The Computer-based Patient Record (CPR) - now the Electronic Health Record (EHR) - arose beginning in the 1960s. One must be careful to differentiate between the application of data processing to healthcare settings from an EHR. As computers began to be applied to business functions in the late 1950s, and early on was applied to the business functions of healthcare, this was not related to EHRs. The EHR concept involves constructing a well thought out persistent data structure for containing the various observations made for an individual (patient) in the process of healthcare which aids the practitioner(s) in guiding that care. The evolution of the ideas embodying this concept has taken a long time and is best illustrated by a set of developmental projects that took place in the 1960s through the 1980s. During this period the ideas about common conventions (standards) for patient care data matured and formal efforts for documenting these conventions began.

For example, in the 1960s at Massachusetts General Hospital (MGH) a variety of efforts began that lead to a system for ambulatory records named Computer Stored Ambulatory Record (COSTAR) which was provided to members of the Harvard Community Health Plan. Slightly later at Regenstreif Institute in Indianapolis another ambulatory record system arose. At Duke University, a system called The Medical Record (TMR) was begun. The US Navy at Brunswick Naval Air Station developed an ambulatory medical record system derived from the MGH experience. A report was published in 1975 Ref A13) by the National Center for Health Services Research and Development of DHEW (now Agency for Healthcare Policy and Research - AHCPR - of DHHS) on the state of such systems.  In 1977 the Veterans Administration (now Dept. of Veteran's Affairs) began work on its EHR architecture known as Decentralized Hospital Computing Program (DHCP - now VISTA Veterans Integrated Service Technology Architecture) which is now really a comprehensive EHR for all settings. The Department of Defense began its Composite Health Care System (CHCS) architecture based upon that of the VA's DHCP in 1987. In 1998 the federal agencies began a collaborative effort named the Government Computer-based Patient Record (G-CPR). More detailed discussion of these developmental models is given in the Developmental Models Section of this EHR Definition Segment. It was not, however, until 1985 that formal efforts to assemble common conventions (standards) for the data structures and the representations for the data items that comprise a patient record began. Neither developmental models nor commercial products have yet to be validated against the common conventions that have been stated. For the viewer, however, these standards must first be understood in terms of the evolutionary history looking at the documentation of the common conceptual content and the process of implementing that content into products and services for the marketplace. The following pages in this Definition segment explore this historical background.