Electronic health records: research into design and implementation.

The whole point of electronic health records (EHRs) is to improve patient care and increase the efficiency of primary care practice. It has long been recognised that these goals are often not realised.1 Not all clinicians are enthusiastic adaptors of technology in the consulting room2 and there are differences between the US and the UK, both in utilisation and in national goals (Box 1). This reluctance may be because there are serious concerns about its impact on care.3,4 | US19 | UK20 | |:-------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------- | | • Over 50% of patients' demographic data recorded as structured data | • Already 100% | | | | • Over 80% of patients have at least one medication entry recorded as structured data | • Near 100% for all patients who have received a prescription of any kind | | | | • Over 40% of prescriptions are transmitted electronically using certified electronic-health-record technology | • Not standard or a planned target | | | | • One clinical decision support rule implemented | • Not standard or a planned target | | | | • Over 10% of patients are provided patient-specific education resources | • Not standard or a planned target | Box 1 US–UK computer utilisation and national goals To guide research which will be directed at improving the situation we need to be sure that the right issues and contexts are being addressed and that the best conceptual frameworks are being used. To date, EHR development and implementation been based on less helpful conceptual frameworks and assumptions.5 There are many potential areas of investigation where research is needed and we mention three for consideration: For the past 30 years the widespread adoption of EHRs was considered inevitable as predicted by the diffusion of innovation theory. The …