Large-scale electronic health record projects promise much, but sometimes deliver little, according to a new study.

In a study published Monday in the U.S. journal Milbank Quarterly, researchers at the University College of London (UCL) said they identified fundamental and often overlooked tensions in the design and implementation of EHRs. The study was based on findings from hundreds of previous studies from all over the world.

Researchers said their findings have implications for President Barack Obama’s election promise to establish electronic health records for every American by 2014, and for other large-scale EHR initiatives around the world.

Professor Trish Greenhalgh, lead author of UCL’s Department of Open Learning, said EHRs are often depicted as the cornerstone of a modern healthcare, capable of making care better, safer and cheaper. Yet, clinicians and managers the world over struggle to implement EHRs.

" Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of electronic health record projects fail – and the larger the project, the more likely it is to fail," Greenhalgh said. 

"Our results provide no simple solutions to the problem of failed electronic patient records projects, nor do they support an anti-technology policy of returning to paper. Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world,” according to Greenhalgh.

The study also found:

• While secondary work like audit and billing may be made more efficient by EHRs, primary clinical work can be made less efficient;
• Paper, far from being technologically obsolete, can offer greater flexibility for many aspects of clinical work than the types of electronic record currently available;
• Smaller, more local EHR systems appear to be more efficient and effective than larger ones in many situations and settings;
• Seamless integration between different EHR systems is unlikely to  ever happen, as human input will probably always be required to re-contextualise information for different uses.

Co-author Henry Potts from UCL’s Centre for Health Informatics and Multiprofessional Education said, "There has been considerable prior debate in the media and among academics about the benefits and hazards of electronic patient record systems. We believe the next generation of research should focus on how human imagination, flexibility and collaboration can work with electronic systems and help overcome their inherent limitations, thereby allowing us to realise the full potential of electronic patient record systems."