is crucial for making your operations run smoothly and enhancing patient care.  ”

With this in mind, this checklist is your go-to when you’re checking out potential EHR systems:

• User-friendly interface: Look for features like pre-populated templates, text shortcuts, and drag-and-drop functionality for faster documentation.
• Seamless patient record management: Integrated demographics, medical history, medications, allergies, immunizations, lab results, imaging reports, and progress notes.
• Robust clinical decision support: Evidence-based guidelines, drug interaction alerts, and reminders for preventive care measures.
• Secure messaging: HIPAA-compliant communication with patients and other healthcare providers.
• eRx: Electronic prescriptions sent directly to pharmacies to reduce errors and delays.
• Automated appointment scheduling and reminders: Online scheduling tools and automated appointment reminders for both patients and staff.
• Reporting and analytics: Customizable reports for quality improvement, population health management, and financial tracking.
• Interoperability: Ability to easily exchange data with other healthcare systems and laboratories.
• Mobile access: Secure remote access to patient records and essential functionalities for improved flexibility and responsiveness.
• Scalability: Choose a system that can grow with your practice and adapt to evolving needs.
• Training opportunities: Look for a vendor that offers university classes.
• Implementation and support: Consider the vendor's implementation process, ongoing support offerings, and responsiveness to user needs.
• Cost and budget: Evaluate pricing models, subscription options, and potential hidden costs to ensure affordability within your budget.
• MACRA/MIPS management: Check for features like automated MIPS reporting and tracking systems to keep your practice on track with earning the most in positive adjustments.
• PDMP and eRx for controlled substances monitoring: Tebra's PDMP enables EPCS enrolled providers to query their state's PDMP when ePrescribing a controlled substance.
• ONC certification: A cloud-based, ONC-certified EHR with easy-to-use documentation supports your staff’s entire workflow and makes the patient experience simpler.

It’s also worth noting that EHRs that offer flexible, build-your-own treatment plans can help improve practice synchronization and kickstart comprehensive treatment options. 

Build-your-own treatment plans enable clinical decision-making that guides patients toward their goals. Of course, better adherence to treatment plans means better outcomes and a higher percentage of collecting practice revenues.

Tebra Care Delivery is a modern, certified EHR solution designed to equip today’s provider with clinical tools that support rather than interfere with patient care. This includes all the innovative features your practice needs — from robust clinical charting and streamlined patient documentation to a comprehensive view of the patient and their history, eLabs, telehealth, and more.

You Might Also Be Interested In

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Creating A New Business Plan for Electronic Medical Record Sales

Finding new sales opportunities is a huge objective for every Electronic Health Record (EHR) software firm. Nevertheless, traditional sales methods like buying lists, cold-calling, and generic sales pitches are not as effective as they used to be.

These days, with the surge of mobile technology and internet accessibility, potential customers hold the key to the sales process. People want to do research by themselves, which usually starts with Google search. According to Roper Public Affairs , 80% of B2B decision-makers prefer to get details from posts over advertisements.

Luckily, there is a new customer acquisition technique called Inbound Sales that includes bringing in potential customers using personalized content to develop new sales opportunities.

Here are some great ways to produce new sales chances for Electronic Health Record (EHR) software business:

Create informative content for ideal buyers

People are constantly seeking info that will help solve their troubles or address their concerns using online research. Knowing this, you should start a blog to share practical content with your target market. According to a Hubspot research study, B2B companies that post blogs more than 11 times every month had three times more organic web traffic compared to those blogging just once a month. To enhance your search engine position, use relevant key phrases in the URL, header, content, and alt photo messages. To get to a bigger target market, advertise your blogs on various social media networks. Make sure to target people who match your buyer personas. When your posts are shared on social media, they will get to a lot more people and develop more sales possibilities.

Use engaging deals

Many people want to know “what’s in it for me” when they come to your landing page. Your offer needs to be engaging enough to encourage these new site visitors to give their contact information. It’s also a good idea to have an offer for every phase of the Buyer’s Journey . Someone in the “Awareness phase” might want to see an ebook or report that shows information on the general topic. In the “Consideration phase,” whitepapers, webinars, and case studies are ideal to help your leads identify a service for their issues. Free trials, demos, and rate charts are great for the “Decision phase,” when your leads want to make an informed buying choice.

Enhance your calls-to-action (CTA)

A call-to-action (CTA) is a message to motivate action with a clickable button, picture, or link that is created to get site visitors to take another step. To produce new sales for your Electronic Health Record software company, you should boost the quality of your CTAs. Make sure each one is “ above the fold ,” to ensure that site visitors see it without needing to scroll. Be clear of what your CTA is offering. If the offer is a free ebook, say “Download our free ebook on Electronic Health Record software 2019 Forecasts,” instead of simply “Download now.” The color of your CTA should contrast with the site’s color to make it draw focus. Any time you create a new blog post, include premium content and a call-to-action at the end. Insightful content like webinars, overviews, reports, and ebooks are effective.

Boost your site’s landing pages

The landing page is the page your lead lands on when they click the call-to-action. To make sure leads know they are on the right page and avoid confusion, you should make the heading of the landing page refer to the CTA. Keep the content on the landing page concise. Forms with just name and email address boxes are enough. Requesting too much information can stop or distract your potential customers. Quickly show the advantages of the offer with bullet points. You can also present a photo on the landing page. For instance, if the offer is an ebook, show a screenshot of its cover page. Remove navigation tabs from the landing page so visitors focus on the offer.

Develop ‘Thank You’ web pages

This page shows up after your potential customers give their information on the landing page. Beyond just saying “Thank you,” this page could be valuable in other ways. Share links to other content on your site to keep new clients involved. Link to your social media accounts and encourage your new clients to follow you.

Nurture your leads automatically

Getting email addresses is not enough. You should nurture your leads consistently until they convert to a customer. There are many email automation tools that could make it easy to complete a lead nurturing project. Send your customers helpful info at least once a week to keep them engaged. Don’t forget to link to relevant articles on your Electronic Health Record software website. Keep these emails as brief as possible. Use short paragraphs and bullet points to make them easy to read. Use eye-catching subjects to urge your readers to open the email and read the content. It should clearly tell what the client will get by reading the message. Stay away from boring or common subjects like “Newsletter #14” and try to customize whenever possible.

The last takeaway

Just as Electronic Health Record (EHR) software has evolved over the years, sales strategies need to evolve to keep up with the times. Many people will avoid traditional sales, but Inbound sales strategies will help your business not only bring in new site visitors, but will also develop new opportunities for sales.

We’ve helped many managers, founders, and CEOs include Inbound into their marketing and sales process. Don’t hesitate to schedule your free strategy session to help examine your methods and find new ways to get more sales for your Electronic Health Record (EHR) software firm!

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EHR Implementation Checklist: How to Successfully Adopt an Electronic Health Record System

• 10 min read
• Business ,   Healthcare
• 17 Aug, 2020
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• First, you need to assess where staff stands in terms of technical skills and mindset.
• Then, you move on to mapping out your current workflow .
• During planning , you put your ideas down on a roadmap.
• The fourth step is to select the appropriate EHR solution.
• Once it’s done, you get down to setting up the system and adjusting it to your processes.
• Next goes the implementation itself.
• Then, it's time to educate the staff about the EHR system.
• Finally, you can estimate the initial results, act on this data, and make necessary improvements.

Eight steps of the EHR Implementation Lifecycle

Step 1: Measure your EHR readiness

• leadership and management
• workflow and process improvement

Snippet of the Organizational Readiness Assessment

Step 2: Workflow analysis

• Document your current workflow by mapping out how patients move through your medical practice.
• Plan your future workflow with an EHR implemented

Office visit workflow mapped out, Source: National Learning Consortium (doc.)

Step 3: Create an EHR implementation roadmap

Step 4: Choose the right EHR product

Self-Hosting vs. SaaS, Source: Health IT

• charting capabilities
• prescriptions and lab results handling
• clinical decision support
• disease and population management
• health records management
• clinical tasks management
• communication within the practice
• patient access to their health data
• entailed finances
• public health reports submission.

Step 5: Tailor EHR to your business processes

Step 6: prepare for the launch, step 7: develop a training program, step 8: evaluate the quality of ehr implementation and make improvements.

• return on investment (ROI) metrics to assess the profitability of the implementation.
• actual numbers of transactions, if wide-scale usage is your priority, and
• turnaround time of orders statistics at various points after the system is fully operational.

Common barriers to EHR adoption

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Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

Chen hsi tsai.

1 Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; moc.kooltuo@iastishnehc (C.H.T.); [email protected] (A.E.); [email protected] (N.D.)

Aboozar Eghdam

Nadia davoody, graham wright.

2 Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; [email protected] (G.W.); [email protected] (S.F.)

Stephen Flowerday

Sabine koch.

Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.

1. Introduction

In the early 1990s, a trend in the shift from paper-based health records to electronic records started; this was in response to advances in technology as well as the advocacy of the Institute of Medicine in the United States [ 1 , 2 ]. As a result of the inadequacies of paper-based health records gradually becoming evident to the healthcare industry [ 3 ], electronic records have continued to be developed and envisioned with many expected benefits over the past 25 years.

Over those 25 years, the names and terms used to represent the concept of electronic records have changed frequently while the basic idea has remained the same [ 4 ]. Nowadays, the term “electronic health record” (EHR) is widely used for records adopted by clinicians [ 4 ]. This usage does not, however, comply with the way different types of electronic records have been defined by the International Organization for Standardization (ISO).

According to ISO/TR 14639-1:2012(en), an “electronic medical record” (EMR) is defined as an “electronic record of an individual in a physician’s office or clinic, which is typically in one setting and is provider-centric”, whereas an “electronic patient record” (EPR) is defined as an “electronic record of an individual in a hospital or health care facility, which is typically in one organization and is facility-centric” [ 5 ]. Given the previous two definitions, an electronic health record (EHR) is defined as follows:

“Information relevant to the wellness, health and healthcare of an individual, in computer-processable form and represented according to a standardized information model, or the longitudinal electronic record of an individual that contains or virtually interlines to data in multiple EMRs and EPRs, which is to be shared and/or interoperable across healthcare settings and is patient-centric.” [ 5 ]

Furthermore, a personal health record (PHR) is defined by ISO/TR 14292:2012(en) as

“…a representation of information regarding, or relevant to, the health, including wellness, development and welfare of that individual, which may be stand-alone or may integrate health information from multiple sources, and for which the individual, or the representative to whom the individual delegated his or her rights, manages and controls the PHR content and grants permissions for access by, and/or sharing with, other parties.” [ 6 ]

However, a continuum exists in many countries between the two strict views of the EHR and PHR on the one hand, regarding the entity that has control over the record and the content within it, and the tethered PHRs on the other. In the latter case, the patient is given access to the EHR by the care provider without the patient controlling it. This access function is often part of a patient portal.

Approximately 25 years after the emergence of EHRs, substantial progress has been made regarding EHR implementation, adoption and use [ 2 ]. Unfortunately, this has mostly been in an uncoordinated way rather than with a coordinated and logical approach. Many of the initial expectations regarding time efficiency, productivity, and increased quality of care have not been met or have only been partially realized, and “current EHRs still do not meet the needs of today’s rapidly changing healthcare environment” [ 2 ]. Data duplication is still a prevailing issue and solutions are still sought even though this was expected to be solved by the uptake of EHRs [ 7 , 8 , 9 ]. Only recently has there been any significant progress in the development of legal frameworks for patient privacy and confidentiality concerning EHR data [ 2 , 10 , 11 ]. Continuing progress on standards for EHR data has strengthened the capability of data exchange, the secondary use of data and decision support [ 2 , 12 ].

Despite the apparent progress in implementation methods and the use of EHRs, the realization of benefits still lags behind expectations. Great challenges for clinicians as end users of EHRs exist, which restricts their potential to facilitate both the work of clinicians and the improvement of patient care quality [ 13 ]. Whether the use of EHRs improves efficiency (i.e., “saves time”) for clinicians or not is still regarded as controversial [ 2 ]. While some believe that the adoption of EHRs has improved patient care, further work needs to be undertaken. In particular, identification of the complex mechanism behind the measurement of patient outcomes related to the implementation of EHRs is needed to reach a more concrete conclusion [ 14 ].

The aim of the study is, therefore, to review the existing literature and elicit current knowledge on the effects of EHR implementation and the barriers to EHR adoption and use.

2. Materials and Methods

In line with Peters et al. [ 15 ], a scoping review of the literature without assessing the quality of the included studies was conducted.

2.1. Study Retrieval

Searches were conducted in PubMed, Web of Science, IEEE Xplore, and ACM Digital Library. A comprehensive search strategy was developed where search terms were combined and used in two different sets (set 1: electronic health record, EHR, personal health record, PHR, and patient record; and care pathways, workflow, work routines, workload, and work process; set 2: electronic health record, EHR, personal health record, PHR, and patient record; and efficiency, advantages, disadvantages, satisfaction, teamwork, collaboration, benefits, and challenges) when retrieving the studies. See Table 1 for electronic search strategy.

Search strategy and the retrieved number of studies from PubMed, Web of Science, IEEE, and ACM for the two data sets.

In total, 8114 studies were identified of which 473 were duplicates that were removed, resulting in 7641 unique and potentially relevant studies.

2.2. Study Selection

The titles and abstracts of the 7641 studies were manually screened against the inclusion and exclusion criteria. Inclusion criteria were review articles, conference papers and original articles published in English between January 2005 and May 2020, focusing on the barriers to and effects of implementing EHRs or tethered PHRs. Individual studies that were also included in a literature review were not removed. Studies reporting on the effects of implementing tethered PHRs were included as we considered them to be part of EHRs. Exclusion criteria included studies related to secondary use of EHRs, data mining of EHRs, methods for evaluating EHR implementation, and EHR-integrated applications/software/tools. Subsequently, 7403 studies were excluded based on these criteria. This left 238 articles, which were read in full by four researchers (A.E., C.H.T., G.W., and S.K.). Two additional researchers (S.F. and S.K.) were called in for a discussion on the disagreements when comparing the assessments of eligibility. Finally, consensus was reached among all researchers on the inclusion of 141 articles in the final analysis of this scoping review ( Figure 1 ). Full-text articles were excluded with reasons, including meeting the exclusion criteria; investigating partial components of EHRs (e.g., e-prescription and decision support); focusing on system development models/methods, strategic/design recommendations, design prototypes, and usability principles; reporting speculations about success factors, prevalence of use, user group characteristics and differences, workflows, and processes of implementation.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the study selection process.

2.3. Data Analysis

The full-text pdf files of the 141 studies were imported into NVivo 12. Using the tool, both qualitative and quantitative studies and their results were analyzed qualitatively by adopting a thematic analysis approach [ 16 ]. G.W. initially read all the articles, coded/annotated them qualitatively and identified potential themes/categories. C.H.T. performed the same steps independently and then re-read all the articles, reviewed the extracted codes and compared the potential themes/categories created by the two researchers to identify recurrent themes/categories. The final themes/categories were defined clearly for further analysis and reporting of the results after reviewing by S.F. and S.K.

The majority of the 141 studies were published between 2017 and 2019. The USA was the country of origin for 81 studies and European countries for six studies. Questionnaire/survey (n = 63), interview (n = 33), observation (n = 16) and time-motion observation (n = 7) were some of the common methods used. Study participants were mainly physicians followed by registered nurses/nurse practitioners ( Table 2 ).

General characteristics of the selected studies.

The three main themes identified were positive effects, negative effects, and barriers, as shown in Table 3 . In the following paragraphs, the identified categories are used as headings to present the combined positive and negative effects and the barriers.

Main themes, categories and sub-categories identified through the analysis of the studies.

3.1. Effects of EHR Implementation

Both positive and negative effects related to the work of healthcare providers/staff, data and information, care of patients, and economic impact were identified in the studies, as shown in Figure 2 .

Mind map showing positive (+) and negative (−) effects of electronic health record (EHR) implementation.

3.1.1. Work for Healthcare Providers/Staff

Improved efficiency following EHR implementation was suggested, with clinicians finding frequently used EHR functions useful for improving work efficiency [ 48 ]. Perceived general efficiency gains in workflow [ 27 ] and in laboratory turnaround time [ 29 ] were found, with these time-consuming tasks related to paper-based records being no longer required [ 29 , 41 , 44 ]. One study showed that EHR adoption did not significantly change the amount of time specialist physicians spent with each patient [ 21 ]. Another time-motion observation study showed a great reduction in time spent on administrative tasks for nurses following EHR implementation [ 22 ]. Clinicians and staff also mentioned improved efficiency through the quick retrieval of information in EHRs [ 20 , 28 , 42 , 43 , 44 , 45 ] and a reduction in documentation time [ 18 , 34 , 49 , 59 ] by, for example, using EHR templates [ 34 ]. The use of templates in EHRs was mentioned as being beneficial [ 45 ] and saved time on documentation [ 34 ]. An observational study, combining data analysis of EHR usage, suggested that clinicians completed their notes sooner post-EHR implementation (mean hours to completion 10–24 h) compared to the pre-EHR period (600–1200 h) [ 50 ]. In one study [ 25 ], interesting downward trends were found in the proportion of clinicians agreeing that EHRs resulted in longer patient visits, from 68% at month 1 post-EHR to 51% at month 12 post-EHR ( p = 0.001). Another study reported overall positive perceptions of nurses towards EHRs in perceived use, system quality, and satisfaction [ 124 ].

Inefficiency following the implementation of EHRs was mentioned. Extensive use of EHRs in all aspects of the care process resulted in providers spending more time using EHRs during work shifts [ 20 , 28 ]. Providers perceived that retrieving and locating necessary information in EHRs was difficult [ 148 ] and took longer than expected, which also had a negative impact on their efficiency [ 34 , 40 , 45 ]. Clinicians expressed concerns and frustration regarding the slowness of systems [ 91 , 96 , 113 ] and the time-consuming nature of patient documentation using EHRs [ 23 , 34 , 38 , 40 , 43 , 44 , 58 , 145 , 154 ], with 81.8% of the respondents (physicians) in a survey agreeing that “to document on paper is faster than on the EHR” [ 39 ]. Another survey showed that 71% of the respondents (physicians) perceived an increase in time spent on patient documentation following the implementation of EHRs [ 17 ]. Two time-motion studies suggested similar findings, with the results indicating that nurses spent a significantly increased amount of time ( p < 0.05) and percentage of time ( p = 0.002) on documentation after EHR implementation [ 22 , 97 ]. Two other studies found that significantly more physicians reported poor or marginal sufficiency of time for documentation in settings with EHRs (46.4%, as compared to 13.6% in non-EHRs setting, p < 0.001) [ 83 ] and 32.8% of nurses reported an insufficient amount of time for documentation [ 110 ]. A systematic literature review concluded that compared with settings without EHR, the overall proportion of staff time spent on documentation was higher for clinicians in the presence of an EHR; for nurses in particular, the difference was statistically significant [ 117 ]. A significant decrease in efficiency (i.e., increased surgical case turnover time) that persisted for five months was shown after the implementation of EHRs [ 132 ]. Considering the usability and functionality perspectives of EHRs, failing to include key functionalities that support the workflow of the entire care team, such as the exchange of laboratory results and medication lists and tools for chronic disease management and preventive care, led to extra steps in the workflow and reduced efficiency [ 29 , 40 , 44 ]. Other design (usability) features of EHRs, including the lack of templates and the ability to reuse existing records, as well as poorly designed interfaces, also negatively affected work efficiency in two studies [ 43 , 44 ]. One study reported no notable improvements in physicians’ ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicated the existence of serious problems and deficiencies which considerably hindered the efficiency of EHR use [ 136 ].

Communication

Studies suggested improvement in communication among clinicians and healthcare teams following EHR implementation. In four studies, physicians perceived improved communication as a benefit after EHR implementation [ 17 , 27 , 34 , 43 ]. In a longitudinal survey [ 25 ], the proportion of clinicians that agreed that communication had improved among clinicians increased from 72% to 93% ( p < 0.001) over time (month 1 to month 12) following EHR implementation. It was reported that instant messaging in EHRs and the increased access to patient information through EHRs, enhanced communication within the healthcare team [ 44 , 45 , 56 ]. Moreover, clinicians created “huddle sheets”, listing patients’ scheduled activities and issues using EHRs [ 56 ], or utilized functions in EHRs such as patient problem lists, to-do lists, and task assignments [ 38 ] as communication tools for the healthcare team. In a study conducted in homecare settings, clinicians reported being satisfied with team communication following EHR implementation both in the survey and in interview sessions [ 50 ]. Respondents (clinicians) interviewed in the same study [ 50 ] claimed that communication using the EHR was similar to face-to-face communication. Another study set in residential aged care settings found that respondents (nurses and aged care staff) expressed that EHR adoption facilitated communication with healthcare providers from other organizations and among staff members within the organization [ 42 ].

However, the decreased frequency of direct communication among healthcare professionals was a common complaint [ 34 , 48 ]. Clinicians were concerned that this would distance physicians from nurses or would even diminish the opportunity for care professionals to share relevant information face to face [ 34 ]. In one study, comments made in the follow-up interview conducted 11 months after EHR implementation revealed dissatisfaction with team communication [ 40 ]. Moreover, misconceptions of communication were observed when providers had spent time carefully documenting patient information in EHRs and had thought that the information would be communicated, only later realizing that the information had not been read by colleagues [ 47 ]. Another study suggested that current EHRs do not adequately support teamwork among oncology providers [ 120 ]. Mixed effects were reported in one study as nurses’ and physicians’ experiences on EHR appeared to vary by EHR brand and employment sector [ 155 ].

Clinicians and staff perceived decreased workloads, as the adoption of EHRs improved communication as well as the availability and accessibility of medical records [ 44 ]. In a study measuring clinicians’ mental workload during a trial period of EHR use, the results showed significant differences for five of the six National Aeronautics and Space Administration-Task Load Index (NASA-TLX) subscales during healthcare team conferences and for all six NASA-TLX subscales during ward rounds. The differences were in favor of the use of EHRs over paper-based records [ 26 ].

Poor integration of workflows involving different care professionals and poor connectivity with other healthcare organizations in EHRs could result in an increased workload for providers [ 29 , 44 , 141 ]. Double/multiple documentation in different systems or double-checks for multiple resources were required to ensure that the information was correct, communicated and/or exchanged [ 44 , 96 , 113 , 148 ]. Primary care physicians spent more than one-half of their workday, nearly six hours, interacting with EHRs during and after clinic hours [ 152 ]. Resource constraints, such as having limited access to EHRs or not having enough user licenses for EHRs, could also lead to clinicians having to carry out extra work such as double documenting patient information [ 44 ]. In one study, new work related to the introduction of EHRs and work or workarounds addressing EHR-related errors and limitations exacerbated the work burden for clinicians following EHR implementation [ 29 ]. Clinicians also considered additional education, training and learning related to the newly implemented EHRs as extra workload for them [ 38 , 45 , 112 ]. Weak findings were indicated in [ 135 ], as only 17% of participants agreed with the impact of increased workload post-EHR implementation, despite the majority anticipating a negative impact on workload pre-implementation. Colligan et al. assessed changes in cognitive workload during the transition to adopting a commercial EHR, with the results suggesting that the difference in average scores of the cognitive workload (NASA-TLX) for participating pediatric nurses was highly significant ( p < 0.001) over time [ 54 ]. Compared to the average score at baseline, which was measured before the implementation of the EHR, the average scores collected at both the first and the fifth shifts after the launch and use of EHR had increased by 15% [ 54 ]. Another study found that the attending and resident physicians’ total TLX score was significantly correlated with the screen item (EHR interface design), meaning that higher ratings on the screen were associated with higher mental workload [ 108 ]. Frustration levels associated with EHRs were significantly higher for attending physicians compared with residents in the emergency department [ 108 ]. Negative effects of EHRs on work life balance/physician burnout were reported [ 127 ]. Another study suggested that 69.8% of physicians with EHRs reported EHR-related stress and the prevalence of burnout symptoms among these physicians was significantly higher (27.2%, as compared to 13.6% for those without EHRs, p < 0.001) [ 83 ]. In addition, 19.8% of nurses in another study reported at least one symptom of burnout [ 110 ]. Alert workload was reported to be related to two of the three dimensions of burnout, including physical fatigue ( p = 0.02) and cognitive weariness ( p = 0.04) [ 139 ].

Work Organization/Workflow

The increased organization of work after EHR implementation was raised by clinicians and staff [ 20 , 28 , 38 , 91 ]. The use of EHRs allowed nurses and aged care staff to rely less on memory or written notes, to check which tasks had been done and which should be carried out, and to develop better care plans [ 20 , 28 , 42 , 56 ]. Moreover, clinicians and staff perceived that EHRs facilitated better task delegation among them and clarified team roles for non-physicians [ 56 ]. A majority of nurses perceived that EHRs helped them in planning their work [ 119 ].

However, altered workflow emerged as a negative effect [ 91 , 112 , 113 , 115 ] related to some of the issues mentioned above, such as poor integration of current workflows in EHRs, poor cross-organizational connectivity in EHRs and communication ambiguity [ 29 , 44 , 47 ]. Nurses reported the difference in workflow in line with how PHR communication was handled in the same clinic [ 141 ]. Clinicians complained that the workflow was disrupted since they had to wait for patients to be triaged and assigned to physicians in EHRs or for physicians to input information in EHRs before they could complete their tasks, which resulted in patient flow being impeded [ 45 , 148 ]. Nurses needed to mentally integrate information in order to support clinical workflow [ 114 ]. Difficulty in following the new workflow after EHR implementation was raised by clinicians and other staff [ 46 ]. Furthermore, a mismatch between workflow and EHR functionality was observed because redesigning workflows both to support new EHR functions and to create new EHR functions to meet practice needs under current workflows were reported to be difficult [ 38 ]. Gaps between EHR design and the functionality needed in the complex inpatient environment resulted in a lack of standardized workflows [ 89 ].

Support Disease and Quality Management

It has been suggested that the implementation of EHRs supports disease and quality management. In one study, 80% of the interviewed physicians perceived the systematic storage of information in EHRs, which supports disease management, as a positive effect [ 43 ]. In another study, customized functions of EHRs were reported to enable more thorough and efficient disease management in chronic and preventive care at one participating primary care facility [ 44 ]. The support of quality management after EHR implementation was mentioned in studies conducted in primary care and residential aged care settings. One reason for this was the ability to collect/extract clinical indicators and monitor the work performance of staff members using EHRs [ 38 , 42 ]. Implementation of an asthma care pathway based on the EHR reduced variability in practice and ensured adherence to high-quality national guidelines [ 151 ].

Support Learning and Decision-Making

The support of peer learning following EHR implementation was reported by staff and managers in residential aged care settings [ 42 ]. One study suggested that physicians reported positive effects of EHRs in terms of providing access to up-to-date knowledge [ 27 ]. This was supported by studies which showed that a majority of respondents (clinicians) agreed on the benefits of EHRs related to the support of learning and decision-making [ 49 , 99 ]. A review study concluded that EHRs had potential in supporting shared decision-making during clinicians’ clinical work [ 105 ].

3.1.2. Data and Information

Accessibility.

Improved access to patient information and records was reported as a benefit following EHR/PHR implementation [ 17 , 34 , 37 , 45 , 48 , 56 , 65 , 69 , 75 , 90 , 91 , 99 , 101 , 128 , 147 , 150 , 153 ]. Nurses perceived that increased accessibility enhanced their job performance [ 20 , 28 ]. Timely access to information [ 119 ], including laboratory results, radiology images and medication history were mentioned as supporting and speeding up care processes [ 20 , 28 , 32 , 43 ]. Moreover, increased accessibility by allowing simultaneous access to patient records was mentioned as a benefit of adopting EHRs [ 20 , 28 , 42 , 44 ]. Still, in one study, the proportion of clinicians who agreed that EHRs improved access to clinical information remained stable (between 92 and 95%) from month 1 to month 12 post-EHR implementation [ 25 ].

However, increased accessibility was reported in studies conducted at other primary care and residential aged care facilities [ 38 , 42 ]. One study found that the majority of responding physicians (81%) reported improved remote access to patient records [ 46 ]. Interestingly, another study also mentioned that the increased accessibility, which allowed physicians to work outside of clinics, could be considered another benefit following EHR implementation [ 17 ]. However, accessibility could be impaired, as physicians suggested that limited information was retrievable in EHRs [ 43 ]. This was reported in a follow-up interview conducted post-EHR implementation in a study showing that clinicians had trouble locating and accessing information as a result of data silos [ 40 ]. Clinicians’ perception of ease of access to patient information decreased after switching to a commercial EHR (from 80.18 to 64.13%, p < 0.01) [ 106 ]. A cross-sectional questionnaire survey showed that the respondents (physicians) disagreed that it was easy to access previous notes (34.7%) or patient medication lists (32.7%) and considered it difficult to check lab results (79.2%) [ 39 ].

Data Quality and Accuracy

Improved data accuracy was suggested following the implementation of EHRs [ 30 , 38 , 48 , 67 , 119 , 147 ], with positive perceptions of EHRs enabling the capture of detailed data and improved documentation quality being reported [ 48 ]. A survey of nurses found that 87.2% of the respondents perceived that EHRs helped improve documentation [ 57 ]. Another study of nurses and aged care staff reported similar findings with 44% of interview respondents perceiving an improved quality of nursing documentation in both the format and content of records [ 42 ]. Process-related and structural elements of nursing documentation in EHRs were better than paper-based records [ 123 ]. Furthermore, in another study documentation was found to be significantly more likely ( p < 0.01) to comply with guidelines post-EHR implementation than pre-EHR implementation [ 50 ]. Patient-generated data in PHR was mentioned as being highly valued and as contributing to more accurate data [ 51 ].

In another survey, dissatisfaction with the completeness and correctness of data was expressed by clinicians [ 40 ]. However, the number of comments addressing dissatisfaction with data completeness and correctness decreased by half from time one (11 months post-EHR implementation) to time two (17 months post-EHR) in follow-up interview sessions [ 40 ]. Data overflow was reported to be an issue resulting from free text fields in EHRs [ 48 ]. The quantity and quality of the contents of nursing documentation were found to be better in paper-based records than in EHRs in a study [ 122 ]. Mixed perceptions were suggested in [ 91 ] as physicians raised issues related to both incomplete records and the comprehensiveness of data and information.

Data Storage and Backup

EHRs allowing the systematic storage of data and information were mentioned by 80% of the interview respondents (physicians) in one study [ 43 ]. In another study, participants (nurses and aged care staff) reported the convenience of data storage, as digital records in EHRs were stored on servers with backup [ 42 ]. As far as the characteristics related to the benefits of better data storage offered by EHRs/PHRs were concerned, the participants believed that data would be less likely to be lost [ 150 ], would not deteriorate over time, would prevent unauthorized edits, and would minimize physical storage space [ 42 , 43 , 67 ].

3.1.3. Care for Patients

Quality of care.

Enhanced quality of care following EHR/PHR adoption was suggested [ 17 , 24 , 27 , 43 , 45 , 46 , 49 , 57 , 64 , 67 , 75 , 84 , 85 , 107 , 111 , 112 , 115 , 128 , 131 , 133 , 135 , 146 , 150 , 153 ]. A randomized trial suggested a significantly lower prevalence in all-cause 30-day readmissions in patients who adopted PHR as compared to non-adopters [ 88 ]. Another study found that patients’ preventive health behaviors were significantly associated with PHR use [ 80 ]. Adoption of a comprehensive EHR was found to be associated with higher quality of care [ 76 ]. In addition, the adoption of EHRs in local health departments had a positive impact on the overall health outcomes of population health ( p = 0.031) [ 63 ]. Being able to respond quickly to care needs, provide person-centered care and carry out better follow-up care with the use of EHRs were mentioned in association with the improvement of care quality [ 42 ]. One study showed that the proportion of clinicians who agreed that EHRs improved quality of care increased significantly ( p < 0.001) from 63% at month 1 post-EHR implementation to 86% at month 12 post-EHR implementation [ 25 ].

Improved patient safety following EHR/PHR implementation was also mentioned [ 24 , 28 , 47 , 48 , 86 , 91 , 99 ]. Compared to EHRs with multiple vendors, a basic self-developed or single-vendor EHR was associated with a significant decrease of 19.2% in the rates of patient safety events [ 119 ]. Specific EHR features such as alerts, reminders and minimum required data entries were reported to help clinicians notice critical laboratory values, prevent errors and improve patient safety [ 28 , 46 , 48 ]. The timely use of EHRs to read patient histories was suggested as being important to ensure patient safety [ 47 ]. One study showed that physicians reported positive effects of EHRs on preventing medication-related errors [ 27 ]. In another study, similar results were found, with a significant increase in the proportion of clinicians who agreed that EHRs reduced the medication-related errors observed during the 12 months following EHR implementation (from 72 to 81%, p = 0.03) [ 25 ]. Yet another study investigated the impact of EHRs from the perspective of patients and found that more than one-third of the survey respondents (patients) agreed or somewhat agreed that EHRs contributed to improved medical safety [ 19 ]. However, one study compared PHR-adopting patients and non-adopters and suggested no significant effect on patient safety measures [ 121 ]. Moreover, continuity of care was raised as a related aspect [ 33 , 47 ]. A study involving nurses showed that they positively rated (from 1.66 to 2.56 out of 5) survey items examining continuity of care with the use of EHRs [ 33 ]. Additionally, clinicians and staff perceived that they had more time to spend with patients following EHR implementation [ 42 ]. Another study demonstrated that following the implementation of EHRs nurses were able to spend more time caring for and interacting with patients as the time devoted to direct patient care increased significantly ( p < 0.05) by 6% [ 22 ]. Significant increased time spent on patient related interventions (e.g., providing emotional support, explaining patient conditions to patient and family, and coordinating patient care) was observed [ 97 ]. Similar findings were indicated in another study where the time resident physicians spent on direct patient care increased significantly ( p < 0.001) from 31% pre-EHR implementation to 44% post-EHR implementation [ 53 ]. Interestingly, positive quality effects associated with the US’s Meaningful Use stage 1 and stage 2 achievement were indicated, whereas no significant quality effect from EHR adoption alone was suggested [ 72 ]. Another study showed that EHR use was associated with a better process of care measure performance, but did not improve condition-specific readmission or mortality rates [ 62 ]. A neutral impact of EHRs on the patient care process and quality was suggested in [ 79 ], as neither the number nor the severity of incidents affecting patients/patient care increased post-EHR implementation and disruptions in the patient care process initially increased but stabilized to the baseline level (pre-EHR) after six months. A literature review investigated the effects of EHRs on advance directives, written statements of end-of-life quality care preferences which can help enable a good death, and concluded that EHRs could potentially support advanced directive documentation but might also create further difficulties [ 74 ].

However, patients’ concerns about impersonal care activities such as information entry in EHRs were noticed by physicians [ 38 ]. A common perception of some clinicians was that the time spent with patients and on direct patient care activities decreased as a result of the use of EHRs [ 20 , 28 , 34 ]. Additionally, other nurses perceived that because of the loss of personalization, quality of care decreased following an EHR implementation [ 28 ]. One study pointed out that the measurement of the quality indicator for access to and the timely provision of influenza vaccine was shown to be worse in nursing homes with EHRs than in such settings without EHRs [ 149 ]. Nurses reported that patient misuse of PHR for reporting medical emergencies posed potential risks for patient safety [ 141 ]. Use of copy and paste related to EHRs was suggested to put patient safety at risk [ 125 ]. Another study showed that medication errors (medication safety reports) increased five-fold after the implementation of a new EHR system in pediatric units [ 94 ]. A comparison of outcomes showed EHR downtime-exposed patients, compared with non-exposed patients, had a significant increase in the duration of operating room time (1.10 times longer, CI 1.08–1.12, p < 0.001) and postoperative length of stay (1.04 times longer, CI 1.01–1.08, p < 0.007) [ 81 ].

Better communication between patients and providers was reported as a benefit following the implementation of EHRs/PHRs [ 32 , 34 , 38 , 42 , 44 , 69 , 86 , 87 , 102 , 134 , 146 , 147 , 153 ]. Physicians recognized the value of being able to share patient-centered information with patients using EHRs [ 34 , 143 ], while clinicians perceived that new communication channels such as messaging through EHRs should improve communication between patients and providers [ 45 ]. Clinicians perceived that PHRs could support the clarification of information for patients [ 64 ]. In addition, 72% of patients in a study believed PHRs would strengthen the provider patient relationship [ 132 ]. In yet another study, patient interview data suggested that EHRs had no negative impact on physician patient communication [ 90 ]. A mixed impact for EHRs on the physician-patient relationship and communication was also found, as physicians and patients perceived these differently [ 84 ].

However, reduced face-to-face/direct communication and less eye contact between patients and physicians were also noted during their clinical consultations, as physicians were preoccupied with entering information in EHRs [ 43 , 45 ]. Clinicians perceived that patients’ satisfaction might be negatively affected by the use of EHRs, owing to their preoccupation with typing and looking at the screen, as well as having computers positioned between patients and clinicians [ 45 ]. In a study investigating the impact of changing from a longstanding homegrown EHR to a vendor EHR, a significant decrease in the number of participating physicians who agreed that EHR does not interfere with the ability to have face-to-face contact with patients was observed and this trend persisted for 25 months after the implementation of the vendor EHR [ 137 ].

Patient Empowerment

Patients’ access to full or partial medical records increased with the adoption of PHRs integrated with EHRs [ 51 ]. Patients reported greater empowerment [ 153 ] and expressed that in being given access to their medical records, they felt more like partners with healthcare providers [ 32 ] and in control of their care [ 65 ]. Moreover, a more collaborative relationship between patients and physicians was reported following the EHR implementation when physicians and patients viewed information in records and made healthcare decisions together [ 37 , 45 ]. Clinicians also mentioned that PHR could give patients opportunities to quality control documented information [ 64 ].

Change in Time Spent

One study reported a decrease in waiting time for patients as a benefit of EHRs [ 19 ], with a trend of shorter waiting times being observed among hospitals that had implemented EHRs for a longer period [ 19 ]. Another study suggested changes in patient time spent on different activities, but no significant difference was found between patient groups in EHR settings and those in paper-based record settings [ 156 ].

3.1.4. Economic Impact

Productivity.

Better productivity was suggested after the implementation of EHRs [ 48 , 85 , 142 ]. One study showed increased productivity related to the completion of documents—from 12.38 completed notes per fulltime equivalent contribution pre-EHR implementation to 127.06 completed notes per full-time equivalent contribution post-EHR implementation [ 50 ]. Another study found that the average number of task occurrences per hour for resident physicians increased significantly from 117 to 154 ( p < 0.01; i.e., from 1.95 to 2.56 activities per minute) following an EHR implementation [ 53 ]. Concerning productivity in surgical inpatient units, a significant positive impact of EHR use on operating room utilization and bed occupancy rates was reported [ 130 ].

However, decreased productivity was also reported [ 27 , 38 , 48 ]. Negative perceptions of EHR productivity outcomes and effect on practice costs were indicated by physicians [ 104 ]. One study showed a reduction in long-term practice productivity post-EHR implementation across all specialities in the ambulatory practice context [ 55 ], while another found that the average number of task occurrences per hour for attending physicians decreased significantly from 138 to 106 ( p < 0.01; i.e., from 2.30 to 1.76 activities per minute) following an EHR implementation [ 53 ].

Decreased Cost

Decreased costs or economic savings after EHR adoption were reported in several areas such as administrative costs, documentation costs and nursing costs [ 30 ]. One study showed a significant decrease in the monthly costs of transcription (a decline of 74.6%; p < 0.001) and the monthly consumption of copy paper (a decline of 26.6%; p < 0.001) post-EHR implementation compared to pre-EHR implementation [ 36 ]. Another study showed that both citizens and physicians (58.1% and 62.5%, respectively) agreed, and both perceived the reduced cost of healthcare as a positive effect of EHRs [ 112 ].

Increased Revenue and Reimbursement

One study reported increased revenues and reimbursements after the implementation of EHRs [ 55 ]. It also argued that being paid more for seeing fewer patients could be suggested as a type of efficiency by the study findings despite the observed productivity losses of the study [ 55 ].

3.2. Barriers to Adoption and Use

Some barriers to EHR adoption and use were identified in the studies as shown in Figure 3 .

Mind map of barriers to EHR adoption and use.

3.2.1. Support for End Users

Poor and insufficient training and lack of technical/educational support for users were suggested as barriers to the adoption/use of EHRs and PHRs [ 27 , 32 , 45 , 48 , 52 , 58 , 66 , 93 , 98 , 100 , 107 , 128 , 129 , 138 , 140 , 157 ]. Clinicians and staff considered the lack of knowledge on EHR functions to be one of the challenges faced when using EHRs [ 38 , 43 ]. The paucity of user involvement during the planning, development, and implementation phases of the system life cycle of EHRs and PHRs was also mentioned [ 32 , 40 , 48 , 51 , 66 , 98 , 138 , 140 ]. Users’ literacy, as well as skills in technology and computing, which include skills in typing [ 43 , 44 ] and use of the internet [ 32 ], were reported to affect EHR and PHR adoption/use [ 27 , 31 , 32 , 43 , 44 , 58 , 66 , 77 , 98 , 100 , 107 , 138 , 140 ].

3.2.2. EHR/PHR System

Complaints concerning poor interoperability and integration between systems were found; these issues hindered both the implementation [ 48 , 61 , 93 , 98 ] and the adoption/use of EHRs and PHRs [ 44 , 47 , 51 , 56 , 134 ]. Clinicians’ resistance [ 86 , 93 , 123 , 140 ] and lack of trust in EHRs/PHRs [ 66 , 92 , 98 , 114 ] regarding issues related to data privacy and the risk of data loss, which were key challenges to fully exploiting EHRs [ 43 ], were suggested. This was highlighted in a study which showed that the survey respondents (clinicians and staff) perceived a lack of trust in the reliability of EHRs and a lack of belief in their value for patient care to be barriers to EHR implementation (mean score 3.47 out of 5 and 4.46 out of 5) [ 58 ]. Other issues regarding EHR systems such as system quality [ 61 , 100 ], system compatibility [ 138 ], system inefficiency (slow response) [ 43 , 48 ], system failures [ 38 , 39 ], server crashes [ 38 ], and difficulties in finding EHRs that meet needs [ 128 ] were mentioned as concerns. Functionality issues concerning EHRs included both too many complex functions [ 38 ] and too few needed functions [ 40 , 45 ] and were reported as barriers to their use. Usability [ 32 ] such as the design of user interface [ 29 , 32 , 138 ] and navigation [ 48 ] were agreed to be critical features. One study showed that the survey respondents (clinicians) were dissatisfied with the usability of EHRs at both months 11 and 17 post-EHR implementation (mean score 2.1 and 2.4 out of 5) [ 40 ].

3.2.3. Data and Information

The privacy and security of data and information were raised as concerns by clinicians and patients for both EHRs and PHRs [ 27 , 32 , 35 , 98 , 100 , 112 , 129 , 138 , 140 , 150 ]. One-third of physicians in a study expressed their concern about the privacy of patient information in EHRs in cases of “illegal leakage” [ 43 ]. Regarding the use of PHRs, providers raised concerns about inappropriate and unauthorized access to the sensitive information, such as mental health information, they might contain [ 31 , 77 ]. It was also mentioned that patients/consumers were concerned about privacy, security and confidentiality issues related to the adoption of PHRs [ 32 , 48 ], while the quality of patient-generated data in PHRs was of concern to clinicians [ 31 , 35 ]. Concerns related to data and information in PHRs causing anxiety for patients if misinterpreted were reported [ 35 , 86 , 150 ]. Clinicians also maintained that it would be problematic if access to medical records in PHRs were to be provided to patients with psychiatric conditions [ 35 ].

3.2.4. Others

Resource constraints, including cost of system upgrades/maintenance [ 38 , 93 ], inadequate funding [ 27 , 48 , 93 ], time constraints [ 48 ], limited access to/number of computers [ 39 , 44 , 47 , 48 , 157 ], limited networks (internet) [ 44 , 47 ], plus an insufficient number of user licenses [ 44 ], were reported as barriers to the implementation and adoption of EHRs/PHRs [ 29 , 77 , 100 , 128 , 140 ]. Moreover, worries about the legal liability of medical records in EHRs/PHRs were raised [ 43 , 150 ]. Lack of administrative and policy support [ 98 , 140 ], as well as low awareness which may hinder the successful adoption and use of PHRs, were mentioned [ 32 , 107 , 129 , 140 ]. In one study, no major barrier was identified [ 95 ].

4. Discussion

The goal of this scoping review was to identify currently available evidence and present an overview of the effects of EHR implementation and the barriers to EHR adoption and use. Our results, which suggest mixed findings with a predominance of positive effects and some negative effects of EHR implementation, include improved efficiency, decreased efficiency, better communication, improved accessibility and enhanced quality of care as some of the identified major effects. This is in line with a recent review which mentioned that the findings of the early literature on EHR effects on care quality, communication, and information management were notably mixed [ 158 , 159 ]. Despite the overall positive findings, in more recent research, mixed results and unanticipated negative consequences (e.g., disrupted workflow) were still reported [ 158 ]. Another recent systematic review focusing on EHR impact in a specific context (i.e., long-term care facilities) also suggested mixed findings but with a predominance of positive outcomes [ 160 ].

Some of the barriers with high occurrence suggested in our results are resource constraints, poor/insufficient training and a lack of technical/educational support for users, as well as poor literacy and a lack of skills in technology. Most barriers identified in this study (e.g., training and technical support, literacy and skill in technology, trust and belief in EHRs, privacy, and resources/costs) are congruent with the findings suggested by recent systematic reviews [ 161 , 162 ]. Interestingly, we found that many of the negative effects and barriers seemed to be consistent over time. One such factor is the impact of EHR use on clinician burnout. Recent research suggests an association between EHR use and emotional exhaustion [ 163 ], as well as between poor EHR usability and experienced time pressure and stress [ 66 ]. Another observation was that the use of definitions of EHR varied from study to study and did not comply with definitions given by ISO/TR 14639-1:2012(en) and ISO/TR 14292:2012(en). This observation, in combination with a lack of contextual information related to the study settings and systems, may hamper any application of the findings. Ammenwerth [ 164 ] points out that incomplete contextual information in publications is related to the inadequate quality of health IT evaluation publications and could make it difficult to use and generalize the evidence. After all, it is within a specific study context that an author draws conclusions about an investigated system, and it is thus the contextual information that enables readers to interpret the findings.

Efforts to improve these deficiencies could be of great value to academia, industry and society. These should be addressed by encouraging researchers and editors of scientific journals to adhere to standardized definitions [ 5 , 6 ], to outline the quality requirements of investigated systems based on standards [ 4 ], to clearly describe the contextual information, and to follow standardized guidelines (e.g., Statement on reporting of evaluation studies in Health Informatics (STARE-HI)) [ 164 , 165 ] for conducting and reporting evaluation studies.

Limitations

This scoping review has some limitations. The fact that there is no consensus on the definition of EHR in the literature rendered the choice of search terms difficult. We could have used “electronic health record” and “personal health record” as MeSH terms (Medical Subject Headings), as they include other terms such as “electronic medical record” and “computerized medical record”. “Electronic patient record” would, however, not then have been included. As authors’ usage of MeSH terms is not stringent in all publications, we decided to look for terms in titles and abstracts instead, which resulted in more hits than using the corresponding MeSH terms. Nevertheless, the choice of search terms, with the omission of “electronic medical record”, as well as using “challenges” and “disadvantages” but omitting “barriers”, may have resulted in limited coverage of articles. Moreover, we included four different databases, which we considered to contain most publications from the medical and technical fields, resulting in the omission of other databases as well as gray literature.

Selection bias is a concern as the screening and selection process may be considered subjective. Multiple researchers’ opinions and consensus meetings were adopted in an attempt to control for this. The limited contextual information provided in the single studies and the variation in definitions of EHRs could have resulted in some relevant studies being overlooked or excluded. Moreover, the homogeneity of the origin countries of the studies (86 out of 141 from North America) and the missing contextual information made it difficult to ascertain whether there were any cultural differences and influence on the effects of an EHR implementation.

The fact that facilitators of implementation were not included in the review may be regarded a limitation, as this could help future implementation projects on how to facilitate the implementation work more than merely being aware of potential barriers.

An important limitation of the work is that a scoping review usually does not include a quality assessment of the included studies. We carried out a qualitative content analysis of the included studies to identify positive and negative effects of implementation as well as barriers to adoption without determining the quality of the individual studies. Results should therefore be considered with caution, even if we highlight effects with high occurrence in different studies, and the number of reviewed studies was relatively high. This is further impacted by the fact that individual studies that were also included in a literature review were not removed.

5. Conclusions

This review of the literature on the topic suggested mixed findings on the effects of EHR implementations and the ongoing barriers to EHR adoption and use. Although there appeared to be an increase in positive effects over time, some of the negative effects such as increased workload and dysfunctional workflows appeared to be stable. In addition to the fact that this review did not contain a quality analysis of the included papers, a lack of uniformity in the use of definitions of EHRs, and a lack of detailed contextual information concerning the study settings could be observed.

Researchers must follow the guidelines for the reporting of evaluation studies to enable others to compare results from different evaluation studies. This would also enable further measurement of the effects of the implementation of EHR systems and eHealth services in general.

Author Contributions

S.K. and N.D. designed the study. N.D. undertook the initial data collection and screened the titles of all potentially relevant studies. N.D. and A.E. screened the abstracts. A.E., C.H.T. and G.W. read the remaining full-text articles for eligibility, and S.F. and S.K. gave second opinions by reading all articles where A.E., C.H.T. and G.W. disagreed. C.H.T. and G.W. performed the initial data analysis independently of each other and S.K. and S.F. reviewed the results of the data analysis and discussed them with C.H.T. and G.W. C.H.T. drafted the first version of the manuscript and G.W., S.F. and S.K. contributed substantially to the writing of the manuscript. All authors have read and agreed to the published version of the manuscript.

This research was jointly funded by the Swedish Research Council for Health, Working Life and Welfare (Forte) (project no. 2016-07324) and the South African Medical Research Council (SAMRC).

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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• What is eCR?
• eCR in Action
• Healthcare Facilities Live for eCR
• Getting Started with eCR
• Electronic case reporting (eCR) is the automated, real-time exchange of case report information between electronic health records (EHRs) and public health agencies (PHAs).
• Healthcare organizations (HCOs), EHR vendors, public health partners and state, tribal, local, and territorial PHAs are all essential in implementing eCR.

CDC's eCR team, in coordination with the Association of Public Health Laboratories (APHL) and the Council of State and Territorial Epidemiologists (CSTE), provides support for eCR implementers. This page outlines the eCR implementation process for healthcare organizations, EHR vendors, and public health agencies.

For healthcare organizations

Step 1: prepare for ecr adoption.

These EHR/Health IT products are ready for general healthcare organization onboarding:

• Altera Sunrise
• athenahealth athenaOne (athenaClinicals and athenaHHS)
• Flatiron OncoEMR
• Medhost eCR 1.0
• Meditech Expanse
• Oracle Cerner Ambulatory
• Oracle Cerner Millennium
• Oracle Cerner CommunityWorks
• Premier Inc. TheraDoc
• Veradigm - Veradigm EHR
• If your HCO uses one of the EHR/Health IT products above, email your vendor to learn more about getting started with eCR.
• Work with the eCR team to connect with your PHA and register your intent for eCR (see Appendix IV – State and Local Public Health Readiness for Interoperability ).
• Partner with your EHR/Health IT vendor to discuss options for implementing eCR.
• Get final approval from your organization's leaders to implement eCR.

Step 2: Implement eCR

• When directed by your assigned eCR onboarding coordinator, follow the process here to begin implementation: eCR for Healthcare Providers .
• Work with your EHR/Health IT vendor to enable eCR functionality and conduct testing.
• Make sure that your policy path is in place for reporting to PHAs without violating HIPAA or any applicable state laws.
• Complete the eCR Provider Intake Form when directed to do so by your eCR onboarding coordinator.

For more information:‎

Step 3: go live.

• Work with your eCR onboarding coordinator, EHR/Health IT vendor, and PHA to ensure testing and data quality meet public health requirements.
• Send production messages.
• Maintain current manual case reporting processes alongside eCR until notified otherwise by the relevant PHAs for your organization.

Step 4: PHA validation

• Collaborate with your PHA(s) for production data validation and quality review.
• Discontinue manual reporting once your PHA(s) confirm you can do so.

For EHR vendors

Step 1: contact cdc.

• Email [email protected] to indicate you are interested in implementing eCR.

Step 2: Build capabilities and connect

• Build eCR capabilities or connect to the eCR Now FHIR® app (APHL).

Step 3: Test

• Test with a client HCO and make sure that eCR capabilities meet real-world testing standards.

Step 4: Offer eCR to other HCOs

• Contact HCOs that use your EHR products and help them implement eCR.

Public Health Agencies

Step 1: confirm completion of ecr prerequisites.

• Ensure you or an affiliated PHA have the appropriate laws or codes for reportable conditions in place for your jurisdiction's providers.
• Publish and maintain the list of reportable conditions where it can be accessed by healthcare organizations or providers, such as a public-facing website.
• Determine if you wish to receive eCR data directly or in collaboration with an affiliated PHA.
• Email [email protected] to connect with the CDC eCR PHA Support Team.

Step 2: Establish connectivity for eCR

• Establish a connection between you or an affiliated public health agency and AIMS, the APHL Informatics Messaging Services platform, to receive electronic case reports.
• Determine if another trusted entity will receive the data on behalf of your PHA and submit a letter of attestation as needed.

Step 3: Author in the Reportable Conditions Knowledge Management System (RCKMS)

• Enter your jurisdiction's reporting criteria for reportable conditions into the RCKMS. There are currently more than 200 conditions available for authoring.
• Update your reporting criteria during outbreaks or when new versions are available.

Step 4: Use electronic case reports

• Make data available to your public health agency epidemiologists.
• Process and use eCR data in your surveillance system(s) for public health investigation and action.
• Assess your surveillance system(s) and infrastructure, and update if needed.
• Request eCR Direct Support technical assistance with this form .

Step 5: Communicate with HCOs

• Engage with the eCR team and local HCOs and facilities to implement eCR. These can be any organizations that are required to carry out provider case reporting for reportable diseases and conditions, including large organizations, federally qualified health centers, or organizations that work with underserved populations.
• Contact [email protected] to request HCO engagement materials and get assistance with outreach.

eCR is the automated, real-time exchange of case report information between electronic health records and public health agencies.

U.S. Government Accountability Office

Electronic Health Records: DOD Has Deployed New System but Challenges Remain

DOD provides crucial health care services to millions of service members, retirees, and their families. DOD has been working to modernize how it handles patients' electronic health records and has deployed a new electronic records system to its health care facilities.

In 2022, DOD began conducting an annual survey of user satisfaction with this new system. User satisfaction rates have improved over the past 2 years, but these rates are still lower than the rates for DOD's old health records systems.

DOD hasn't established goals for improving user satisfaction with this new system. We recommended , among other things, that it do so.

What GAO Found

The Department of Defense (DOD) has deployed its new federal electronic health record (EHR) system, called MHS GENESIS, at military treatment facilities. The final system deployment took place in March 2024 at the Federal Health Care Center, a joint DOD and VA facility.

As of March 2024, DOD and VA reported that they had completed the 35 critical tasks and milestones required to implement the new system at the joint facility, but the departments have opportunities to further integrate their systems. Accordingly, DOD and VA began a process to resolve differences between their respective workflows and EHR configurations to increase integration. However, the process did not result in a fully integrated approach due to reasons such as legal and policy barriers. Until it addresses these barriers, DOD and VA will likely not meet the integration goal established for the Federal Health Care Center.

In 2022, DOD began conducting an annual survey of MHS GENESIS user satisfaction and worked with a contractor to analyze survey data. User satisfaction rates for DOD's new system have improved over the past 2 years. However, the user satisfaction rates for the new system were generally lower than the rates for users of DOD's legacy systems and for private-sector users of the commercial version of MHS GENESIS (see table).

User Satisfaction Results from DOD's 2023 Annual User Satisfaction Survey Compared to Results for DOD's Legacy Systems and Similar Private-Sector Systems

Source: GAO analysis of Department of Defense (DOD) information. │ GAO 24 106187

Note: DOD legacy system data come from 2022 survey results. Data for DOD's new electronic health record and for private-sector systems come from 2023 survey results.

Although user satisfaction levels are below those for its other relevant systems, DOD has not yet established satisfaction goals. Without goals for improving user satisfaction, the department will be limited in its ability to measure progress, plan for improvements, and ensure the system meets users' needs.

DOD's Program Executive Office has implemented an issue management plan to address key issues affecting MHS GENESIS. However, it has not been able to resolve problems with its dental module, called Dentrix. These problems, which began in 2018, continued to plague Dentrix through January 2024. This led to DOD elevating the issue to the severe level and deciding to identify Dentrix alternatives. However, DOD does not yet have a plan or schedule for identifying alternatives. Until the office resolves the Dentrix issue, the new federal EHR will not provide critical functionality to dentists who treat DOD beneficiaries.

Why GAO Did This Study

DOD's health care system is one of the largest in the nation, providing crucial services to millions of service members, retirees, and their family members. The department has taken major steps to modernize the EHR systems it uses to manage patient health information.

Federal law includes provisions for GAO to review DOD's EHR system modernization. This report examines (1) the progress DOD and VA have made toward implementing the federal electronic health record system at the Federal Health Care Center, (2) the extent to which DOD has identified user satisfaction with the system, and (3) the extent to which DOD has managed key issues affecting system implementation.

GAO analyzed agency documentation, such as implementation plans and results of user satisfaction surveys. GAO also reviewed program documentation on long-standing EHR-related issues, including issues with deploying the dental module. In addition, GAO observed monthly program management meetings where top program risks were discussed, interviewed department officials, and conducted a site visit to the Federal Health Care Center.

Recommendations

GAO is making four recommendations: one to DOD and one to VA to address integration barriers at the Federal Health Care Center, and two to DOD to establish user satisfaction targets and implement a plan to provide a dental module alternative. In written comments on a draft of this report, DOD and VA generally agreed with our recommendations.

Recommendations for Executive Action

Full report, gao contacts.

Carol C. Harris Director [email protected] (202) 512-4456

Office of Public Affairs

Chuck Young Managing Director [email protected] (202) 512-4800

Oracle's $28B Gamble On Cerner's AI-Driven Health Records System Backfires

Oracle Corporation (NYSE:ORCL) made a $28 billion bet on Cerner Corporation to revolutionize healthcare. However, the electronic health records system has been linked to patient deaths, leading to a massive liability for Oracle.

What Happened : In 2021, Oracle acquired Cerner, a major EHR provider, with the intention of integrating its vast medical data into Oracle’s AI models to create the EHR of the future, reported Business Insider on Monday.

However, Cerner’s EHR system, which was responsible for managing the electronic health records of a quarter of all American hospitals, including those run by the Pentagon and the Department of Veterans Affairs (VA), was found to be severely flawed. The system’s rollout at the VA, which serves 9 million veterans, was described as a “slow-moving catastrophe.”

One feature of the EHR system caused over 11,000 orders for medical care to disappear into an “unknown queue,” resulting in thousands of patients not receiving the treatment their doctors had ordered. These errors were contributing factors in three deaths.

See Also: Days After Facing Lawsuit For Drug Use, Musk Says He Would Take Cocaine If It Boosted ‘Long-Term Productivity’

Despite Ellison’s vision for a futuristic, AI-driven healthcare system, the acquisition of Cerner has become a significant liability for Oracle. The company is now racing against time to fix the dysfunctional system it inherited from Cerner before more veterans are injured or killed.

Why It Matters : Oracle’s acquisition of Cerner was intended to revolutionize healthcare by leveraging AI to improve patient outcomes and reduce costs. However, the flawed EHR system has led to a series of patient deaths, tarnishing Oracle’s ambitious plans.

Despite the setbacks, Oracle’s AI ambitions have not been entirely derailed. The company is reportedly in talks with Elon Musk ‘s artificial intelligence startup, xAI, for a potential $10 billion deal to rent Oracle’s AI servers. This deal, if finalized, would make xAI one of Oracle’s largest customers.

The healthcare industry is increasingly turning to AI to streamline administrative tasks, optimize treatment plans, and enable more precise diagnostics. The global AI in healthcare market is expected to reach $148.4 billion by 2029 , presenting a significant opportunity for AI companies like Oracle to drive innovation and transformation in the sector.

Read Next: 10 Simple Weight Loss Tips To Consider Before Taking That Ozempic Pill

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Australian government investigating 'large-scale ransomware' data breach of script provider MediSecure

The ABC can confirm e-script provider MediSecure is the health organisation at the centre of the large-scale ransomware data breach announced by the national cyber security coordinator on Thursday.

MediSecure's website has been pulled, and the company has posted a statement saying it has identified a cyber security incident impacting "the personal and health information of individuals".

A MediSecure spokesperson said it was too early to respond to detailed questions about the nature and extent of the incident but added that "a lot of investigation work is being conducted". 

The company is a prescription exchange service, which facilitates electronic prescribing and dispensing of prescriptions.

In a statement, the company said it has "taken immediate steps to mitigate any potential impact on our systems", and believed the incident originated from a third-party vendor.

"MediSecure takes its legal and ethical obligations seriously and appreciates this information will be of concern," it said.

"MediSecure is actively assisting the Australian Digital Health Agency and the national cyber security coordinator to manage the impacts of the incident."

MediSecure was one of two companies awarded contracts by the federal government to provide PBS e-script services until late last year, when the tender was granted exclusively to another company, eRx.

In October last year, the ACCC granted authorisation for MediSecure to transfer all publicly- funded electronic prescriptions and data to eRx.

MediSecure said at the time it would remain in the market providing private prescriptions. It's unclear what data has been compromised and over what time period.

Earlier, national cyber security coordinator Michelle McGuinness was unable to share what company had been affected.

"I am working with agencies across the Australian government, states and territories to coordinate a whole-of-government response to this incident," Lieutenant-General McGuinness said in a statement on social media platform X.

"We are in the very preliminary stages of our response and there is limited detail to share at this stage, but I will continue to provide updates as we progress while working closely with the affected commercial organisation to address the impacts caused by the incident."

The organisation is also working with the Australian Federal Police.

Cyber Security Minister Clare O'Neil says she was briefed on the breach, and the government had convened a national coordination mechanism.

"Updates will be provided in due course," she said on social media platform X.

"Speculation at this stage risks undermining significant work underway to support the company's response."

Australian Medical Association president Steve Robson said the organisation is seeking urgent briefings on the incident.

"There needs to be a thorough and transparent investigation, backed by clear and consistent communication to the public and profession," Professor Robson said.

"These are critical to maintaining community trust in the electronic systems that are now integral to the functioning of our health system."

In October 2022, Medibank revealed hackers accessed the personal data of all customers across its Medibank, ahm and OSHC brands, affecting millions of Australians.

• X (formerly Twitter)

Related Stories

Firstmac customer data including driver's license numbers and banking details exposed in cyber attack.

Medibank says nearly 10 million current and former customers affected by data breach

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