Next Generation EHRs - What Problems Are These Systems Aiming to Solve?

EHRs elicit an array of different aspirations all underpinned by the widely held conviction that they can deliver benefits for patients, clinicians, researchers, IT vendors, policy-makers and society as a whole. While techno-centric visions abound, reflection on their history, the challenges evident in their design, implementation and evaluation and the limited evidence of their beneficial impacts over time is instructive. From a socio-technical perspective EHRs appear to be a set of 'wicked problems' unlikely to be resolved in favor of one position or another, but rather requiring judgement, nuance and negotiation around the kinds of problems we want these systems to solve. This paper presents some perspectives on important potential features for next generation EHRs and on the types of problems that these systems could aspire to solve. The focus is not on prediction but rather on actively shaping the kind of future that we desire and how EHRs will support its achievement.