What Airline Reservation Systems Tell Us about the Future of EHRs

In the airline industry, the justification for adoption of computerized reservation systems (CRSs), shifted from operational efficiency, to marketing strategies to recoup investment, to competitive advantages of essential business tools. This progress contributed to fundamental changes in the structure of the industry. In large part, network externalities created by these systems and the discrepancy between who paid for the systems, and who reaped the financial benefits drove these changes. In this paper we argue that 1) this turbulent systems evolution was driven by environmental, technological, and structural factors, 2) it is analogous to current trends in the health care industry and that 3) similar patterns of adoption will occur in electronic health records (EHRs). Lessons learned from the evolution of CRSs are utilized to analyze problems and issues in the development of EHRs. We conclude with recommendations for the evolution of EHRs as essential tools in the health care industry.