How Did We Get Here? – the “Official”, “Unofficial” Beginnings


When did the electronic health record (EHR) evolve? Why did it evolve? How did it all really begin? Are there benefits? So many questions. Where should I begin?

Once upon a time….Isn’t that how stories usually start?

According to The American Health Information Management Association (AHIMA), EHRs have been around in the United States healthcare setting in one form or another since the late 1960’s or early 1970’s.

Photo Credit: ESO

We have been trying to figure out how to make health data more useable and accessible for quite a while. Homegrown systems were popping up in different places and the technology was rudimentary, but something big was starting from computerized physician order entry systems to the storage of patient data for easier retrieval.

Skipping ahead a few decades, in 1996 the Health Insurance Portability and Accountability Act (HIPAA), brought us one-step further in the evolution of the EHR.  Providers were suddenly trying to figure out whom we could talk to and when we could talk to them. Didn’t healthcare professionals already have a standard in place for that called the ‘Code of Ethics’?  Clinton_signing_documentHIPAA’s main objective is to protect health insurance coverage for workers who change or lose their jobs by making it “more portable” and easier to continue without having to restart time requirements regarding pre-existing conditions.  How does one make data more portable when there are no standards? Prior to HIPAA, healthcare billing was like the Wild West; anything goes. Payers could have their own set of codes.

HIPAA established administrative simplification standards for healthcare systems and was a driving force behind the security and privacy regulations of the electronic transmission of healthcare and financial data. In addition, it mandated standards for code sets used for encoding data elements such as tables of terms, medical concepts, medical diagnosis procedure, and drug codes. ICD-10-CM is an example of a code set, for more information on such code set, check out our Code Words blog. HIPAA also helped corral security, electronic signatures, coordination of benefits, and unique identifiers such as the national provider identifier (NPI). It was more than just a method of ensuring the privacy of protected health information (PHI) and who can have access, it was actually the “official”, beginning of the EHR.

Stayed tuned to see how the EHR plays a role in the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009. The Act to promote the adoption and meaningful use of health information technology.

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