Chapter 3

Electronic Health Record from a Historical Perspective

Nicholas E. Davies Program founded by CPRI in 1993 awards excellence in HER implementation.
- Organized into 3 different categories
- The award program has recognized 20 healthcare organizations, 7 primary care
practices and 3 public health initiatives.
- Applicants for the award answer questions outlined by the project evaluation criteria,
- These questions are focused on the four areas (management, functionality,
technology and value)
- A review of award receiving applicants reveals that some characteristics of winning
organizations remain unchanged over the past decade while other characteristics are
remarkably different.

Computer based Patient Record Institute (CPRI), a nonprofit organization founded in 1992, was
a unique organization representing all stakeholders in healthcare, focusing on clinical
applications of information technology.
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The first nationally based organizations to initiate and coordinate activities to facilitate
and promote the routine use of computer-based patient record throughout healthcare.

The Davis program, named for Dr. Nicholas E Davies-an Atlanta-based physician, president-elect
of the American College of Physicians and a member of the Institute of Medicine (IOM)
committee on improving the patient record, was killed on a plane crash just as the IOM report on
CPRs was being released.
Management many davies winners stressed the importance of operational planning for the EHR
implementation. To maximizes success, it must be recognized that the forthcoming
implementation will bring about a culture of change.
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This changes must focused in medical, nursing, and administrative leadership.

Value based on the care processes

- Great emphasis was placed on the organizations ability to demonstrate positive
impact.
- Early davies winners have contributed significantly to the body of research on the
power of importance of clinical decision support to improve the process of healthcare
and patient safety.
- Quality of care enhancement through avoidance of medicine error, increased
appropriateness of care intervention, and compliance with managed care and disease
management protocols were obtained by all organizations.
- Quality of care in improved continuity of care as medical records and plans of care
- Business value of its project, this model then provides balanced decision-making
criteria including tangible and intangible benefit and risks. Result analysis provides
net present value, internal rate of return, playback periods and ROI for each system

Functionality- focuses on decision support

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Functionaly of an EHR is the result of the data it captures and the assistance it
provides to all members of the healthcare team.
Clinical support in the decision-making process
2 guidelines (1 can be seen in application that are designed ot facilitate best practices
through evidence-based clinical practice guidelines, electronic order protocols,
electronic defaults, allowable order specific elements. 2 found in alerts and reminders
that warn clinicians about patient variables

Technology
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Technology behind each EMR affects the ability to meet users demands for rapid
response, system reliability, future growth and customization.
Unique interfaces, user agreements, user agreements, cultural changes, workflow
revisions and window and menu customizations tend to make each EMR unique.
Document imaging system have been incorporated