You just received your July issue of JOP. This is the Journal's first thematic issue addressing electronic health records (EHRs). It is long overdue.

Three manuscripts in the issue set up the legislative and regulatory underpinning related to the topic. Robert Miller and Jeff Kan review the certification of EHRs and the process of qualifying for federal incentive monies for implementing EHRs, respectively.

Peter Yu's manuscript deals with meaningful use. Meaningful use (MU) is a specific term of art and law. The term was coined in the federal legislation that many recognize as the 'stimulus' act, i.e., the American Recovery & Reinvestment Act (ARRA) of 2009. This sweeping federal legislation includes sections collectively known as HITECH (Health Information Technology for Economic and Clinical Health). This legislation provides funding for practices and health care institutions that implement electronic health records, and requires that these systems are used in a meaningful manner—hence, the necessity of rules defining meaningful use.

The rules demand a lot from vendors in terms of building products that can capture and share information. (Dr. Miller’s article concerning certification elucidates this.) However, the rules’ burden falls heaviest on the practitioners, as we must document and certify that we use the capabilities provided by the products. Implementation of MU regulations is 'staged'. Stage one is in place and comments are being gathered concerning Stage 2 and Stage 3 regulations. Each stage increases the requirements on vendors to provide more functionality and providers to use it – all towards broad goals which will redefine the clinical enterprise.

In these times, when discussions of health care reform focus on the Affordable Care Act (ACA) signed into law in March 2010, the impact of meaningful use is less appreciated by practitioners. Arguably, ARRA, through MU regulations driving EHR technology into every practice, will reform the day to day provision of care more extensively than the reimbursement and payment reforms of the ACA. History underlines this potential when one considers that medicine has always been transformed by technological advance. My father practiced in an era which saw the introduction of antibiotics. Many of us (being of age!) have seen medicine change with the development of computerized enhanced imaging (CT Scans and MR). EHRs will effect even greater changes, in that their use will force structural changes on how we deliver care. They will change how we obtain and process information, how we collaborate with colleagues, and how our patients engage us. New tools will demand new skills—reforming the care we deliver.

I encourage you to dive into the issue, and would love to hear comments.

Adapted from Editor’s Desk July JOP