Electronic patient records are not a panacea

Dec 14, 2009

Large-scale electronic patient record (EPR) programmes promise much but sometimes deliver little, according to a new study by UCL researchers that reviewed findings from hundreds of previous studies from all over the world.

The major literature review, published today in the US journal Milbank Quarterly, identifies fundamental and often overlooked tensions in the design and implementation of EPR programmes. The findings have implications for President Obama's election promise of "a computerized medical record for every American within five years", and for other large-scale EPR programmes around the world.

First author Professor Trish Greenhalgh of UCL's Department of Open Learning said: "EPRs are often depicted as the cornerstone of a modern health service. According to many policy documents and political speeches, they will make healthcare better, safer, cheaper and more integrated. Implementing them will make lost records, duplication of effort, mistaken identity and drug administration errors a thing of the past.

"Yet clinicians and managers the world over struggle to implement EPR systems. Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of EPR projects fail - and the larger the project, the more likely it is to fail. This comprehensive review suggests that the EPR is a complex technology introduced into a complex system - and that only a small proportion of the research to date has been capable of addressing these complexities.

"Our results provide no simple solutions to the problem of failed EPR projects, nor do they support an anti-technology policy of returning to paper. Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world."

Key findings of the new review include:


  • While secondary work like audit and billing may be made more efficient by EPRs, primary clinical work can be made less efficient;
  • Paper, far from being technologically obsolete, can offer greater flexibility for many aspects of clinical work than the types of electronic record currently available;
  • Smaller, more local EPR systems appear to be more efficient and effective than larger ones in many situations and settings;
  • Seamless integration between different EPR systems is unlikely ever to happen, as human input will probably always be required to re-contextualise information for different uses.
Co-author Dr Henry Potts from UCL's Centre for Health Informatics and Multiprofessional Education (CHIME), added: "There has been considerable prior debate in the media and among academics about the benefits and hazards of EPR systems. We believe the next generation of research should focus on how human imagination, flexibility and collaboration can work with electronic systems and help overcome their inherent limitations, thereby allowing us to realise the full potential of EPR systems.

"In the US, the debate over these issues is just beginning and it's important that worldwide pay attention to the problems and issues we raise in order to avoid costly mistakes."

The research was sponsored by the Medical Research Council, the UK Department of Health and the UK NIHR Service Delivery and Organisation programme The full text of the paper is available for downloading free of charge at Milbank.org.

Source: University College London (news : web)

Explore further: Allergan to cut 1,500 employees in restructuring (Update)

add to favorites email to friend print save as pdf

Related Stories

Researchers extend Einstein's work

Dec 20, 2005

A University of Queensland research team has celebrated the end of the Einstein International Year of Physics by developing a ground-breaking theory based on work originated by the great scientist.

Protect your vote -- avoid election machine errors

Nov 03, 2008

Of all the conceivable problems that could lead to a miscount Election Day, there's one possibility that voters can do something about – avoid making election machine-related errors, says a University of ...

Wanted: 40,000 more health IT professionals

Apr 17, 2008

If the U.S. healthcare system moves toward wider adoption of advanced information technology systems to control health care costs, reduce medical errors and improve patient care, it will need at least 40,000 additional health ...

Recommended for you

British Lords hold ten-hour debate on assisted dying

Jul 19, 2014

Members of Britain's unelected House of Lords spent almost ten hours on Friday discussing whether to legalise assisted dying, in an often emotional debate putting the question back on the agenda, if not on the statute books.

AbbVie, Shire agree on $55B combination

Jul 18, 2014

The drugmaker AbbVie has reached a deal worth roughly $55 billion to combine with British counterpart Shire and become the latest U.S. company to seek an overseas haven from tax rates back home.

Safety problems at US germ labs acknowledged

Jul 16, 2014

(AP)—The director of the U.S. Centers for Disease Control and Prevention acknowledged Wednesday that systemic safety problems have for years plagued federal public health laboratories that handle dangerous ...

User comments : 0