Electronic health records systems are increasingly sophisticated, but still a work in progress

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The kindly physician scrawling notes inside a paper folder with your name on it evokes an image from a simpler time.

The “kindly” part may be alive and well, but paper and pen are being replaced by keyboards and clicks.

Electronic health records, or EHRs, have rolled out in force over the last several years. Hundreds of companies offer software, and government has provided incentives and mandates for medical offices to modernize. Many patients are logging on to perform tasks that once took a phone call or visit: requesting appointments and prescription refills, for instance, or viewing lab results with user-friendly features such as graphs of past data and red flags signaling follow-up.

In a sense, EHRs — instead of bulging paper files — are a no-brainer in this technological era. They allow the many facets of patient-care information to be centralized, stored and shared among professionals as needed.

Though still evolving, EHRs offer a long list of positives. Government and industry are pushing toward a “universal” system, meaning a patient could walk into just about any health care facility in the country with their health history virtually following them. Their data — complete and up to date — could be accessed rapidly by caregivers, who would contribute their findings and actions to the record.

But achieving that ideal while keeping data secure and accurate is a complicated undertaking, and it must be done correctly.

“Currently, there is not a single, 'universal' EHR and there are multiple EHR options available to hospitals, physician practices and health systems,” said Tim Tarnowski, senior vice president and chief information officer at UMass Memorial Medical Center in Worcester.

“Given the variety of EHRs that are available, interoperability among the various EHR products continues to be challenging,” he said in an email response to a question from the WBJ.

Still, Tarnowski said, interoperability has made much progress in recent years. “For example, health information exchanges (HIE) have emerged as a means to securely share patient data among health-care providers. Also, the various EHR vendors offer interoperability capabilities and work continues to evolve in this space,” he said.

HIEs are vehicles through which health-related information is shared electronically using nationally recognized standards. They must, for instance, comply with the patient-privacy provisions in HIPAA, the federal Health Insurance Portability and Accountability Act.

As described at HealthIT.gov — a website maintained by the U.S. Department of Health and Human Services (HHS) — there are three types of HIEs: directed, query-based and consumer mediated. A directed exchange involves encrypted communication between providers involved in a patient's ongoing care. A query-based exchange is provided on request, such as for unplanned or emergency care. A consumer-mediated HIE refers to patient-controlled management and flow of health information.

In the quest for system interoperability, the software industry is on the case.

“Data needs to be portable so that the difference in systems does not matter and, as an industry, we are getting there,” said Heather Caouette, spokeswoman for eClinicalWorks. The Westborough-based company is one of the nation's largest providers of EHR technology, counting Tufts Medical Center and its physician network among its clients.

“At many doctor's offices, various points of data are already coming into the EHR from several sources, including from insurance companies, discharge summaries from emergency rooms, laboratories and referrals with different practices,” she said. “We support standards that will further move the industry towards true interoperability.”

Caouette noted that EHR systems' expectations have changed vastly over the last decade, “making it difficult to say definitively if EHR technology is where we want to be. … We are continuously innovating.” Already, she said, “EHRs are more than a way to digitize records.,” including features that aid clinical-decision support, analytics, and tools to boost patient engagement.

In recent years, medical organizations large and small have faced three crucial questions on switching from paper to EHRs: whether, when and which one. Hundreds of companies offer EHR-related products.

UMass Memorial Health Care, the largest health-care system in Central Massachusetts, has a variety of EHRs for its various care settings, Tarnowski said, and a task force is eyeing two finalist vendors for the future: Cerner, of Waltham, and Wisconsin-based Epic. Once the choice is made, UMHCC will implement the new system gradually, aiming for a seamless transition of some 40,000 patients.

With the 2009 passage of the HITECH Act — Health Information Technology for Economic and Clinical Health — which provides incentives to deploy EHRs, installations of such systems have accelerated in hospitals, physician practices and health systems, Tarnowski said.

A 2013 HHS report showed a steady rise in EHR adoption, with nearly three-quarters of office-based physicians having a system in 2012. Hospital adoption rates were higher.

Many in Central Massachusetts and around the U.S. are working to ensure the prognosis is good. EHRs are here to stay, and the more technologically sophisticated and universal they become, the more routine they'll seem.