IOM cites core functions to improve EHR systems

Setting standards prior to widespread adoption

As part of a national effort to encourage the adoption of computer-based health records, an Institute of Medicine (IOM) panel has identified a set of eight core functions that electronic health records (EHRs) should perform to promote greater safety, quality, and efficiency in health care delivery.

"[Secretary of Health and Human Services] Tommy Thompson was very keen on stepping up to the plate to offer incentives for more providers to adopt EHRs," notes Paul Tang, MD, chief medical information officer at the Palo Alto (CA) Medical Foundation and chair of the IOM committee that identified the core functions.

"The first question that comes up is: What is an EHR, and what criteria should it use? We were asked to spell out the key capabilities of an EHR in health care settings and to list the things for which there is evidence that, if you had them, you would gain benefits," he adds.

The committee looked at four major issues: quality of care, chronic disease management, efficiency, and feasibility. This last item was as important as the other three, Tang says.

"You can’t just say, Everyone has to have a full-fledged EHR next year," he explains. "We wanted to lay out what they are, when our best guess is that they will become commercially available, and when we could reasonably expect early’ docs to have them available. This report will not say, The whole country will have it by this particular time.’"

The eight core functions are:

Health information and data. 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 multiple 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.

Decision support. Using reminders, prompts, alerts, and computerized decision-support systems to improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.

Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients.

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. Computerized administrative tools, such as scheduling systems, to improve hospital and clinic efficiency and provide more timely service to patients.

Reporting. Electronic data storage that employs uniform data standards to enable health care organizations to respond more quickly to federal, state, and private reporting requirements.

The committee’s report, which will be published in full this fall, was produced much more rapidly than typical IOM studies. "IOM studies typically last 1½ to two years," Tang notes.

"Fortunately, they had another committee working on a study of data standards for patient safety we could tag onto, so we added our findings to their report," he says.

The plan is for the key capabilities to be used by Health Level Seven, Inc. (HL7) in Ann Arbor, MI, one of the main standard development organizations in health care. "They are developing a common industry standard for EHRs that will guide the efforts of software developers," Tang explains.

Having a common understanding about the key functions that EHR software should possess will allow health care organizations to more easily compare the systems currently available and help vendors build systems that meet care providers’ expectations, the report says.

The specification of core functions also will help accreditation organizations and others certify EHR systems that are ready for adoption. In addition, the report says that Medicare and private health care programs are considering providing financial rewards to providers for investing in EHRs with specific capabilities.

The IOM also says that all EHRs must protect patient privacy and confidentiality, and comply with the standards for security, storage, and exchange of data required by the Health Insurance Portability and Accountability Act.

The committee also predicts that by 2010, comprehensive EHR systems will be available and implemented in many health systems and regions.

Need More Information?

For more information, contact:

Paul Tang, MD, Chief Medical Information Officer, Palo Alto (CA) Medical Foundation. E-mail:

Health Level Seven Inc., 3300 Washtenaw Ave., Suite 227, Ann Arbor, MI 48104. Tele-phone: (734) 677-7777. Fax: (734) 677-6622. E-mail: