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  • Electronic health records (EHRs) are evolving as an essential technology for use in medical practice. They have the potential to improve quality and safety in modern healthcare and reduce costs.

  • “Meaningful use” is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that must be met by eligible providers and hospitals to earn incentive payments and avoid penalties.

  • Clinical decision support (CDS) is still in its infancy and will likely improve in the future with artificial intelligence and become an essential element in improving healthcare delivery. It is also a measure of “meaningful use.”

  • The emergency department electronic medical records (ED EMRs) should be integrated with the hospital EHR, preferably as different faces or displays of the same EHR system.

  • The ED EMR module must have additional specialized features to optimally match the workflow of the ED, including a dynamic status board and ability to create a chart quickly.

  • ED EMR documentation for teaching physicians must comply with CMS regulations.

  • The ED is a 24/7 dynamic service. It is important to have a clear downtime policy and procedure in case the system fails partially or entirely.

  • Despite the potential benefits of EHRs, obstacles and controversies persist. It is vital that future eHealth technologies are evaluated against a comprehensive set of measures.

Healthcare has transitioned from a paper-based system to one that relies on information technology to support all facets of healthcare delivery. These include (but are not limited to) the implementation and use of electronic health records (EHRs), picture archiving and communication systems (PACS), electronic prescribing (ePrescribing), computerized provider (or physician) order entry (CPOE) systems, automated clinical decision support (CDS) systems, telemedicine, mobile data capture, disease surveillance, charge capture for professional and facility services, and electronic billing and reimbursement. This transformation moves us closer to the goal of providing patients with the right care at the right time in the right place every time.

The American Recovery and Reimbursement Act (ARRA) of 2009 provided a major incentive for electronic health records, with reimbursement by Medicare and Medicaid for the Meaningful Use of certified EHRs, as well as other programs that supported EHR education and health information exchange. Such large-scale expenditures have been justified based on the belief that technology can help address the problems of variable quality and safety in modern healthcare.1

However, there is a gap between the postulated and empirically demonstrated benefits of eHealth technologies. There is little convincing research showing that these technologies are cost effective.


The electronic medical record (EMR) is an application environment composed of clinical data repositories, clinical documentation, CDS tools, controlled medical vocabulary order entry, and pharmacy systems. This environment supports the patient’s EMR across both inpatient and outpatient settings and is used by healthcare practitioners to document, monitor, and manage ...

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