What is ehr emr?

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

For several decades, electronic health records (EHRs) have been touted as key to increasing of quality care. Electronic health records are used for other reasons than charting for patients; today, providers are using data from patient records to improve quality outcomes through their care management programs. EHR combines all patients demographics into a large pool, and uses this information to assist with the creation of "new treatments or innovation in healthcare delivery" which overall improves the goals in healthcare. Combining multiple types of clinical data from the system's health records has helped clinicians identify and stratify chronically ill patients. EHR can improve quality care by using the data and analytics to prevent hospitalizations among high-risk patients.

EHR systems are designed to store data accurately and to capture the state of a patient across time. It eliminates the need to track down a patient's previous paper medical records and assists in ensuring data is up-to-date, accurate and legible. It also allows open communication between the patient and the provider, while providing "privacy and security." It can reduce risk of data replication as there is only one modifiable file, which means the file is more likely up to date and decreases risk of lost paperwork and is cost efficient. Due to the digital information being searchable and in a single file, EMRs (electronic medical records) are more effective when extracting medical data for the examination of possible trends and long term changes in a patient. Population-based studies of medical records may also be facilitated by the widespread adoption of EHRs and EMRs.

The terms EHR, electronic patient record (EPR) and EMR have often been used interchangeably, but differences between the models are now being defined. The electronic health record (EHR) is a more longitudinal collection of the electronic health information of individual patients or populations. The EMR, in contrast, is the patient record created by providers for specific encounters in hospitals and ambulatory environments and can serve as a data source for an EHR.

In contrast, a personal health record (PHR) is an electronic application for recording personal medical data that the individual patient controls and may make available to health providers.

While there is still a considerable amount of debate around the superiority of electronic health records over paper records, the research literature paints a more realistic picture of the benefits and downsides.

The increased transparency, portability, and accessibility acquired by the adoption of electronic medical records may increase the ease with which they can be accessed by healthcare professionals, but also can increase the amount of stolen information by unauthorized persons or unscrupulous users versus paper medical records, as acknowledged by the increased security requirements for electronic medical records included in the Health Information and Accessibility Act and by large-scale breaches in confidential records reported by EMR users. Concerns about security contribute to the resistance shown to their adoption. When users log in into the electronic health records, it is their responsibility to make sure the information stays confidential and this is done by keeping their passwords unknown to others and logging off before leaving the station.

Handwritten paper medical records may be poorly legible, which can contribute to medical errors. Pre-printed forms, standardization of abbreviations and standards for penmanship were encouraged to improve the reliability of paper medical records. An example of possible medical errors is the administration of medication. Medication is an intervention that can turn a person's status from stable to unstable very quickly. With paper documentation it is very easy to not properly document the administration of medication, the time given, or errors such as giving the "wrong drug, dose, form, or not checking for allergies" and could affect the patient negatively. It has been reported that these errors have been reduced by "55-83%" because records are now online and require certain steps to avoid these errors.

Electronic records may help with the standardization of forms, terminology, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice. Overall, those with EMRs that have automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.

EMRs can be continuously updated (within certain legal limitations: see below). If the ability to exchange records between different EMR systems were perfected ("interoperability"), it would facilitate the coordination of health care delivery in nonaffiliated health care facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management, and public health communicable disease surveillance. However, it is difficult to remove data from its context.

Sharing their electronic health records with people who have type 2 diabetes helps them to reduce their blood sugar levels. It is a way of helping people understand their own health condition and involving them actively in its management.

They could also be useful in research, enabling various scientific analyses and novel tools (see below).

Electronic medical records could also be studied to quantify disease burdens – such as the number of deaths from antimicrobial resistance – or help identify causes of, factors of, links between and contributors to diseases, especially when combined with genome-wide association studies.

This may enable increased flexibility, improved disease surveillance, better medical product safety surveillance, better public health monitoring (such as for evaluation of health policy effectiveness), increased quality of care (via guidelines and improved medical history sharing), and novel life-saving treatments.

Privacy: For such purposes, electronic medical records could potentially be made available in securely anonymized or pseudonymized forms to ensure patients' privacy is maintained even if data breaches occur. There are concerns about the efficacy of some currently applied pseudonymization and data protection techniques, including the applied encryption.

Documentation burden: While such records could enable avoiding duplication of work via records-sharing, documentation burdens for medical facility personnel can be a further issue with EHRs. This burden could be reduced via voice recognition, optical character recognition, other technologies, involvement of physicians in changes to software, and other means which could possibly reduce the documentation burden to below paper-based records documentation and low-level documentation.

Theoretically, free software such as GNU Health and other open source health software could be used or modified for various purposes that use electronic medical records i.a. via securely sharing anonymized patient treatments, medical history and individual outcomes (including by common primary care physicians).

Ambulance services in Australia, the United States and the United Kingdom have introduced the use of EMR systems. EMS Encounters in the United States are recorded using various platforms and vendors in compliance with the NEMSIS (National EMS Information System) standard. The benefits of electronic records in ambulances include: patient data sharing, injury/illness prevention, better training for paramedics, review of clinical standards, better research options for pre-hospital care and design of future treatment options, data based outcome improvement, and clinical decision support.

Health Information Exchange

Using an EMR to read and write a patient's record is not only possible through a workstation but, depending on the type of system and health care settings, may also be possible through mobile devices that are handwriting capable, tablets and smartphones. Electronic Medical Records may include access to Personal Health Records (PHR) which makes individual notes from an EMR readily visible and accessible for consumers.

Some EMR systems automatically monitor clinical events, by analyzing patient data from an electronic health record to predict, detect and potentially prevent adverse events. This can include discharge/transfer orders, pharmacy orders, radiology results, laboratory results and any other data from ancillary services or provider notes. This type of event monitoring has been implemented using the Louisiana Public health information exchange linking statewide public health with electronic medical records. This system alerted medical providers when a patient with HIV/AIDS had not received care in over twelve months. This system greatly reduced the number of missed critical opportunities.

Within a meta-narrative systematic review of research in the field, various different philosophical approaches to the EHR exist. The health information systems literature has seen the EHR as a container holding information about the patient, and a tool for aggregating clinical data for secondary uses (billing, audit, etc.). However, other research traditions see the EHR as a contextualised artifact within a socio-technical system. For example, actor-network theory would see the EHR as an actant in a network, and research in computer supported cooperative work (CSCW) sees the EHR as a tool supporting particular work.

Several possible advantages to EHRs over paper records have been proposed, but there is debate about the degree to which these are achieved in practice.

Several studies call into question whether EHRs improve the quality of care. One 2011 study in diabetes care, published in the New England Journal of Medicine, found evidence that practices with EHR provided better quality care.

EMRs may eventually help improve care coordination. An article in a trade journal suggests that since anyone using an EMR can view the patient's full chart, it cuts down on guessing histories, seeing multiple specialists, smooths transitions between care settings, and may allow better care in emergency situations. EHRs may also improve prevention by providing doctors and patients better access to test results, identifying missing patient information, and offering evidence-based recommendations for preventive services.

The steep price and provider uncertainty regarding the value they will derive from adoption in the form of return on investment has a significant influence on EHR adoption. In a project initiated by the Office of the National Coordinator for Health Information, surveyors found that hospital administrators and physicians who had adopted EHR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented, as well as the need to increase information technology staff to maintain the system.

The U.S. Congressional Budget Office concluded that the cost savings may occur only in large integrated institutions like Kaiser Permanente, and not in small physician offices. They challenged the Rand Corporation's estimates of savings. "Office-based physicians in particular may see no benefit if they purchase such a product—and may even suffer financial harm. Even though the use of health IT could generate cost savings for the health system at large that might offset the EHR's cost, many physicians might not be able to reduce their office expenses or increase their revenue sufficiently to pay for it. For example, the use of health IT could reduce the number of duplicated diagnostic tests. However, that improvement in efficiency would be unlikely to increase the income of many physicians." One CEO of an EHR company has argued if a physician performs tests in the office, it might reduce his or her income.

Doubts have been raised about cost saving from EHRs by researchers at Harvard University, the Wharton School of the University of Pennsylvania, Stanford University, and others.

In 2022 the chief executive of Guy's and St Thomas' NHS Foundation Trust, one of the biggest NHS organisations, said that the £450 million cost over 15 years to install the Epic Systems electronic patient record across its six hospitals, which will reduce more than 100 different IT systems down to just a handful, was "chicken feed" when compared to the NHS's overall budget.

The implementation of EMR can potentially decrease identification time of patients upon hospital admission. A research from the Annals of Internal Medicine showed that since the adoption of EMR a relative decrease in time by 65% has been recorded (from 130 to 46 hours).

The Healthcare Information and Management Systems Society, a very large U.S. healthcare IT industry trade group, observed in 2009 that EHR adoption rates "have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available." The U.S. National Institute of Standards and Technology of the Department of Commerce studied usability in 2011 and lists a number of specific issues that have been reported by health care workers. The U.S. military's EHR, AHLTA, was reported to have significant usability issues. Furthermore, studies such as the one conducted in BMC Medical Informatics and Decision Making, also showed that although the implementation of electronic medical records systems has been a great assistance to general practitioners there is still much room for revision in the overall framework and the amount of training provided. It was observed that the efforts to improve EHR usability should be placed in the context of physician-patient communication.

However, physicians are embracing mobile technologies such as smartphones and tablets at a rapid pace. According to a 2012 survey by Physicians Practice, 62.6 percent of respondents (1,369 physicians, practice managers, and other healthcare providers) say they use mobile devices in the performance of their job. Mobile devices are increasingly able to sync up with electronic health record systems thus allowing physicians to access patient records from remote locations. Most devices are extensions of desk-top EHR systems, using a variety of software to communicate and access files remotely. The advantages of instant access to patient records at any time and any place are clear, but bring a host of security concerns. As mobile systems become more prevalent, practices will need comprehensive policies that govern security measures and patient privacy regulations.

Other advanced computational techniques have allowed EHRs to be evaluated at a much quicker rate. Natural language processing is increasingly used to search EMRs, especially through searching and analyzing notes and text that would otherwise be inaccessible for study when seeking to improve care. One study found that several machine learning methods could be used to predict the rate of a patient's mortality with moderate success, with the most successful approach including using a combination of a convolutional neural network and a heterogenous graph model.

When a health facility has documented their workflow and chosen their software solution they must then consider the hardware and supporting device infrastructure for the end users. Staff and patients will need to engage with various devices throughout a patient's stay and charting workflow. Computers, laptops, all-in-one computers, tablets, mouse, keyboards and monitors are all hardware devices that may be utilized. Other considerations will include supporting work surfaces and equipment, wall desks or articulating arms for end users to work on. Another important factor is how all these devices will be physically secured and how they will be charged that staff can always utilize the devices for EHR charting when needed.

The success of eHealth interventions is largely dependent on the ability of the adopter to fully understand workflow and anticipate potential clinical processes prior to implementations. Failure to do so can create costly and time-consuming interruptions to service delivery.

Per empirical research in social informatics, information and communications technology (ICT) use can lead to both intended and unintended consequences.

A 2008 Sentinel Event Alert from the U.S. Joint Commission, the organization that accredits American hospitals to provide healthcare services, states, 'As health information technology (HIT) and 'converging technologies'—the interrelationship between medical devices and HIT—are increasingly adopted by health care organizations, users must be mindful of the safety risks and preventable adverse events that these implementations can create or perpetuate. Technology-related adverse events can be associated with all components of a comprehensive technology system and may involve errors of either commission or omission. These unintended adverse events typically stem from human-machine interfaces or organization/system design." The Joint Commission cites as an example the United States Pharmacopeia MEDMARX database where of 176,409 medication error records for 2006, approximately 25 percent (43,372) involved some aspect of computer technology as at least one cause of the error.

The British National Health Service (NHS) reports specific examples of potential and actual EHR-caused unintended consequences in its 2009 document on the management of clinical risk relating to the deployment and use of health software.

In a February 2010, an American Food and Drug Administration (FDA) memorandum noted that EHR unintended consequences include EHR-related medical errors from (1) errors of commission (EOC), (2) errors of omission or transmission (EOT), (3) errors in data analysis (EDA), and (4) incompatibility between multi-vendor software applications or systems (ISMA), examples were cited. The FDA also noted that the "absence of mandatory reporting enforcement of H-IT safety issues limits the numbers of medical device reports (MDRs) and impedes a more comprehensive understanding of the actual problems and implications."

A 2010 Board Position Paper by the American Medical Informatics Association (AMIA) contains recommendations on EHR-related patient safety, transparency, ethics education for purchasers and users, adoption of best practices, and re-examination of regulation of electronic health applications. Beyond concrete issues such as conflicts of interest and privacy concerns, questions have been raised about the ways in which the physician-patient relationship would be affected by an electronic intermediary.

During the implementation phase, cognitive workload for healthcare professionals may be significantly increased as they become familiar with a new system.

EHRs are almost invariably detrimental to physician productivity, whether the data is entered during the encounter or sometime thereafter. It is possible for an EHR to increase physician productivity by providing a fast and intuitive interface for viewing and understanding patient clinical data and minimizing the number of clinically irrelevant questions, but that is almost never the case. The other way to mitigate the detriment to physician productivity is to hire scribes to work alongside medical practitioners, which is almost never financially viable.

As a result, many have conducted studies like the one discussed in the Journal of the American Medical Informatics Association, "The Extent And Importance of Unintended Consequences Related To Computerized Provider Order Entry," which seeks to understand the degree and significance of unplanned adverse consequences related to computerized physician order entry and understand how to interpret adverse events and understand the importance of its management for the overall success of computer physician order entry.

In the United States, Great Britain, and Germany, the concept of a national centralized server model of healthcare data has been poorly received. Issues of privacy and security in such a model have been of concern.

In the European Union (EU), a new directly binding instrument, a regulation of the European Parliament and of the council, was passed in 2016 to go into effect in 2018 to protect the processing of personal data, including that for purposes of health care, the General Data Protection Regulation.

Threats to health care information can be categorized under three headings:

These threats can either be internal, external, intentional and unintentional. Therefore, one will find health information systems professionals having these particular threats in mind when discussing ways to protect the health information of patients. It has been found that there is a lack of security awareness among health care professionals in countries such as Spain. The Health Insurance Portability and Accountability Act (HIPAA) has developed a framework to mitigate the harm of these threats that is comprehensive but not so specific as to limit the options of healthcare professionals who may have access to different technology. With the increase of clinical notes being shared electronically as a result of the 21st Century Cures Act, an increase in sensitive terms used across the records of all patients, including minors, are increasingly shared amongst care teams, complicating efforts to maintain privacy.

Personal Information Protection and Electronic Documents Act (PIPEDA) was given Royal Assent in Canada on 13 April 2000 to establish rules on the use, disclosure and collection of personal information. The personal information includes both non-digital and electronic form. In 2002, PIPEDA extended to the health sector in Stage 2 of the law's implementation. There are four provinces where this law does not apply because its privacy law was considered similar to PIPEDA: Alberta, British Columbia, Ontario and Quebec.

The COVID-19 pandemic in the United Kingdom led to radical changes. NHS Digital and NHSX made changes, said to be only for the duration of the crisis, to the information sharing system GP Connect across England, meaning that patient records are shared across primary care. Only patients who have specifically opted out are excluded.

Legal liability in all aspects of healthcare was an increasing problem in the 1990s and 2000s. The surge in the per capita number of attorneys in the USA and changes in the tort system caused an increase in the cost of every aspect of healthcare, and healthcare technology was no exception.

Failure or damages caused during installation or utilization of an EHR system has been feared as a threat in lawsuits. Similarly, it's important to recognize that the implementation of electronic health records carries with it significant legal risks.

This liability concern was of special concern for small EHR system makers. Some smaller companies may be forced to abandon markets based on the regional liability climate. Larger EHR providers (or government-sponsored providers of EHRs) are better able to withstand legal assaults.

While there is no argument that electronic documentation of patient visits and data brings improved patient care, there is increasing concern that such documentation could open physicians to an increased incidence of malpractice suits. Disabling physician alerts, selecting from dropdown menus, and the use of templates can encourage physicians to skip a complete review of past patient history and medications, and thus miss important data.

Another potential problem is electronic time stamps. Many physicians are unaware that EHR systems produce an electronic time stamp every time the patient record is updated. If a malpractice claim goes to court, through the process of discovery, the prosecution can request a detailed record of all entries made in a patient's electronic record. Waiting to chart patient notes until the end of the day and making addendums to records well after the patient visit can be problematic, in that this practice could result in less than accurate patient data or indicate possible intent to illegally alter the patient's record.

In some communities, hospitals attempt to standardize EHR systems by providing discounted versions of the hospital's software to local healthcare providers. A challenge to this practice has been raised as being a violation of Stark rules that prohibit hospitals from preferentially assisting community healthcare providers. In 2006, however, exceptions to the Stark rule were enacted to allow hospitals to furnish software and training to community providers, mostly removing this legal obstacle.

In cross-border use cases of EHR implementations, the additional issue of legal interoperability arises. Different countries may have diverging legal requirements for the content or usage of electronic health records, which can require radical changes to the technical makeup of the EHR implementation in question. (especially when fundamental legal incompatibilities are involved) Exploring these issues is therefore often necessary when implementing cross-border EHR solutions.

The United Nations World Health Organization (WHO) administration intentionally does not contribute to an internationally standardized view of medical records nor to personal health records. However, WHO contributes to minimum requirements definition for developing countries.

The United Nations accredited standardization body International Organization for Standardization (ISO) however has settled thorough word for standards in the scope of the HL7 platform for health care informatics. Respective standards are available with ISO/HL7 10781:2009 Electronic Health Record-System Functional Model, Release 1.1 and subsequent set of detailing standards.

The majority of the countries in Europe have made a strategy for the development and implementation of the Electronic Health Record Systems. This would mean greater access to health records by numerous stakeholders, even from countries with lower levels of privacy protection. The forthcoming implementation of the Cross Border Health Directive and the EU Commission's plans to centralize all health records are of prime concern to the EU public who believe that the health care organizations and governments cannot be trusted to manage their data electronically and expose them to more threats.

The idea of a centralized electronic health record system was poorly received by the public who are wary that governments may use of the system beyond its intended purpose. There is also the risk for privacy breaches that could allow sensitive health care information to fall into the wrong hands. Some countries have enacted laws requiring safeguards to be put in place to protect the security and confidentiality of medical information. These safeguards add protection for records that are shared electronically and give patients some important rights to monitor their medical records and receive notification for loss and unauthorized acquisition of health information. The United States and the EU have imposed mandatory medical data breach notifications.

The purpose of a personal data breach notification is to protect individuals so that they can take all the necessary actions to limit the undesirable effects of the breach and to motivate the organization to improve the security of the infrastructure to protect the confidentiality of the data. The US law requires the entities to inform the individuals in the event of breach while the EU Directive currently requires breach notification only when the breach is likely to adversely affect the privacy of the individual. Personal health data is valuable to individuals and is therefore difficult to make an assessment whether the breach will cause reputational or financial harm or cause adverse effects on one's privacy.

The Breach notification law in the EU provides better privacy safeguards with fewer exemptions, unlike the US law which exempts unintentional acquisition, access, or use of protected health information and inadvertent disclosure under a good faith belief.

The U.S. federal government has issued new rules of electronic health records.

A common data model (CDM) is a specification that describes how data from multiple sources (e.g., multiple EHR systems) can be combined. Many CDMs use a relational model (e.g., the OMOP CDM). A relational CDM defines names of tables and table columns and restricts what values are valid.

Each healthcare environment functions differently, often in significant ways. It is difficult to create a "one-size-fits-all" EHR system. Many first generation EHRs were designed to fit the needs of primary care physicians, leaving certain specialties significantly less satisfied with their EHR system.

An ideal EHR system will have record standardization but interfaces that can be customized to each provider environment. Modularity in an EHR system facilitates this. Many EHR companies employ vendors to provide customization.

This customization can often be done so that a physician's input interface closely mimics previously utilized paper forms.

At the same time they reported negative effects in communication, increased overtime, and missing records when a non-customized EMR system was utilized. Customizing the software when it is released yields the highest benefits because it is adapted for the users and tailored to workflows specific to the institution.

Customization can have its disadvantages. There is, of course, higher costs involved to implementation of a customized system initially. More time must be spent by both the implementation team and the healthcare provider to understand the workflow needs.

Development and maintenance of these interfaces and customizations can also lead to higher software implementation and maintenance costs.

An important consideration in the process of developing electronic health records is to plan for the long-term preservation and storage of these records. The field will need to come to consensus on the length of time to store EHRs, methods to ensure the future accessibility and compatibility of archived data with yet-to-be developed retrieval systems, and how to ensure the physical and virtual security of the archives.

Additionally, considerations about long-term storage of electronic health records are complicated by the possibility that the records might one day be used longitudinally and integrated across sites of care. Records have the potential to be created, used, edited, and viewed by multiple independent entities. These entities include, but are not limited to, primary care physicians, hospitals, insurance companies, and patients. Mandl et al. have noted that "choices about the structure and ownership of these records will have profound impact on the accessibility and privacy of patient information."

The required length of storage of an individual electronic health record will depend on national and state regulations, which are subject to change over time. Ruotsalainen and Manning have found that the typical preservation time of patient data varies between 20 and 100 years. In one example of how an EHR archive might function, their research "describes a co-operative trusted notary archive (TNA) which receives health data from different EHR-systems, stores data together with associated meta-information for long periods and distributes EHR-data objects. TNA can store objects in XML-format and prove the integrity of stored data with the help of event records, timestamps and archive e-signatures."

In addition to the TNA archive described by Ruotsalainen and Manning, other combinations of EHR systems and archive systems are possible. Again, overall requirements for the design and security of the system and its archive will vary and must function under ethical and legal principles specific to the time and place.

While it is currently unknown precisely how long EHRs will be preserved, it is certain that length of time will exceed the average shelf-life of paper records. The evolution of technology is such that the programs and systems used to input information will likely not be available to a user who desires to examine archived data. One proposed solution to the challenge of long-term accessibility and usability of data by future systems is to standardize information fields in a time-invariant way, such as with XML language. Olhede and Peterson report that "the basic XML-format has undergone preliminary testing in Europe by a Spri project and been found suitable for EU purposes. Spri has advised the Swedish National Board of Health and Welfare and the Swedish National Archive to issue directives concerning the use of XML as the archive-format for EHCR (Electronic Health Care Record) information."

When care is provided at two different facilities, it may be difficult to update records at both locations in a co-ordinated fashion. Two models have been used to satisfy this problem: a centralized data server solution, and a peer-to-peer file synchronization program (as has been developed for other peer-to-peer networks). Synchronization programs for distributed storage models, however, are only useful once record standardization has occurred. Merging of already existing public healthcare databases is a common software challenge. The ability of electronic health record systems to provide this function is a key benefit and can improve healthcare delivery.

The sharing of patient information between health care organizations and IT systems is changing from a "point to point" model to a "many to many" one. The European Commission is supporting moves to facilitate cross-border interoperability of e-health systems and to remove potential legal hurdles, as in the project www.epsos.eu/. To allow for global shared workflow, studies will be locked when they are being read and then unlocked and updated once reading is complete. Radiologists will be able to serve multiple health care facilities and read and report across large geographical areas, thus balancing workloads. The biggest challenges will relate to interoperability and legal clarity. In some countries it is almost forbidden to practice teleradiology. The variety of languages spoken is a problem and multilingual reporting templates for all anatomical regions are not yet available. However, the market for e-health and teleradiology is evolving more rapidly than any laws or regulations.

See Electronic health records in the United States

In 2011, Moscow's government launched a major project known as UMIAS as part of its electronic healthcare initiative. UMIAS - the Unified Medical Information and Analytical System - connects more than 660 clinics and over 23,600 medical practitioners in Moscow. UMIAS covers 9.5 million patients, contains more than 359 million patient records and supports more than 500,000 different transactions daily. Approximately 700,000 Muscovites use remote links to make appointments every week.

The European Commission wants to boost the digital economy by enabling all Europeans to have access to online medical records anywhere in Europe by 2020. With the newly enacted Directive 2011/24/EU on patients' rights in cross-border healthcare due for implementation by 2013, it is inevitable that a centralised European health record system will become a reality even before 2020. However, the concept of a centralised supranational central server raises concern about storing electronic medical records in a central location. The privacy threat posed by a supranational network is a key concern. Cross-border and Interoperable electronic health record systems make confidential data more easily and rapidly accessible to a wider audience and increase the risk that personal data concerning health could be accidentally exposed or easily distributed to unauthorised parties by enabling greater access to a compilation of the personal data concerning health, from different sources, and throughout a lifetime.

The Lloyd George envelope digitisation project is the aim to have all paper copies of all historic patient data transferred onto computer systems. as part of the roll out new patients will no longer be given a transit label to register when moving practices. Not only is it a step closer to a Digital NHS and reduce the movement of records between practices, The Project also frees up space in practices that are used to store records as well as having the added benefit of being more environmentally friendly

Lyniate was selected to provide data integration technologies for Health and Social Care (Northern Ireland) in 2022. Epic Systems will supply integrated electronic health records with a single digital record for every citizen. Lyniate Rhapsody, already used in used in 79 NHS Trusts, will be used to integrate the multiple health and social care systems.

In UK veterinary practice, the replacement of paper recording systems with electronic methods of storing animal patient information escalated from the 1980s and the majority of clinics now use electronic medical records. In a sample of 129 veterinary practices, 89% used a Practice Management System (PMS) for data recording. There are more than ten PMS providers currently in the UK. Collecting data directly from PMSs for epidemiological analysis abolishes the need for veterinarians to manually submit individual reports per animal visit and therefore increases the reporting rate.

Veterinary electronic medical record data are being used to investigate antimicrobial efficacy; risk factors for canine cancer; and inherited diseases in dogs and cats, in the small animal disease surveillance project 'VetCOMPASS' (Veterinary Companion Animal Surveillance System) at the Royal Veterinary College, London, in collaboration with the University of Sydney (the VetCOMPASS project was formerly known as VEctAR).

A letter published in Communications of the ACM describes the concept of generating synthetic patient population and proposes a variation of Turing test to assess the difference between synthetic and real patients. The letter states: "In the EHR context, though a human physician can readily distinguish between synthetically generated and real live human patients, could a machine be given the intelligence to make such a determination on its own?" and further the letter states: "Before synthetic patient identities become a public health problem, the legitimate EHR market might benefit from applying Turing Test-like techniques to ensure greater data reliability and diagnostic value. Any new techniques must thus consider patients' heterogeneity and are likely to have greater complexity than the Allen eighth-grade-science-test is able to grade."

You may have heard of the terms "EHR" and "EMR," but what do they mean, and which one is suitable for your healthcare organization?

EHR (electronic health record) and EMR (electronic medical record) are both software systems used to manage patient data. However, there are a few key differences between the two that could make one more appropriate for your needs than the other.

In this article, we'll break down EHR vs. EMR and help you decide which one is right for you.

EHR and EMR are both electronic management systems, but they differ in many ways.

An EMR (Electronic Medical Record) is a single provider's digital representation of a patient's health chart. An EHR (Electronic Health Record) is a more detailed report of the patient's overall health details. It is tailored to be shared with other health providers, allowing authorized users to access a patient's medical records instantly.

While EHRs are made to allow authorized clinicians and personnel from several organizations to access a patient's information, EMRs are primarily utilized by healthcare professionals for diagnosis and treatment. An EMR does not easily travel outside the practice and may require printing and mailing to get to another provider.

EHRs and EMRs both pose a set of benefits and drawbacks:

EMRs offer several perks to clinical practice. Not only are they an improvement from paper records, but they are also more affordable. EMRs also allow you to:

If you’ve been wondering why we discussed EMRs first, here’s why: EHR systems offer all the benefits of EMRs plus more.

EHR systems are not always user-friendly and can be expensive to implement. In addition, some laws restrict the use of EHRs in mental health settings or specialty practices. EMR systems are often more affordable than their EHR counterparts, so you may consider this option if your practice is on a tight budget or wants to start small with just one system.

An EHR/EMR system is a great way to improve the efficiency of your medical practice. However, you can't just rely on an EMR or EHR system to do everything for you. You need to make sure that your organization uses its information management tools correctly and effectively for them to be effective.

Here are some tips:

Store all records related to diagnosis, treatment plans, billing information, and more electronically. It would help if you also tracked how long patients have been treated using digital charts that store all patient data (including test results).

This is especially true when monitoring patient compliance with their prescribed therapies. You should use the system to track each patient's medication usage (including dosage and frequency) to determine how well they respond to the treatment plan.

Employ robust security layers to inhibit breaches and put up security measures to ensure all access credentials are only accessible to authorized persons. This helps ensure that no one has access without necessary permission and ensures HIPAA compliance.

Effectively configure the system initially and continually back up your data to avoid losses.

EHR and EMR systems are beneficial to companies of all sizes. They can help manage your medical records, improve patient satisfaction, reduce liability, and increase productivity.

With both systems' clear advantages and disadvantages, it is crucial to determine which would work best for your organization. There are many factors to consider when choosing and implementing an EMR or EHR system. You must consider if any specific needs within your facility or office space will benefit from having one of these tools installed on-site.

Do you need more help determining whether you need an EHR or an EMR for your practice? At Software Advice, we’ll help you find the right system for your needs and budget in 15 minutes or less. Schedule a call to chat with a software advisor now for free. You can also visit our resources hub for more software insights.

What’s in a word? Or, even one letter of an acronym?

Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.

In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.

What’s the Difference?

Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:

But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”

The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.

And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.

Benefits of EHRs

With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:

So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a world of difference.

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• Automated scheduling. The EHR app inputs the info into the scheduling system in order to keep it updated about the most recent appointments.
• Monitoring patients' status.
• Managing tasks.
• Generating support documentation.
• Processing claims.
• Digital chart.
• Voice and handwriting recognition.
• Generating reports.

Although some clinicians use the terms EHR and EMR interchangeably, the benefits they offer vary greatly. An EMR (electronic medical record) is a digital version of a chart with patient information stored in a computer and an EHR (electronic health record) is a digital record of health information.

Practice Fusion is a cloud-based EHR system that securely stores data on external servers and can be accessed with any device that has an internet connection, whereas server-based EHR systems store data on either a personal server or in a data center.

The EMR, or electronic medical record, refers to everything you’d find in a paper chart, such as medical history, diagnoses, medications, immunization dates, and allergies. While EMRs work well within a practice, they’re limited because they don’t easily travel outside the practice. In fact, the patient’s medical record might even have to be printed out and mailed for another provider to see it.

An EHR or electronic health record is a digital record of health information. It contains all the information you’d find in a paper chart — and a lot more. An EHR may include past medical history, vital signs, progress notes, diagnoses, medications, immunization dates, allergies, lab data and imaging reports. It can also contain other relevant information, such as insurance information, demographic data, and even data imported from personal wellness devices.

Practice Fusion is a cloud-based EHR system that allows enables interoperability and the secure sharing of health information. It offers the opportunity to extend the capabilities available to health organizations in order to implement better ways of working and to offer new services to patients.

The power of an EHR lies not only in the data it contains, but how it’s shared – health information becomes instantly accessible to authorized providers across practices and health organizations, helping to coordinate care efficiently. An EHR can be shared with clinicians and organizations involved in a patient’s care, such as labs, specialists, imaging facilities, pharmacies, emergency facilities, and school and workplace clinics.

An EHR is necessary to meet Meaningful Use requirements. Meaningful Use is a Medicare and Medicaid program that supports the use of an EHR to improve patient care. To achieve Meaningful Use and avoid penalties on Medicare and Medicaid reimbursements, eligible providers must follow a set of criteria that serve as a roadmap for effectively using an EHR. CMS has renamed the Medicare Meaningful Use program into MIPS and the Medicaid program into Promoting Interoperability.

Using Practice Fusion enables you to meet the criteria for Meaningful Use so you can receive reimbursement.

EHRs are the future of healthcare because they provide critical data that can help coordinate care between all providers in the healthcare ecosystem.

While both EHR and EMR are commonly used terms, the term “EHR” (electronic health records) is now referenced more frequently. This is likely due to the Centers for Medicare & Medicaid Services (CMS), as well as the Office of the National Coordinator for Health Information (ONC) preference for the term “EHR.”

When speaking of health care reform, CMS always uses the terminology, “meaningful use of an EHR.” The ONC exclusively uses the terms “EHR” and “electronic health records,” explaining that the word ‘health’ is more encompassing than the word ‘medical’. The term “Medical Records” implies clinician records for diagnosis and treatment, while the term “Health Records” more broadly denotes anything related to the general condition of the body. A Personal Health Record known as PHR is just that: personal. It is those parts of the EMR/EHR that an individual person “owns” and controls.

According to the Centers for Disease Control and Prevention (CDC), 85.9% of office-based physicians use any EMR/EHR system, while 79.7% use a certified EMR/EHR system.1

A fully functional EHR system goes beyond basic functionalities such as clinical notes and documentation. It incorporates more of your practice workflows. With a fully functional EHR, your practice is seamlessly integrated with other members of the healthcare community, helping to:

Practice Fusion is a cloud-based EHR system and offers an affordable, turnkey solution that is considered one of the most user-friendly EHRs available. For only $149 per provider, per month, Practice Fusion can help your practice meet regulations, electronically prescribe controlled substances, and integrate patient records with laboratories and imaging centers.

Practice Fusion can help you and your staff save time and improve clinical efficiency. You’ll also get all the support you need for no extra or hidden charges. Practice Fusion’s expert support staff stands ready to assist with training and issues if they arise.

While there are many advantages to having an EMR or EHR system, there are some disadvantages as well.

The EHR is the future of healthcare because they provide critical data that can help coordinate care between everyone in the healthcare ecosystem. An EHR has the following benefits over an EMR:

In order to capture and share patient data efficiently, providers need an EHR that stores data in a structured format. Structured data allows patient information to be easily retrieved and transferred and allows the provider to use the EHR in ways that can aid patient care.

Regardless if providers and vendors use the terms, “Electronic Medical Record” or “EMR” when talking about Electronic Health Record (EHR) technology, for the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals must use certified EHR technology or CEHRT.

Practice Fusion is 100% certified EHR technology (CEHRT).

Choosing a fully integrated EHR goes beyond just the features — you’ll need to evaluate the costs, required hardware, the complexity of implementation, and the available training and support. Learn more about how to choose an EHR.

Improving clinician workflows and practice efficiencies passes the benefits of the EHR on to patients. Quality of care and patient satisfaction improves as clinicians become more efficient in their daily tasks. Spending less time charting allows for more time to do what matters most: care for your patients.

Practice Fusion can provide an affordable EHR solution for small and independent practices. Its cloud-based EHR platform enables clinicians to comply with electronic prescribing of controlled substances (EPCS) regulations, qualify for meaningful use reimbursement, and integrate patient records with labs and imaging centers.

An easy-to-use EHR like Practice Fusion, can help reduce clinician burnout due to time spent maintaining paper charts or working with cumbersome, hard-to-use software. Most importantly, Practice Fusion can help improve interoperability and contribute toward a better quality of care and patient experience. Your practice is our purpose.

References:

Medical data is broadly classified into three parts which are used interchangeably. They are Electronic medical records (EMR), electronic health records (EHR), and personal health records (PHR). EMR is a health information technology solution such as software or a platform that is used by a healthcare provider to record all patient diagnoses and treatment.  In brief, EMRs are digitalized versions of medical paper charts of a patient’s treatment. These are usually transactional in nature, the solutions are used to record medical history, diagnoses, medications, immunization dates, and other information related to the current treatment of a patient. The technologies which are used by Government initiatives and healthcare providers to maintain such health records are known as EMR software or solutions.

Electronic medical records (EMR) is not only beneficial for the patients, but it also has numerous benefits for healthcare providers and doctors.

Physicians benefit from electronic medical records in the following ways.

Improves organization of data.

Across various intersections of patient care, there is a lot of data that a hospital or clinic generates. EMR helps in the integration and organization of data, thereby improving efficiency and enhancing the quality of healthcare delivery.

Help keep physicians stay up-to-date

Many times, a patient needing treatment for more than one ailment or a complex surgery undergoes doctor consultation from multiple experts and stakeholders. An EMR is consistently updated with greater accuracy of various medical views and medicines or treatments prescribed. Therefore, it helps physicians stay updated.

Reduces operational costs.

As EMR brings efficiency to the system, it helps minimize operational costs and wastage of resources. It helps by sending reminders and alerts to various stakeholders, making reporting and communication easy. Furthermore, it reduces the time of healthcare providers by digitalizing manual paperwork.

Scalable.

EMR solutions are software-as-a-source technologies, which are not rigid by nature. The technologies can be scaled up or down as per the requirement of the hospital in a cost-effective manner.

EMR offers the following key benefits to patients.

Easy access to care.

EMR makes access to care easy for patients. For patients, often medical knowledge and information are too complicated to record and understand or remember. With regards to doctor’s consultations, they may not be able to explain and divulge information with accuracy. However, with EMR, not only do patients have access to records but doctors also have access to records, which helps them offer better-informed treatment regimens.

Keeps data safe and protected.

It is imperative for institutions to safeguard patient data so that the information is only used for legal and right issues. As most EMR systems are backed by cloud technologies, data security and protection are of utmost importance for technologies.

Easy to track reports.

Needless to explain, EMR makes data and diagnostic report recording easy and therefore it also makes accessing and tracking reports very convenient for stakeholders.

Promotes preventive healthcare.

With easy access to prescriptions, reports, and clinical advice, the patient is always motivated to monitor their progress and take adequate preventive measures to prevent worsening of health conditions by following the prescribed lifestyle.

Often EMR is used to refer to all three types of health records, including HER and PHR. EMR is fundamentally the digital recordkeeping of information systems and data generated within a healthcare facility. However, it also includes EHRs which are the medical records of a patient across doctors and healthcare providers.

There are some key differences between EMR and EHR software. EMR is usually a digitalized version of clinical charts, including patient treatment information, used by healthcare providers for diagnosis and treatment. It is mostly for hospital and patient use and is not designed for external use. Contrarily, EHR is a digital record of a patient’s health information, and it is integrated for access to other healthcare providers who are authorized by the patient and the Government. It also offers access to tools used by healthcare providers for informed decision-making.

PHR is the personal, compiled, and updated copy of health records of a patient-generated for their own records and health management.

There are several types of EMRs catering to the specific needs of hospitals and healthcare providers.

Mac EMR Software.

It is a software specially designed to work on Mac Operating System (MacOS) or Macintosh Computers.

Medical Billing Software.

As EMR record the complete patient treatment cycle in a hospital, it can easily be integrated with medical billing systems for the management of claims, billing, payments, and other financial transactions, without requiring to deal with paper-based systems.

Cloud-Based EMR Software.

Most good EMR SaaS technologies, like KareXpert’s EMR solutions,  are backed by cloud storage technologies. Cloud makes data storage and security more robust by saving all information on remote servers. Furthermore, the technology makes EMR systems more scalable, simple, cost-effective, and easy for secured data sharing.

Mental Health EMR Software.

These EMR solutions provide workflows to behavioral and mental health providers and counselors for psychological situations in patient management.

ONC-Certified EMR Software.