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This local site visit was intended to allow participants to observe the electronic health record (EHR) as used in practice by two U.S. leaders in technology and quality, the Veterans Health Administration (VHA) and Kaiser Permanente (KP). The VHA has employed an EHR system since 1997; KP is in the process of implementing a standard system for all clinicians nationwide. The site visit was designed to provide an opportunity for participants to explore both the expected benefits from EHR adoption and the specific lessons these two large, integrated delivery systems have learned in their transition from paper to electronic records. How the experiences of the VHA and KP might apply to smaller, more fragmented medical practices also was a topic. Issues explored included privacy protection, infrastructure building, beneficiary access, and interoperability. More fundamentally, the group was asked to consider what barriers might be removed or incentives created to speed the dissemination of health information technology.

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