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Editorial
May 14, 2019

Restricting the Number of Open Patient Records in the Electronic Health Record: Is the Record Half Open or Half Closed?

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2UCSF Health Informatics, University of California, San Francisco
  • 3Center for Clinical Informatics and Improvement Research, University of California, San Francisco
JAMA. 2019;321(18):1771-1773. doi:10.1001/jama.2019.3835

Over the past decade, the percentage of hospitals with electronic health record (EHR) systems has increased from less than 10% to more than 90%, and the adoption curve in outpatient settings has been similar. This means that most clinical work in the United States and in other resource-rich countries now involves the complex interaction between clinicians and their digital tools.

A central critique of EHRs is that they have not been built with the needs of clinicians or patients as top priorities.1 This criticism spans both the user interface design (eg, how screens are configured) and decisions about how to integrate EHRs into clinical workflow. In the case of the former, there are clear guidelines regarding what constitutes good design.2 In the case of the latter, there is substantial ambiguity, limited evidence, and complex tradeoffs.

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