Electronic Health Record Data in Cancer Learning Health Systems: Challenges and Opportunities

摘要

INTRODUCTION: If electronic health records (EHRs) are ubiquitous in health care, then why are EHR data so difficult to access and use? Since their inception in the 1970s, EHRs have been envisioned to transform how health systems generate and use knowledge, including in oncology. Federal investments from the 2010 Health Information Technology for Economic and Clinical Health (HITECH) Act led to near-universal EHR adoption by 2017 in nonfederal acute care settings (96%) and high adoption in clinics (80%). In parallel, the learning health system (LHS) model was born, which seeks to use EHR and other data on patients and patient care processes to increase quality at reduced cost. The reality of EHRs has been mixed. Early studies showed potential to optimize work processes; provide information gathering, summarization, reminders, and clinical decision support (CDS); improve quality; and lower costs. However, recent studies have shown that EHRs require provider workarounds that negatively affect ability to access or write information reliably, leading to burnout and inefficient and lower quality care delivery.