History of Electronic Health

Records
(EHR)
TIMELINE:

Mid 1960's Late 1960s 1972 1982

1965 Early 1970s Early 1980s

Late 1980s 1994 1996 1999 2002

Early 1990s 1995 1997 Early 2000s

2004 2007 2009 2011

2006 2008 2010 Mid-2011

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

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

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Late 1960s: “Problem-Oriented Medical
Record” Introduced
 Physician Larry Weed introduces the idea of
recording patient information electronically, aiming to
generate a record that would allow a third party to
independently verify the diagnosis.
 Prior to this, a doctor only recorded his diagnoses
and the treatment provided.

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Early 1970s: VistA Initiated to Manage
Veterans' Health Data
 The predecessor to today's Agency
for Healthcare Research and Quality
(AHRQ) initiates the concept behind
Veterans Health Information Systems
and Technology Architecture (VistA).
 This marks the start of heavy
government investments in VisTA and clinical IT.

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1972: First Electronic Medical Records
System Developed
 The Regenstreif Institute develops the first
electronic medical record system.
 Although the technology is widely regarded as a
major advancement for medical practices, it does not
attract many physicians.

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Early 1980s: VA Health Information
Software Declared Public
 The VistA information system is
legally declared available for
unrestricted use within the public
or private sectors.
 This open-source collaboration
marks the evolution of VA health
software. Major hospitals in other countries adopt
and modify VistA and its information-driven care
model
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TIMELINE
1982: Dragon Systems Pioneers Voice
Dictation Software
 Early voice recognition prototype
evolves into Dragon Dictation,
used today by more than 150,000
doctors and caregivers.
 Its wide adoption illustrates that one early key to
success in healthcare IT was a design built around
doctors’ existing processes.

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Late 1980s: Emergence of Low-Cost PCs
Spurs Wide Adoption
 Lower costs of personal computers
(PCs) make it an affordable way to
automate core health care functions.
Windows-based software emerge
soon thereafter. Doctors follow the
trend and buy PCs for their offices.
 While EHRs weren’t widely adopted yet, practice
management functions (billing and scheduling)
started to move to computers.
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Early 1990s: Emergence of the World
Wide Web
 After Tim Berners-Lee established the World Wide
Web in 1990, new developments in browser
interfaces – such as Microsoft Explorer and
Netscape Navigator – make it faster and easier to
access information online.
 People begin to access health information online and
the stage is set for web-based EHRs.

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1994: Clinitec Sells Software to Convert
Paper Records to EHRs
 Two years after its birth the company
is bought by Quality Systems, Inc., a
dental software company, which
soon merges with Micromed, which
provides front- and back-office practice
management software.
 In 2001, Clinitec and Micromed combine to form
NextGen Healthcare Information Systems, which
becomes
NextGen Healthcare. BACK TO
TIMELINE
1995: Eclypsis Corporation Founded
 The company provides hospitals and other
healthcare organizations with EMR, computerized
physician order entry, and revenue cycle
management software.
 In 2008, the company acquires physician practice
management software company MediNotes.
 Eclypsis merged with Allscripts in August 2010.

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1996: Health Insurance Portability and
Accountability Act
 All software used to manage health
insurance claims must follow HIPAA’s
new regulations on health record use,
disclosure and confidentiality.
 Software developers accurately
predict one consequence of HIPAA will
be a shift to electronic health record (EHR),
which can greatly aid providers in complying with
confidentiality laws.
NEXT
Veterans Health Administration
Mandates Use of EHRs
 The largest integrated health care
system in the United States, VHA,
mandates use of EHRs throughout all
facilities. VHA quality of care shows
significant improvement in the wake of
these changes.
 Later research indicates VHA care is
better than that administered by Medicare,
the government social insurance program
administered BACK TO
TIMELINE
to Americans 65 and older.
1997: Allscripts Begins Focusing on
Healthcare IT
 The company a year later launches
an electronic prescribing solution for
physicians, then acquires a series of
ambulatory electronic medical record
companies.
 By 2011 the product is used by over
180,000 physicians. Allscripts is now
arguably the largest EHR vendor.

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

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Early 2000s: Emergence of Web-based
Software
 Salesforce.com and other web-based companies
emerge, proving that the software-as-a-service
(SaaS) model is viable.
 EHR vendors begin to offer remotely-hosted options,
and new purely web-based vendors start to enter the
market.

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2002: GE Acquires MedicaLogic and
Millbrook
 The acquired solutions are later
re-branded Centricity with two
applications, Centricity EMR and
Centricity Physician Office.
 Building on the momentum and
experience of MediaLogic and Millbrook,
Centricity eventually emerges as the brand
of 31 healthcare IT solutions that form part
of GE Healthcare, a division of General
Electric valued at $17 billion today. BACK TO
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2004: President George W. Bush
Promotes Adoption of EHRs
 Demonstrating his commitment to healthcare
information technology, the President doubles
funding for health care IT demonstration projects to
$100 million, creates a new sub-Cabinet position of
National Health Information Coordinator, and calls
for widespread adoption of EHRs by 2014, referring
specifically to standards for electronically
transmitting X-rays, lab results and electronic
prescriptions. EHRs gain momentum.

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2006: CCHIT Certifies Electronic Health
Records Systems
 Certification Commission for
Health Information Technology
(CCHIT), a nonprofit aiming to
accelerate adoption of secure and
interoperable health IT, begins certifying
electronic health records systems to help providers
choose quality products. Controversy emerges later
over
CCHIT’s close ties to the board of trustees of
Healthcare BACK TO
Information and Management Systems Society TIMELINE

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

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2008: Idea of Personal Health Record
Reemerges
 Growth in the Internet drives the idea of the
personal health record (PHR), a record where an
individual curates his/her own health data online or
via an electronic device.
 With the development of web technologies, the
possibility of storing, exporting, and sharing patient-
reported data makes sense. Google and Microsoft
release PHR solutions.

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2009: HITECH Act Passes
 Health Information Technology for
Economic and Clinical Health
(HITECH) Act passes as part of
President Obama’s American Recovery
and Reinvestment Act (ARRA) of 2009
stimulus package.
 ARRA encourages the switch to electronic
records by providing Medicaid rebates of up to
$63,750 and Medicare rebates of up to $44,000.
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2010: Apple’s iPad Spurs Widespread Use
of Tablet Computers
 The iPad ushers in the reemergence of the tablet
era to build on the features of the earlier Tablet PC.
Experts predict Gen Y and Z’ers will be eager to
engage with personal medical records in part
because of the high-tech, interactive format.
 Physicians start to demand the same simplicity and
convenience in the workplace that they enjoy at
home with their iPads.

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2011: ONC-ATCB Certification Program
Created
 The Office of the National
Coordinator of the HITECH Act
creates a certification program in
response to the need for clarity on
what EHRs are capable of meeting
meaningful use criteria during the first
phase, or Stage 1, of adopting EHRs.
Specifically, the ONC announces which
that 6 certification bodies, including CCHIT,
are approved to verify meaningful use. BACK TO
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Mid-2011: HHS Proposes Accountable
Care
 To help providers better coordinate
care across settings for Medicare patients,
new regulations propose creating
Accountable Care Organizations. ACOs
that help reduce healthcare costs and
meet performance standards would be rewarded.
 This represents a shift away from fee-for-service
model toward a focus on prevention – with the HER
playing a key role in capturing patient data for sharing
within an ACO. NEXT
THE FUTURE: Connectivity Key to
Future of Healthcare
 With the rapid evolution of technology, healthcare
providers will continue to look to software and
devices to connect to patients and other providers.
This will likely include greater connectivity and
collaboration among providers, payers and other
healthcare participants.
 More expansive use of social networking, and
improvements in home-based health monitoring
using mobile technology are expected.

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