What Is the History of Electronic Medical Records?

For many, it’s challenging to imagine a time before electronic medical records existed. But believe it or not, in the not-so-distant past, paper-based records were the standard way for providers to detail a patient’s medical information. Due to technology, we’ve leaped from pen-to-paper documentation to typing on handheld mobile devices. Yet, how exactly did electronic medical records come to be, and what should we anticipate next? 

Below, we’ll explore the history of electronic medical records, shedding light on how far we’ve come and what to expect in the coming years. Given all that’s happened in such a short time, it’s exciting to envision what patient record-keeping will look like in the future. 

What Are Medical Records? A Quick Overview

Before we fully dive into the history of electronic medical records (also called EMRs), it’s essential first to clarify what the term ‘medical record’ means. 

Medical records are documents, in written or graphic form, that identify a patient and detail all or some of the following: 

• Their health history
• Clinical symptoms and signs 
• Diagnostic work-up
• Treatment procedures
• Medication use case and management 
• Follow-up care 

The First Medical Records: Ancient Times & Middle Ages

Usually, when people think of how medical records started, they often envision handwritten doctor notes stored in folders and maintained in a locked cabinet. Interestingly, though, paper-based records, as we know them today, didn’t become common until around 1900 to 1920. We have to go back much further in time if we want to accurately understand what some of the first medical records looked like. 

Also, keep in mind that most of the medical records created during ancient and medieval times were primarily done for educational purposes, not to keep the best track of patients.

Ancient Egyptian Inscriptions 

Admittedly, it’s difficult to pinpoint when medical records first appeared, but the most dated ones were ancient Egyptian texts written on papyrus. In 1862, American Egyptologist Edwin Smith obtained a papyrus manuscript that seemed to have been written between 1600 and 1700 B.C. It’s considered the oldest manuscript about injuries, and explains examination methods, the determination of diagnosis, and a treatment plan. 

Another record, “Papyrus Ebers,” was acquired by Georg Ebers, a German Egyptologist, in 1873. This medical text is one of the oldest known medical papyri, dating to around 1550 B.C.

Recordkeeping in Greece: Hippocrates 

Known as the father of medicine, the Greek physician and philosopher Hippocrates of Kos has significantly influenced modern medicine. The book, Corpus Hippocraticum, written by Hippocrates and other physicians in the 5th century B.C., includes a collection of nearly 70 medical scripts that closely resemble today’s medical records. For instance, it describes medical procedures, prescriptions, and doctors’ recommendations. 

Medical Scripts During Islamic Civilization 

During the early Middle Ages, Abū Bakr Muhammad ibn Zakariyyā al-Rāzī, also known as Rhazes, created the “Al-Kitab al-Hawi”. The latter translates to “The Comprehensive Book on Medicine” and includes components that mimic modern-day medical records. 

Medical Data Archiving in Medieval Europe 

Established in the 9th century, the Schola Medica Salernitana, a medical school based in Italy, developed the first medical data archiving in Europe. The records were held within religious institutions and comprised a list of the patients admitted to and released from hospitals.

It’s said that the medical records from the medieval period were more autonomous than those developed during ancient times. Documenting their medical observations and procedures was a standard part of a doctor’s practice.

Modern Times: An Introduction to Paper-Based Records 

Following the medieval era, the technique of medical records started to change. 

Capturing Medical Records via Sketches

Sketches became a popular approach for recordkeeping, likely inspired by Leonardo da Vinci’s anatomical drawings around the 15th century. The physician, Andreas Vesalius, published the book “De Humani Corporis Fabrica” in 1534, which included drawings of the human body. Shortly after, medical records began to include post-mortem sketches. 

A Shift to More Detailed Medical Records 

By the mid-18th century, an American physician, Benjamin Rush, created what is now considered the archetype of medical history. He kept elaborate medical records of patients in the form of a casebook, with details such as: 

• Patients name 
• Prescriptions used
• Presented medical issues 
• Treatment dates

Around the same timeframe, in Berlin, junior surgeons at a surgical collegium began inspecting patients daily and providing an overview of their ailments and treatment history. These medical records became a way for experienced physicians and those in training to communicate. 

At the Hotel-Dieu hospital in Paris, around the late 18th century, patients were required to have daily check-ups for research purposes, and detailed recordkeeping became the expectation in modern Europe. 

The Evolution of Paper-Based Records 

In the early 1790s, the United States created its own system for patient case records, starting with the Book of Admissions and the Book of Discharges in the New York Hospital. This move led to the State of New York setting up a medical register and hospital rules. 

Nearly ten years later, it was suggested that home doctors should register all medical cases. Interestingly, most doctors’ notes were completed retrospectively and included the physician’s personal opinions. It wasn’t uncommon for them to insert cultural stereotypes and personal medical theories. 

However, during the early 19th century, it was determined that these registries needed certain standards. A database of abbreviations and acronyms was established to streamline this process. 

By the second half of the 19th century, the volume of medical records had grown significantly. They were usually copied and held in libraries, but were still heavily utilized for research and educational purposes. However, they were also beginning to have more importance in society. For instance, these records became necessary in the United States and Europe for abuse or insurance procedures. 

The 20th Century: A Turning Point for Medical Records 

It was during the 20th century, 1918 specifically, when the American College of Surgery decided to register all patients in every hospital to monitor treatments and compare results properly. Although documentation had become expected, it was usually illegible, hindering its advantages. 

At the same time, healthcare specialties were expanding, there were a growing number of therapeutic and diagnostic procedures, and medical documentation involved many more employees. Standardization became crucial, and in 1919, the American College of Surgeons created regulations surrounding what they called “treatment diaries. These diaries had to include details regarding: 

• Laboratory tests 
• Diagnosis 
• Chronology of treatment plan 
• Physician-patient interviews 

Several hospitals followed suit, and administrative networks and offices were designed to maintain the centralized registers. People were even hired to start managing data obtained from the records. 

Although paper-based medical records had a more structured format and storage protocols at this point, new issues emerged. Standardization still lacked across healthcare organizations and among practitioners. The medical documents also weren’t easily searchable, and information was often misplaced. In addition, clinical observations and reports occasionally included unsolicited messages, or what we’d call spam today. 

It became clear that there was a great need for quality checks to mitigate the chaos brought about by paper-based records. 

The Advent of Electronic Medical Records

Around the 1960s, there was a big push for electronic health (eHealth) records. Healthcare providers wanted a less time-consuming and labor-intensive practice for collecting medical encounters than using envelopes and color-coded cards. 

One of the first eHealth records was punch cards. These edge-notched cards acted as a data-sorting system, with each hole representing a specific category. Users could make a notch and write notes in the middle to document patient information. However, this process was admittedly time-consuming. 

Electronic Medical Records Progress

The very first EMR wasn’t created until 1972. It was developed by the Regenstreif Institute, a medical research and development company based in the United States. This technological advancement was regarded as a major milestone in healthcare, but utilization was low. The cost of EMRs was a barrier for most medical institutions due to the high fees associated with premature computer systems. 

In the early 1990s, computer hardware became much more robust and cost-effective. That, coupled with faster Internet, made EMRs more powerful and accessible. By 1992, academic medical facilities primarily used electronic medical records, but didn’t yet include all of the data found in paper charts. 

At this time, EMRs were seen as complementary to paper records, although the Institute of Medicine recommended a shift from paper-based records to electronic ones. The idea seemed too far-fetched then, due to factors like physician resistance, and there were no real incentives to make the change. 

Incentivizing EMRs

Things started to change in 2009, when the Obama Administration pushed for the adoption of EHRs as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Billions of dollars were allocated to incentivize healthcare providers to adopt them. 

The Meaningful Use Incentive Program was also launched around 2011, allowing providers to earn financial benefits when using EHRs. The goal was to create a standardized way to handle and exchange medical data among clinical staff, insurance companies, and more.

The Value of EMRs During COVID-19

We truly saw the power of EMRs during the pandemic, when practitioners heavily relied on them to coordinate care among hospitals. They helped provide a more accurate depiction of the number of persons infected, and the data obtained could also be used to assess a patient’s likelihood of post-infection complications or death from COVID-19. Plus, not using paper-based records helped minimize the spread of infection. 

Today, EMRs have entirely altered the provider-patient dynamic, making possible things like virtual consults, patient portals, and medication ordering. It’s common now for practitioners to use voice recognition and order sets to enter details into an EMR. Even mobile devices with advanced cameras are being used by providers to capture images at the bedside to add to an EMR. 

There are even tools that can leverage data from EMRs to help clinicians make more informed medical decisions, like advanced clinical decision support systems (CDSS). This function could result in fewer medical errors, improved health outcomes, and more efficient organizations. 

The Future of Electronic Medical Records

Reflecting on the history of electronic medical records reveals that we’ve accomplished so much up to this point. Given their current capabilities, it’s almost impossible to imagine how EHRs could become even more beneficial. However, as the needs of patients, providers, and health systems change, so will their features. 

More Consumer-Centric 

For example, Deloitte shared that by 2030, EMRs will likely be more consumer-centric. They found that consumers want to build a better relationship with their providers and desire convenience. Therefore, we’ll likely see advancements in patient communication tools, virtual registration, and online appointment scheduling. 

Improved Interoperability 

One of the most significant issues with EMRs is the lack of interoperability, which has hindered them from operating at their full potential. Factors like hardware or system usability barriers, or insufficient universal terminology and security standards, limit their ability to connect with other applications. 

We anticipate that these silos will be broken down at some point, so patient data can more easily flow across organizations and providers. 

Artificial Intelligence

EMRs carry the most reliable medical data in the healthcare system, and when paired with artificial intelligence (AI), they can help practitioners with clinical decisions. Machine learning algorithms have already shown promise in predicting wound healing time and the incidence of diabetes mellitus. As AI improves, clinicians could use it to help decrease errors, diagnose diseases, and suggest customized treatment plans. 

Better Data Security and Integrity 

EHRs carry a wealth of sensitive and personal data, making them an attractive target to hackers. Data breaches can be disastrous, costing health systems millions of dollars and leaving patients vulnerable. We imagine future EMRs will have more measures in place to protect patient privacy, such as: 

• Advanced access controls 
• Multi-factor authentication 
• Encryption 

More Streamlined Administrative Duties

Some of the best EHRs today have gotten really good at helping organizations meet regulatory, coding, and billing requirements, which are all time-consuming administrative tasks. Future EMRs, though, will likely feature additional automations that streamline tasks like manual data entry, data analysis, and scheduling. 

The History of Electronic Medical Records Uncovered 

Reflecting on the history of EMRs allows us to ruminate on how each milestone has gotten us to where we are now. Each step has made providers’ jobs easier and patient outcomes better, and the best is yet to come.  From written papyrus inscriptions to cloud-based EHR solutions designed to scale, it’s clear we’ve come a long way from ancient times.