Open Access Highly Accessed Research article

Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records

Dean F Sittig1*, Adam Wright2, Seth Meltzer3, Linas Simonaitis4, R Scott Evans5, W Paul Nichol6, Joan S Ash7 and Blackford Middleton3

Author Affiliations

1 UTHealth-Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA

2 Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA

3 Clinical Informatics Research & Development, Partners Healthcare System, Boston, MA, USA

4 Regenstrief Institute, Inc.; Indiana University School of Medicine, Indianapolis, IN, USA

5 Department of Medical Informatics, Intermountain Health Care, Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA

6 Patient Care Services, Veterans Health Administration, Seattle WA, USA

7 Department of Medical Informatics, Oregon Health & Science University, Portland, OR, USA

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BMC Medical Informatics and Decision Making 2011, 11:13  doi:10.1186/1472-6947-11-13

Published: 17 February 2011



We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria.


We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content.


All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified.


If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.