How and When Did EMR Emerge?

EMR has been around for a long time since it was introduced in prototype form in the 1960s as part of the earliest hospital administration data-processing systems. The first official electronic medical record was released in 1972 by the Regenstreif Institute, but the concept failed to gain traction. In 1991, the Institute of Medicine was the first to recommend using electronic records, identifying it as one of seven key recommendations for improving patient records, and to propose a means of converting paper to electronic records. Even as the emergence of EMR’s continued, in 1996 the Health Insurance Portability and Accountability Act (HIPAA) was introduced in response to growing issues facing healthcare coverage, privacy and security in the United States. To follow disclosure and confidentiality regulations included in HIPPA, organizations started shifting to electronic records to comply with these laws.

EMRs were initially designed around the unique workflows of a particular care delivery organization (CDO) and were known as clinical information systems. Accordingly, an EMR System was meant to be a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information "within the confines of a single organization". It could touch clinical data repositories, lab applications and patient information management systems, among others -- but all within the reach of a single care delivery organization (CDO). Data in EMR was meant to be a legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.

Due to high costs, EMR systems were not attractive to physicians but that started changing in 1990's with the personal computers becoming more affordable and more powerful at the same time. This set the stage for the development of web based EMRs which were implemented in client-server mode and were accessed using a browser. The ability to access information remotely or store on a remote-system, made the electronic method of maintaining records more appealing and also more affordable for physicians to implement into their practice.

 

EHR is born

During President George W. Bush’s time in the Oval Office, a call was made for an industry-wide adoption of electronic health record systems by 2014. This mandate was thereafter supported by President Obama as part of the American Recovery and Reinvestment Act (ARRA), a piece of legislation aimed at directing additional funding and incentives to healthcare professionals who adopt these electronic medical systems and follow the concept of “meaningful use” by the year 2014.

 

Difference between EHR and EMR

Today, it's not uncommon for health care professionals to use "EMR" and "EHR" interchangeably; however, EMRs and EHRs share a lot of functionality and capabilities; many people believe they're synonymous. Both contain some version of a paperless chart that collects, tracks, and manages patient information such as demographics, diagnoses and treatment histories, and health benchmarks, and both include features to increase efficiencies and improve quality of care. But there are major differences, too. 


 

What is EMR?Electronic-Medical-Records.jpg

An Electronic Medical Record (EMR) is "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization."

EMR contains some version of a paperless chart that collects, tracks, and manages patient information such as demographics, diagnoses and treatment histories, and health benchmarks, and includes features to increase efficiencies and improve quality of care.

Paper vs. Electronic Medical Records

According to HealthIT.gov, the easiest way to define an electronic medical record is to compare it to a digital version of the paper chart in a doctor's office. EMR is able to:

  • Collect patient demographic data

  • Document patient encounters and treatment history; record response to treatment

  • Track data and health metrics over time

  • Identify patients due for preventive services and routine care

  • Generate data to help monitor and improve the overall quality of care within the practice

These functions are extremely helpful to clinicians within the practice, and therein lies the main limitation of EMR software.

What you should know about EMR?

  • EMR systems are designed to replace the paper chart and streamline the documentation and data management within a particular practice.

  • EMRs don't travel with patients, they aren't amenable to information sharing across health care systems and networks

  • EMRs are usually designed around the workflows, procedures, and processes of a particular organization and medical specialty. Therefore you will see Pediatrics-specific EMR, or Cardiology EMR, for example. These specialty-specific EMR systems include templates and features that simplify the care delivery, documentation, and billing processes unique to a specialty practice.

  • EMRs may incorporate ancillary services such as lab and imaging, and even include clinical decision support, but these components are tightly organized around the needs of the individual physician and practice.

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What is EHR?

EHR Definition

Again, according to HealthIT.gov, Electronic Health Records (EHRs) "go beyond standard clinical data collected in a provider’s office and are inclusive of a broader view of a patient’s care."

An EHR system includes all of the functionality of an EMR, but adds other key elements:EMR_vs_EHR.png

  • The ability to securely share information across health care systems, networks, and authorized public health agencies in real time.
  • Patient access portal to view, add to, and manage portions of the health record.
  • The ability to upload digital images, lab results, and progress notes by all clinicians involves in the patient's care.
  • Broad spectrum clinical decision support and medication management.
  • Portable across all sites of care, including hospitals, skilled nursing facilities, emergency departments, and outpatient facilities whether in or out of patient's home network.
  • The ability to monitor and manage population health and quality of care across broad networks and care delivery organizations.

What you should know about EHR?

  • EHRs are a global and all-encompassing view of the patient's health status and care that is useful to anyone treating the patient, including pharmacists, workplace health clinics, and school and public health agencies.

  • EHRs facilitate true coordination of care across the entire health care spectrum.

  • HIMSS Analytics states 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.

  • The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs providing significant benefits.

 

EHR vs EMR : What is the Real Difference Between EMR & EHR?

Both EMR and EHR contain digital version of a paperless chart that collects, tracks, and manages patient information such as demographics, diagnoses and treatment histories, and health benchmarks, and both include features to increase efficiencies and improve quality of care. But there are major differences, too. Perhaps the most significant difference between an EMR and an EHR is that an EMR is designed to replace a paper chart within a specific practice or health care system; the information in an electronic medical record is meant to be used by staff within that practice alone. An electronic health record on the other hand, is designed to be compiled, accessed, and shared by anyone who provides care or treatment for a particular patient or group of individuals. It moves beyond traditional boundaries of practice, health care network, and even geography to provide a complete, longitudinal record of the patient's health to enable more complete coordination of care.

Examples of differences between EHR and EMR

  • An EMR records immunization data, but an EHR enables electronic sharing of that information with government, school, or workplace clinicians. 

  • A primary care practice can enter the report from a patient's diagnostic imaging study in an EMR, but the radiologist can upload digital images and notes into the patient's EHR. 

  • A patient can request that information from the EMR be transmitted to a consulting physician, but multiple authorized providers can view and add information to an EHR, enabling interactive communication and care coordination.

In addition, patients have an element of control over information in their EHR that isn't required in an EMR; Meaningful Use explicitly lays out guidelines that allow patients to access, share, and even add to certain portions of the EHR. In reality, secure patient-to-provider and provider-to-provider communication is a hallmark feature of electronic health records. 

 

Which Is Better, an EMR or EHR?

EHRs offer a wealth of advantages to both patients and providers over their EMR counterparts:

  • Clinical notes and hospital documentation move with the patient from one care setting to another to ensure continuity of care. 
  • Diagnosis and treatment histories, as well as allergy information, are available to emergency medical personnel to inform treatment decisions when the patient is unable to speak for himself. 
  • Health reporting and surveillance across multiple care organizations improve public health and population health outcomes. 

In a nutshell, then, EHRs are designed to break down barriers between all the stakeholders involved in a patient's care, while EMRs are designed around the workflows and efficiencies of a particular practice or provider. And that's why certification standards and CMS Meaningful Use requirements apply specifically to products designated as electronic health records—these systems are meant to have broader applications than a practice-specific EMR.