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EHR workflow diagram Electronic Health Record
Lynne Rosenthal (

Overview:  When visiting a new doctor, have you ever failed to recall your medical history accurately?  Have you been asked to have lab work repeated, even though you just recently had that blood test?  Given the duress of an illness or injury, such patient experiences are common, yet, they could be avoided through modern heath information technology.  Having access to complete patient health information is critical to improving clinical care, reducing medical errors and decreasing costs.  The Electronic Health Record (EHR) is a longitudinal collection of patient-centric healthcare information available across providers, care settings, and time.  It is a central component of an integrated health information system.  However, full benefits of EHRs can not yet be realized, for barriers exist to their acquisition and use.  There is a lack of interoperability and standards.  Organizations such as ANSI/HITSP, HL7, ASTM, and HIMSS/IHE, in partnership with vendors, users and government organizations, are addressing these challenges. Evolving examples include HITPS Interoperability Specifications, HL7’s functional model for EHR systems, and ASTM’s continuity of care record (CCR) for patient referrals.  NIST, through the development of conformance test tools and measurements, is working with these organizations to accelerate development, adoption and use of standard-based EHR systems.

Industry Need: Today, a person’s medical information is scattered among various providers who most often store it in thick paper files. Although pieces of this overall record may be in digital format, they are probably located on different, incompatible health information systems.  There is no coordinated, standard-based system that integrates a person’s medical information within and across care settings. EHRs and EHR systems can provide this capability.  But first, patient information must be captured digitally for a common set of EHR functions.  To be successful, digital patient information must be accurate, sharable, and improve workflow.  EHR systems must be integrated, secure, and interoperable, yet not be prohibitive to implement. 

NIST Approach: NIST’s contribution emphasizes a pivotal aspect, the interoperability of EHR systems. We work with HHS's Offic of the National Coordinator to define testing strategies that support EHR implementation and integration efforts via the development of conformance criteria, tests, and tools.  Collaborating with HL7 and IHE, we are designing distributed models and architectures for healthcare information systems (e.g., IHE profiles, EHR Functional Model).  Our efforts have resulted in providing the basis for the Certification Commission for Healthcare Information Technology (CCHIT) certification program.

Impact: Testing and quality assurance activities, when integrated into standards, software and certification processes, raise the quality of the outcomes, lower costs to implement, and foster adoption. The EHR has a capacity to speed care, reduce costs, and improve patient safety.  An EHR improves clinical decision making at the point of care, provides better long term health outcomes and yields important data for public health monitoring and research. However, this can only happen within a setting of standardized, interoperable EHR functions and elements.  The HL7 EHR-S will provide a common functionality model upon which developers, vendors, and users can plan and evaluate EHR systems.  A full patient EHR, while in the future, will definitely materialize as part of the systematic automation and modernization of health care.