Electronic health records (EHRs) have traveled on quite a journey since their inception in the 1960s. Powered by the advancement of modern technology, they no longer exist simply on stand-alone terminals – EHRs are now mobile, enabled by mobile broadband, smart phones, and tablets. In recent years, EHR adoption has increased quickly, spurred in part by the federal Meaningful Use Incentive program, bringing promise of vast improvements in healthcare quality, patient safety, workplace efficiencies, and patient empowerment.

Despite this progress, basic EHR functionality remains largely unchanged since 1982, slowing the evolution and integration of new technologies and capabilities, which remain paramount to transforming the healthcare system.

[Commentary: Inside meaningful use stage 2 NPRMs: A difficult balance.]

Recently, the California HealthCare Foundation (CHCF) sought to understand the next-generation EHR landscape and promises for the future. On behalf of CHCF, Booz Allen Hamilton conducted interviews with an array of industry experts across multiple disciplines – from providers to payors and informatics experts.

To understand the current and future environment, we started by examining the history of EHRs. From research and interviews, we found several issues that had contributed to slowing the evolution of EHRs:

1. Initial Focus on Coding, Billing, and Documentation: Vendors designed EHRs originally to ensure payment. Many had few incentives to enable EHRs to improve the quality and efficiency of care. Most cite this initial focus as a significant roadblock for true EHR innovation.
2. Complexity of Healthcare: It is challenging for EHRs to facilitate clinical decision-making while remaining user-friendly for physicians.
3. Limited Focus on Information Exchange: The majority of EHRs operate on closed networks that do not easily connect with other systems. Vendors have few incentives to open up these closed systems, but a freer flow of information and data can have a powerful effect on care coordination and delivery.
4. Fee-For-Service Payment Structures: EHRs operate within the confines of the current system, where coding structures and patient visit volume still determine payment.
5. Prohibitive Costs: EHR implementation remains financially out of reach for some providers, especially small practices that tend to operate on slim margins.

The Meaningful Use Incentive program, however, initiated as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, has created a "tipping point" for EHR adoption, by lowering the financial barriers and raising the bar on expectations for functionality to support high quality care. Providers are now less likely to wonder why they should implement an EHR, and are more likely to consider how they will adopt this technology in the next few years.

Challenges remain – usability, implementation costs, and interoperability – but consensus shows EHRs are poised for significant change. The Patient Protection and Affordable Care Act (ACA) signaled a shift toward delivery models – patient-centered medical homes (PCMHs) and Accountable Care Organizations (ACOs) – that reward quality of care, not volume. Additionally, new investments in integrated analytics for clinical data, health information exchange (HIE), and patient communication technologies will help deliver the next-generation EHRs.

These next-generation EHRs hold enormous promise, playing a large role in helping to provide high quality, low-cost care. While experts might disagree on which forces – government versus private, free market – should drive EHR development, four themes emerged on the future of EHRs in the next few years:

1. Further integration with mobile technologies;
2. Greater affordability and personalization for providers;
3. More accessibility and interoperability with other systems; and
4. Greater emphasis on patient centeredness to encourage patient engagement in care decisions and communication with providers.

Experts will continue to debate current policies and programs to spur EHR innovation and adoption, and the proper role and responsibilities for government and private industry. However, our research showed consensus that EHRs are poised for significant change in the coming decade, as technology evolves and the healthcare system reforms. We agree – the more effective use of EHRs has the potential to transform every aspect of healthcare in the United States.

The full report, titled “What's Ahead for EHRs: Experts Weigh In,” is available on the California Healthcare Foundation's Web site.