Electronic health record (EHR) systems are part of an evolving concept comprising a wide range of information systems, from files compiled in single units of care to longitudinal collections of patient electronic health data [1]. EHR systems’ primary use is to support the continuation of efficient and quality integrated health care, based on reminder functions for patients’ health histories and on automated decision support systems, which provide alerts and advice on diagnosis or treatment [1], [2], [3]. Their secondary uses include quality assessment, safety monitoring, health policy planning, and medical research [4], [5]. If shared, the information collected in EHR systems can also support communication between healthcare providers [6].
All these uses can be facilitated by the integration of core functionalities (SOAP model, problem list, episode of care) and the standardisation of health information. The SOAP model is the possibility to enter notes in a template to document patients’ concerns and the health issues managed during encounters. In the SOAP model, the S stands for the symptoms presented by the patient, O for the clinical findings of the practitioner (objective data), A for the practitioner's assessment of health issues and P for the plan of care, which includes performed and prescribed procedures [7], [8]. The problem list is composed of “active” and “inactive” health problems; a problem is considered to be active if it has the attention of the practitioners or of the patient, as reflected by present treatment, subsequent diagnostic investigations, disease monitoring, or the known progressive course of a disease [9], [10]. The episode of care is defined as the time interval during which healthcare activities are performed by one healthcare provider to address one professionally defined health issue [11]. This concept supports the continuity of information, which in turn supports the continuity of care [12].
In addition, the use of standardised terminologies, associated with controlled vocabularies, is a prerequisite to achieve semantic interoperability of EHR information [2]. Standardisation improves the reliability of medical data, especially if the data are to be shared with other healthcare providers [6], [13] or used for administrative functions or research [14]. Standardised data are also required to run clinical decision support systems [15].
In 2007, 87% of European general practitioners (GPs) were equipped with computers in their consultation rooms. In France, the level of computerisation has been estimated at 83%, varying from 78% in solo practices to 100% in group practices of four or more GPs. However, computers are only used (in any manner) in 66% and 72% of consultations by European and French GPs, respectively [16]. In the U.S.A. in 2007, only 35% of office-based physicians declared that they used EHR systems, which infrequently included a “full functional system” (4%) or even a “basic system” (12%). Furthermore, their use of any EHR system varied from 21% in solo practices to 74% in practices with 11 or more physicians [17]. Apart from the capital costs, the primary reported barrier for adopting EHR systems in ambulatory care was these systems’ inadequacy for meeting physicians’ needs [18].
It is now admitted that the actors involved should focus on increasing the adoption of robust EHR systems that allow the use of specific features, rather than simply deploying EHR systems regardless of their functionality [19]. Whereas an unprecedented effort is in progress to implement EHR systems worldwide, the capabilities of EHR systems are poorly understood (apart from decision support systems [20]), especially in primary care. Our objective was therefore to assess the main functionalities of the EHR systems used in French general practices.