This issue of JAMIA focuses on various uses of electronic health records (EHRs) to provide better care for individuals and assist caregivers within and across institutions.
EHRs have been used for clinical decision support (CDSS) for a long time, but their wide adoption in the United States was achieved only in the past decade. Several informatics studies based on EHR data have followed since then. In this issue of JAMIA, we present articles related to the use of CDSS to improve patient care. Grundmeier (p. 1160) evaluates a predictive model for site infections, Sperl-Hillen (p. 1137) reports on a randomized trial of a CDSS to reduce cardiovascular risk, Cheung (p. 1202) shows how the risk for a specific cardiovascular condition was reduced in a major academic medical center upon implementation of a CDSS, Slight (p. 1183) shows how a CDSS can promote safety in the form of aversion of adverse events related to medications, Ramirez (p. 1167) describes a CDSS for diabetes medication dose adjustments, and finally Gamble (p. 1240) systematically reviews availability and clinical drug information coverage in machine-readable format, without which the implementation of CDSS is not practical.
EHRs can be utilized to improve patient care in other ways as well. Mummadi (p. 1228) reports on the effect of displaying price information to clinicians using a computerized order entry system, while Laranjo (p. 1248) systematically reviews conversational agents in healthcare. An increasing demand towards transparency of EHR usage can also explain the increasing adoption of OpenNotes described by Fossa (p. 1153).
While widely adopted and playing important roles in supporting decision making and safety in healthcare, it is important to note that EHRs are not a panacea for a highly fragmented and somewhat cost-ineffective healthcare system: Krumholtz (p. 1218) provides a perspective on the promise of EHRs to benefit patients, Ratwani (p. 1197) assesses usability and safety of EHR systems, and Gilmore-Bykovski (p. 1206) addresses the lack of structure in clinical documentation of cognitive and behavior dysfunctions. The association of intra-hospital sharing of EHR information and health system organizational structure is reported by Holmgren (p. 1147).
This issue of JAMIA also includes studies on the sharing of health information across healthcare institutions. The benefits and gaps of health information exchange (HIE) across institutions are described by Menachemi (p. 1259) and Everson (p. 1114), respectively. Vest (p. 1189) reports that adoption of intra-hospital HIE is negatively associated with inter-hospital HIE. Beskow (p. 1122) describes patients’ perspectives on the use of EHRs that results in their being contacted by researchers.
It is important to understand that an EHR is not the only source of health data that can impact a patient’s care: this issue of JAMIA provides examples of the impact of online support groups, wearable technology, mobile-based pediatric clinical decision support, and telehealth as reported by Friedman (p. 1130), Bumham (p. 1221), McCulloh (p. 1175), and Gurbeta (p. 1213), respectively.
The articles we present here are prime examples of the diversity of our field and the many practical ways in which informatics can help promote health and mitigate disease. At the same time, it is important that we experiment with other novel applications that will be mainstream in the near future. Stay tuned for the October issue in which we focus on clinical and translational research informatics.