trials (Breitfeld et al., 1999; Carlson et al., 1995; Ohno-Machado et al., 1999; Papaconstantinou et al., 1998). Other effective electronic administrative tools include reporting tools that support drug recalls (Schiff and Rucker, 1998) and artificial neural networks that can assist in identifying candidates for chronic disease management programs (Heden et al., 1997; Kok and Boon, 1996; Petrick et al., 2002).

Reporting and Population Health Management

Institutions currently have multiple public and private sector reporting requirements at the federal, state, and local levels for patient safety and quality, as well as for public health. In addition, the internal quality improvement efforts of many health care organizations include routine reporting of key quality indicators (sometimes referred to as clinical dashboards) to clinicians. Most of the data for these reports must be abstracted from claims data, paper records, and surveys, a process that is labor-intensive and time-consuming, and usually occurs retrospectively. Thus such reporting is often limited to entities that have sufficient administrative infrastructure to develop the necessary data (Institute of Medicine, 2002c). Additionally, chart abstraction has been shown to involve a number of significant errors (Green and Wintfeld, 1993). Having clinical data represented with a standardized terminology and in a machine-readable format would reduce the significant data collection burden at the provider level, as well as the associated costs, and would likely increase the accuracy of the data reported.


When identifying the core functional requirements for an EHR system, the IOM Committee was asked to consider both the care setting of each function and the time frame for its introduction. Table 1 at the end of this report lists the eight key EHR system capabilities described above, broken down at a more detailed level, according to these two dimensions. The committee was asked to provide guidance pertaining to four care settings: (1) hospitals; (2) ambulatory care settings, including small practice settings, community health centers, and group practices; (3) nursing homes; and (4) care in the community.

In addressing the fourth setting, care in the community, the IOM Committee focused on functional requirements for the personal health record (PHR), defined to include (1) a subset of data from the individual’s EHR, and (2) information recorded by the individual, including health mainte-

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