US Institute Publishes Core Capabilities for EHRs

In a new report the independent Institute of Medicine (IOM), part of the US National Academies, has published a set of eight core functions that electronic health records (EHRs) should be able to offer.

The IOM report, ‘Key Capabilities of an Electronic Health Record System’, is intended to provide a basic ‘functional model’ for an EHR to promote greater safety, quality and efficiency in healthcare, by building a common understanding about what the key functions of EHR software should be.

The report was sponsored by the US Department of Health and Human Services, which asked the IOM committee behind the report to focus on ‘care delivery functions’, rather than infrastructure functions and healthcare data standards. The IOM says it will publish a full report on data standards this autumn.

According to the IOM report publication of the eight core standards and ‘functional model’ will help healthcare organisations to compare systems currently available and enable vendors build systems that meet care providers’ expectations.

The core functions identified in ‘Key Capabilities’ focus on health information; test result reporting; order communications; clinical decision support; electronic communications and connectivity; tools to support patient self-care; streamline administrative processes and improved reporting on quality and patient safety.

According to the committee behind the report the eight core functions were selected on the basis of their ability to improve patient safety, support effective care, assist in the management of chronic disease, and improve efficiency

The IOM says that the ‘Key Capabilities’ report will encourage the adoption of computer-based health records in the US. They will be used by Health Level Seven (HL7), a leading developer of health care standards, to devise a common industry standard for EHRs that can guide software developers.

"Improving patient safety starts with fundamental changes in information technology systems that support care," said committee chair Paul Tang, chief medical information officer, Palo Alto Medical Foundation, California.

He added: "Electronic health records that allow care providers to gather, store, and use health information more efficiently could increase the effectiveness of care and greatly reduce errors and costs."

As well as identifying core capabilities the report considers the timeframe in which it should be feasible to implement each capability. The report predicts that by 2010, comprehensive EHR systems will be available and implemented in many health systems and regions.

The IOM report notes that development of EHRs will be evolutionary: “It is recognised that the EHR systems will be built incrementally, utilising clinical information systems and decision support tools as the building blocks of an EHR.”

The eight core capabilities identified as critical to EHRs are:

• Health information and data. Having immediate access to key information – such as patients’ diagnoses, allergies, lab test results, and medications.


• Result management. The ability for all providers participating in the care of a patient in different settings to quickly access new and past test results.


• Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system in order to enhance legibility, reduce duplication, and improve the speed with which orders are executed.


• Decision support. Using reminders, prompts, and alerts, computerised decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, including identifying possible drug interactions.


• Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients to improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.


• Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home-monitoring and self-testing can improve control of chronic conditions, such as diabetes.


• Administrative processes. Computerised administrative tools, such as scheduling systems, to improve hospitals’ and clinics’ efficiency and provide more timely services to patients.


• Reporting. Electronic data storage that employs uniform data standards will enable health care organisations to respond more quickly to reporting requirements, including those that support patient safety and disease surveillance.