Notes on Engineering Health, March 2021

A Short History of the EMR

In the late 1960’s, the idea to record patient information in electronic form rather than on paper emerged. The goal of the first EMR, presented by Lawrence “Larry” Weed, was to allow a third party to independently verify a diagnosis in order to improve patient outcomes. The first EMR was developed in 1972 by the Regenstrief Institute and was welcomed as a major advancement in healthcare / medical practice.

Due to the high cost and scarce presence of computers, the adoption of the EMR was slow. It was still common in the early oughts to have someone run down to the records room and dig through hundreds of thousands of paper files to find a patient’s previous record—if the patient even had one—upon an admission. Logistically burdensome, prone to transcription errors, and incredibly inefficient, the paper-based system was kept in place until shockingly recently.

The first step to modernize medical records was to digitize them. In 2004, President George W. Bush signed an executive order designed to oversee the development of health information technology infrastructure that included adopting EMRs. In 2016, the government began an EMR implementation incentive program that offered benefits to providers that utilize these systems. The program’s success is undeniable. In a 2020 survey of national electronic health records, 89% of physicians reported using an EHR or EMR system. It is worth noting the difference between Electronic Medical Record (EMR) and Electronic Health Record (EHR). While the former is the digital version of the paper charts the clinicians used to work with, the EHR is a more comprehensive record of the patients’ health, going beyond standard clinical data collected by health providers. 

The fast adoption of EMRs and EHRs by health systems did not come without challenges. It was accelerated when hospitals came to see the clear economic advantage of the electronic records. Indeed, EMRs were often implemented more as a billing tool useful to administrators than a solution to improve care for MDs and patients. As a consequence, in a 2020 survey of physicians by Deloitte, only 10% said they would leave their current EHR system unchanged. As far as EHRs are concerned, different studies have resulted in different findings, but one thing is fairly consistent: physicians hate them. Doctors resent the time spent on their computer entering data and keeping them away from interacting with and caring for their patients. 

Both the promises and the challenges of the EHRs have created a myriad of opportunities for new companies—from retrieving and digitizing the data, structuring it, mining it with or without machine learning and artificial intelligence—as well as a series of perils mostly around security and biases. The wide adoption of EHRs has transformed the initial goal of getting a second opinion for a patient’s diagnosis to the opportunity to access and mine population-wide data for new medical insights—from N of 1 to N of many and back to N of 1. Regulatory agencies have started to measure the importance of this trend and the work of Amy Abernethy as the agency’s Principal Deputy Commissioner and acting Chief Information Officer for the past two years (she is leaving the FDA next month) is a testament to how vast amounts of data will shape and reshape the healthcare industry. 

Jonathan Friedlander, PhD & Geoffrey W. Smith