Regulating Electronic Health Records Through the "Nuclear" Threat and Other Enforcement Options: Federal Government Actions to Compel EHR Industry Changes

By John Jay Kenagy, Ph.D., J.D., Senior Vice President / Chief Information and Administrative Officer, Legacy Health, Portland, OR


The oldest existing patient record, discovered in Egypt in 1862, dates back to 1600 B.C.  It was written on papyrus and included 48 case reports of injuries, wounds, and tumors.1 By the end of the 1800s, paper charts began to resemble present-day content and formatting.2  In the 1960s, Lockheed developed one of the first computer-based electronic health records (EHRs) in the United States.3  While adoption was initially slow, government promotion of incentives in the past decade has increased EHR deployment significantly.4

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