Unusual Consequences of an Intramuscular NSAID Injection: Streptococcus Pneumoniae Subdeltoid Bursitis and Endocarditis

A large portion of every day as a physician is spent interacting with an electronic health record (EHR). Understanding how to use an EHR effectively and efficiently is quickly becoming required knowledge for the modern physician. Studies show that most physicians now spend a higher percentage of their time entering and reviewing data in the EHR than any other activity, with estimates as high as 57%, more than double the time actually spent with patients. The US federal government has determined that the widespread use of EHRs is so important that it created large financial incentives for hospitals and individual physician practices that implement EHRs that meet certain meaningful use criteria under the HITECH Act, spending nearly $20 billion already by the end of 2013. Hospital systems and individual physicians are investing heavily in EHR systems, with some institutions investing upwards of $700 million to implement them. Given the massive investment that the government and healthcare institutions are making into EHRs, as well as the fact that physicians are spending around half their time using the EHR, physicians should have a better understanding of how the EHR will affect patient care. This talk begins with a review of the history of the EHR, dating back to the 1960s, when the first EHR systems, known then as clinical information systems, were developed. I discuss the development of the first EHRs, including the well-known EHR of the Department of Veterans Affairs, DHCP (now known as VistA), that continues to be the the best example of a nationwide EHR system in the United States. I then examine the political and scientific movements that led to the massive push for all healthcare institutions to implement EHRs, beginning with the Institute of Medicine’s study, The Computer-Based Patient Record, that called for widespread implementation of EHRs, and finishing with a brief overview of the HITECH Act and meaningful use. I then provide a review of the current literature showing the positive and negative effects that EHRs have on patient health outcomes, as well as the effect they have on how physicians interact with patients. I discuss how EHRs reduce certain types of errors, while also increasing other kinds of errors. I conclude with a look into the future direction of the EHR, which will include advanced clinical decision support systems, easy data entry and review, and other systems that will hopefully improve patient health outcomes, patient satisfaction, and efficient use of resources.