The neatly organized digital records that have become integral to healthcare in the 21st century had to start somewhere.
Like the transition from bulky desktop computers to the smartphones that now fit in our pockets, the data-driven electronic health record (EHR) systems in use today arose from decades of evolution. So when and how was the concept of the EHR actually first conceived?
|1960s||Early electronic medical record systems like COSTAR emerge|
|1970s||Health informatics field develops, focus on using IT in healthcare|
|1980s||Standards develop for coding medical data electronically|
|1991||IOM publishes The Computer-Based Patient Record report|
|1996||HIPAA provides privacy and security rules for health data|
|2004||President Bush calls for EHR adoption, sets goal of 2014|
|2009||HITECH Act incentives and penalties spur EHR adoption|
The origins of digitized medical data can be traced back to the 1960s and 1970s. While computers were still in their infancy, some visionaries saw the potential for using them to store patient information and make healthcare more efficient.
At Massachusetts General Hospital in the mid-1960s, Dr. Octo Barnett was one of the pioneers who imagined bringing electronics into medicine. He helped develop COSTAR (Computer Stored Ambulatory Record), one of the first systems to electronically collect and store clinical patient data.
Other basic hospital information systems for tracking admissions, discharges, billing and inventory also emerged in the 1960s and 70s. However, these solutions were generally department-specific and not connected. Meanwhile, the field of health informatics was just starting to take shape by the 1970s, examining how computer science could be applied to medicine and healthcare administration. Initial health IT systems were being experimented with, but widespread adoption was still a distant vision.
In the 1980s, the drive to harness electronics and digital data for improving medical care continued. More hospitals implemented basic information systems for functions like laboratory tests, pharmacy orders and scheduling. The tools remained departmentalized, but interest was growing in connecting clinical data across a hospital or clinic.
The American College of Physicians published recommendations in 1984 that called for adoption of computer-based patient record systems. While the technology was still emerging, the goals were similar to today’s EHRs – improving availability of records, controlling costs, and enhancing patient care.
In the 1990s, attention moved towards standards for health data coding and transmission. This introduced the idea of interoperability – allowing electronic patient records to be shared and accessed across different healthcare providers.
Around this time, problem lists, clinical notes, test results and other patient data began to be stored digitally. More advanced hospital information systems emerged to integrate various clinical, financial and administrative functions. However, interoperability across organizations was still minimal.
A series of pivotal reports from the Institute of Medicine (IOM) provided a catalyst for EHRs as we know them today.
In 1991, the IOM advocated computerizing patient records in “The Computer-Based Patient Record: An Essential Technology for Healthcare.” This influential report highlighted the inefficiencies of paper records and outlined a vision for digital records and interconnected clinical information systems.
The IOM followed up in 1997 with a broader examination of the potential for information technology to improve healthcare delivery in its report “The Computer-Based Patient Record: An Essential Technology for Healthcare, Revised Edition.” This further detailed how EHR systems could enhance access, reliability, accuracy and security compared to paper records.
The 1997 report noted barriers to widespread EHR adoption including costs, lack of standards, and physician resistance. But it ambitiously set goals for electronic records with clinical decision support to become standard practice by the 2010s. While this timeline proved optimistic, the IOM reports spearheaded a growing consensus that computerized records were the future of healthcare documentation.
The push to digitize health records raised valid concerns around privacy and security of patient data. The Health Insurance Portability and Accountability Act (HIPAA), passed in 1996, was crucial in establishing protections for electronic medical data.
The HIPAA Security Rule set national standards for securing health information, including required physical, network and process security measures. The HIPAA Privacy Rule established standards for accessing and disclosing protected patient information. These safeguards were essential for enabling broader EHR adoption and exchange of health data.
While interest in EHR systems was expanding by the early 2000s, prototypes for actually exchanging data regionally were also beginning to emerge. This took the form of regional health information organizations (RHIOs) that brought together healthcare stakeholders within a specific area to share resources.
RHIOs began demonstrating community-wide health information exchange on a trial basis, although comprehensive nationwide exchange remained complex and distant.
Santa Barbara County Care Data Exchange in California was one pioneering effort starting in 1998. Other regional exchanges and common health record projects for linking EHRs followed.
By the 2000s, the technical infrastructure and national will for transitioning to EHR systems was coming together.
Health policy experts were increasingly touting the cost savings and quality benefits of health IT. Large technology vendors began investing in robust commercial EHR products tailored for clinical settings that could support advanced use cases.
Epic Systems Corporation launched its EHR platform in the late 1990s and became a leader in the space. Other major players like Cerner, Allscripts, eClinicalWorks and NextGen also gained prominence in the 2000s EHR market. At the same time, open source EHR systems like VistA and Tolven EMR offered different models for health data systems.
Still, by the mid-2000s, less than one-quarter of U.S. hospitals had adopted EHR systems, and only a small percentage of physician practices had done so. The technology was spreading but not yet standard. This set the stage for an explosion in EHR adoption spurred by Federal legislation in the coming years.
A pivotal moment came with the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, part of the broader U.S. economic stimulus package. This introduced Medicare and Medicaid financial incentives for healthcare providers who adopted and meaningfully used certified EHR systems.
The criteria required EHRs to have patient record and data capabilities like e-prescribing, lab integration, clinical summaries and security. At the same time, penalties were slated to rise for providers without EHR adoption. This combination of carrots and sticks led to a rapid upswing in EHR implementation through the 2010s. By 2015, over 80% of hospitals had adopted an EHR system, along with over half of physician practices.
The development of EHR systems over decades has led to the robust health IT infrastructure we have today. However, optimizing interoperability, usability, and ethical data use remains a priority.
As EHR technology continues advancing, comprehensive practice management tools like Calysta EMR offer an integrated solution for modern healthcare facilities. Calysta combines seamless operations, secure patient data, and flexible growth in a single cloud-based platform designed for aesthetic medicine.
From managing patient records to coordinating suppliers and communicating with clients, Calysta can help streamline it all in one HIPAA-compliant system. It's the one-stop solution aestheticians and medspas need to run smoothly as their practice grows and evolves.