The Electronic Health Record – Realizing the Potential

W. Ed Hammonda, Jeff Ferrantib, and Eugenia Hinzc

aCenter for Health Informatics, Duke University Medical Center

b CMIO, Duke Medicine

cAssistant CMIO, Duke Health Technology Solutions


The Electronic Health Record (EHR) suffers from inconsistent meanings, architecture, content, and purpose. This tutorial presents the EHR as the center-piece for patient-centric data collection, storage and use – it’s all about the data. The EHR contains all data from all sites and sources, aggregated into a single virtual record, in a structured form, required to manage a patient’s care and health. The content of the EHR must support continuous use of data for multiple purposes.  The EHR must provide enhanced capability for navigation and for query. The tutorial addresses new roles of the EHR and new content of the EHR crossing the spectrum from basic science and the ‘omics community, clinical research, patient care, public health, and population health. The tutorial will address ways to capture the right data at the right time through appropriate, smart entry systems. New data will include genomic, environmental, cultural and geospatial data as well as a variety of data types. The tutorial will discuss the use of the Clinical Data Warehouse as a way to provide user-initiated access to the data contained in the EHR. We will discuss the creation of data marts for specific purposes, including research, marketing, and managing populations. Some specific issues will be discussed including creation of phenotype sets and management of population health through risk stratification of ambulatory populations. Issues of interoperability, access, privacy and confidentiality, and generally functional requirements are addressed.


Outline of topics

  • This tutorial will focus on three topics:

  • The reality of today’s deployed EHR systems and the changes that must occur to meet the demands for an interoperable health care system – with interoperability being defined for both internal and external settings.

  • The paradigm shift – a focus on the data – quality, completeness, continuing use, low energy collection, trust, and new types of data are some of the issues that will be addressed.

  • Effective use – continuous use of data for research and patient care, data elements and phenotype sets, geospatial sets, and risk stratification.


Educational objectives

  1. Identify expectations for EHRs as the foundation of an engineered system of healthcare and clinical research that are not met by today’s deployed systems.

  2. Define barriers and issues that are yet to be solved.

  3. Describe logical organization of content of EHR to support a variety of uses.

  4. Describe the structure, content, user interface, and functions of a Clinical Data Warehouse

  5. Describe new and novel methods of data collection including smart text

  6. Discuss potential broadness of use of EHR.


Target audience

Individuals responsible for quality/cost improvement in a health system or individuals responsible for implementing or developing information technology to enable those improvements.