Electronic Health Record (EHR) systems – a brief history and 3 key players

April, 2022
Electronic Health Record (EHR) systems – a brief history and 3 key players

Electronic Health Record (EHR) systems are transforming healthcare provision across the globe. Slowly but surely, paper-based records are becoming a thing of the past, and being replaced with digital health records that follow a patient from ‘cradle to grave’.

In particular, for clinical trial sites looking to show they are ‘eSource-ready’, an advanced EHR system is increasingly necessary.

For those new to EHRs, here we take you through a brief history of their development, as well as an outline of three of the key suppliers.

The foundations of EHRs

We owe a lot of the development in EHR systems to work that has happened in the US over the last 60 years.

The earliest foundations of EHRs can be traced back to the 1960s, when the Mayo Clinic became one of the first to adopt an electronic health record system. But throughout the 60s and 70s, the cost of equipment meant that they were out of reach for most hospitals. Only the biggest institutions and research institutions could afford the investment, and it was largely economic factors driving things, with billing and scheduling being the main priorities.

Shifting the focus to patient care, however, the 1960s also saw the birth of the Problem-Oriented Medical Record. This was, effectively, one of the first attempts at capturing structured data around a patient’s entire health history. Rather than just recording diagnosis and medication, it included medical history, complaints, care plans and progress notes. As this developed into being captured in a database, it formed the basic principles we rely on today for collecting structured data that can be shared between different parts of the system – AKA, an EHR.

During the 80s and 90s, as computers gradually became cheaper and more widely used, so did EHRs, but adoption was very slow.

The role of legislation

Government, again primarily in the US, has been instrumental in pushing forward the adoption of EHR systems.

In 2004, President George W. Bush created the Office of the National Coordinator for Health Information Technology, outlining plans to ensure that most Americans had electronic health records within the following 10 years.

In 2009, President Obama incorporated EHR into his American Recovery and Reinvestment Act, as part of the Health Information Technology for Economic and Clinical Health Act (HITECH). This provided additional funding to health care providers that met particular criteria, which involved using EHR and meeting technological requirements by 2014. Money talks, clearly… The US went from 10% of hospitals using an EHR system in 2008 to over 80% in 2015. As of 2018, 98% of hospitals in the US either had an EHR or were planning for one.

In 2016 came another pivotal turning point. President Obama’s 2016 21st Century Cures Act, requires all new US-developed EHR systems to use a common language – HL7 FHIR, and have an application programming interface (API) – SMART on FHIR, giving access to the data in the system. This paved the way for a new level of interoperability between different systems.

Read more about the Evolving Landscape of Clinical Trial Data

EHR vendors

We’re focusing on legislation in the US because it has driven the development of the major players in the EHR market. The three largest global providers of EHRs are US companies. Because US EHR systems have developed to an advanced stage, more large NHS Trusts in the UK are adopting those systems to increase efficiency and standards.

Here, we give a very brief overview of three of the largest providers of EHR systems and where they are being used in the UK.

#1 Epic

Epic is the largest provider in the US (in 2021, they had cornered 34% of the US market), and is in the top three, both globally and in the UK/Ireland market.

It is also arguably the largest system, in terms of functionality and availability of add-ons. With a modular structure, it has dedicated modules for every medical speciality, from anaesthesia to wound care.

With options for cloud-based or on-premise deployment, its features include AI- and analytics-powered smart tools for decision making, telehealth integrations, and interoperability with other systems.

Epic is in use at NHS Trusts, including Cambridge University Hospitals, University College London Hospitals, Great Ormond Street and Royal Devon, with plans to implement with other Trusts. For example, in 2020, Guy’s & St Thomas’ NHS Foundation Trust confirmed a £175M contract to deploy Epic, due to go live in 2023.

#2 Cerner

Cerner is, historically, even larger than Epic in the global market and holds a strong 2nd place in US terms (with 24% of the US market in 2021). In the UK/Ireland it’s also one of the largest suppliers.

Cerner’s Millennium EHR platform can be deployed on-premises or cloud-based, and has solutions for administrators, clinicians, patients and researchers. It can support over 50 specialty areas and includes analytics solutions, as well as supporting documentation tools that automate clinical notes using voice recognition. Like other major players, it also features interoperability with other systems.

According to Cerner, in 2020, their Cerner Millennium EHR platform was being used across 24 NHS Trusts. In 2021 Cerner and East Lancashire Hospitals NHS Trust (ELHT) signed an agreement to implement Cerner Millennium across the Trust. The same year, London North West University Healthcare NHS Trust and The Hillingdon Hospitals NHS Foundation Trust also signed an agreement to join the EHR domain already in use by their neighbours at Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust.

#3 Allscripts

Allscripts is one of the top four EHR providers in the UK/Ireland and top three globally, but sits a little lower down in the US, with a market share of around 5%.

Allscripts’ Sunrise system offers a cloud-based scalable solution, including specialist options from acute care to oncology care, a mobile interface for clinicians, and workflow management.

According to Allscripts, their solutions are being used in 18 NHS Trusts. These include Gloucestershire Hospitals NHS Foundation TrustThe Dudley Group NHS Foundation Trust, and Maidstone and Tunbridge Wells NHS Trust. King’s College Hospitals Trust rolled out Allscripts solutions in 2016, but have recently secured funding to join up with Guy’s and St Thomas’ NHS Foundation Trust for a joint rollout of Epic in 2023.

Are you new to IgniteData?

IgniteData is the company shaping the future of clinical trials. Through our innovative digihealth platform, Archer, we enhance interoperability between Electronic Health Records (EHR) and key research applications such as Electronic Data Capture (EDC).

Our solution features turnkey integration with major EHRs, including Epic, Cerner and Allscripts. Find out more about Archer – the world’s first truly agnostic, scalable EHR2EDC solution – here.

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