• List common barriers to implementing an EHR.
• List common benefits of implementing an EHR.
• Identify the steps involved in selecting an EHR.
• Identify the steps involved in implementing an EHR into a clinical practice.

Ron Greer , MD
Assistant Medical Director
North Mississippi Medical Clinics, Inc.

Katie Crenshaw, JD, MSEd
Assistant Director
UAB Division of CME
Birmingham, AL

Trudi Horton, PhD
Program Manager
UAB Division of CME
Birmingham, AL

Jeroan J. Allison, MD
Assistant Dean and Director
UAB Division of CME
Birmingham, AL

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The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Electronic health record (EHR) is a term used to describe a system of storing an individual patient’s medical information in a digital format over a longitudinal period of time. A similar term that is also used to describe individual medical records in digital format is the electronic medical record (EMR). While EHRs in some format or another have been in existence for over thirty years, integration of an EHR system into primary care practice and hospital systems has been slow to occur.

• As of 2005, research funded by the Agency for Healthcare Research and Quality (AHRQ) indicated that only 14.1% of the medical group practices who participated in the study used an EHR. Results from this study differed based on the size of the practice, with small practices being less likely to report using an EHR system than larger practices.[1]
• Results from a 2007 random survey of 4,000 active American Academy of Family Physicians (AAFP) members indicate that 37% of the respondents had a fully implemented EHR system and 13% were currently involved in implementing a system into their practice. Those physicians who reported having a functional EHR system were more likely to practice in an urban setting, to not own their practice, to have been in practice for seven or fewer years, and to practice in a setting with at least two other physicians.[2]
• It is estimated that approximately 20% of practices in the state of Alabama currently have an EHR system in place.
• In regard to electronic prescribing, a recent report indicated that 2% of all eligible new and renewal prescriptions were routed electronically during 2007. While the 2% appears insignificant, the number of prescriptions that were routed electronically during the first three quarters of 2007 was greater than those routed electronically during 2004, 2005, and 2006 combined.[3]

Reasons for the slow implementation of EHR systems and electronic prescribing are many, including significant up-front or front-end costs; perceptions of a significant amount of time and energy required to transition one’s practice from paper to electronic records; lack of computer hardware, software, and Internet capability; lack of evidence that implementation of an EHR system will result in positive outcomes; etc.