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Features

Electronic Records: EMR vs. EHR

By Chris Hobson, MD

Posted on: July 29, 2009
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Health IT industry news followers have probably noticed industry confusion and inconsistencies regarding terminology about what to call patient information that is collected and shared electronically.

In fact, analysts, vendors, journalists and practitioners all are guilty of using the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably as if they are one and the same. In fact, these are two different terms that address two different sets of business needs with different -- although overlapping -- sets of features and capabilities. The distinction is more than minor semantics, and it's crucial for health IT decision-makers to understand the difference.

Electronic record

To many, an electronic record is considered to be any clinical record that isn't paper-based or hanging on a clipboard. The problem is, this doesn't describe how the data will be used, gathered or shared. Will the electronic record be used only within the confines of a single office or practitioner, or within a single regional health system? Alternatively, will the data be shared across a wide range of different providers, such as specialists' offices, labs, insurance providers and government agencies? For the sake of clarity and accurate understanding, it is important to distinguish between electronic records that can be shared widely and those that are designed to reside within a single organization.

When discussing digitized medical records, depending on the software vendor, geographic region, country or even the personal preferences of the presenter, the two terms -- EMR and EHR -- are being used interchangeably. Unfortunately, that distinction has been lost in the flood of material appearing in the literature.

According to the Healthcare Information and Management Systems Society (HIMSS), an EMR is a component of an electronic health record that is owned by the health care provider. The EMR is 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. An EMR system may touch clinical data repositories, lab applications and patient information management systems, among others -- but all within the reach of a single organization.


Electronic Records: EMR vs. EHR

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Thank you for this enlightening article, clarifying this difference in terminology is fundamental to improving health outcomes. Many organizations have successfully applied technology to the business of providing health services to consumers, so that appointments, claims and invoices are processed in a reliable and efficient manner (EMR Technology). Within an EMR, the information shared between the patient and a single organisation is often well organized, however most patients are unaware that in most cases this information is generally not available when they interact with another organization, generally they assume the health system is actually built around some kind of system and are surprised that the next doctor is asking them the same questions and repeating the same tests. If you admit to working in health, people take delight in telling you about what they perceive to be an isolated system failing and how the system let them down. Most practitioners don't have the heart to tell the patients that the system lets them all down this way each and every time.

Clearly there is a safety issue if the patient is providing information to providers on the assumption of information sharing, when the reality is otherwise. However all is not doom and gloom, and technology is now being applied so that patients expectations are aligned with a new reality.

This kind of EHR technology is clearly aligned with both patients expectations and the adminstration's intentions under ARRA and the HITEC act. The reality and availability of this type of technology makes it even more important that the consumers of health understand the capabilities of the system they are covered by so that they interact with the system appropriately.

Wai PiataAugust 01, 2009

I agree with Anonymous that *everyone* political leaders, policy makers, healthcare providers and IT vendors are all focused on one thing - the quality of care delivered to the patient. Technology is just an enabler to help healthcare providers deliver improved patient care, to the right patient at the right time.

This is my personal conclusions (I'm absolutely not writing on behalf of HIMSS!) based on a long period working in the area. I believe that making the distinction between EMR versus EHR is significant and is not just a concern of HIMSS. Many industry groups other than HIMSS are also concerned with having a clear definition of what constitutes an EHR because of the impact on the way patient care is delivered.

An EHR should provide enable a unified, much more complete view of patient information and in that way improving the quality of patient care delivered. Just one example from a report by the California Healthcare Foundation in 2006 supports a unified, shared electronic record of the patient. "Studies of chronic diseases, using unified data from EHR based solutions, have found that 14% of diabetes patients had heart disease, and that 77% had hypertension. To address such complex illnesses, at least one researcher has suggested that chronic disease care should focus on the patient and all of his or her diagnoses and symptoms, not on any single disease". A single electronic record spanning the continuum of care, gives healthcare providers a complete picture of a patient's conditions in order to delivery the best care."

Chris Hobson,  Chief Medical OfficerJuly 31, 2009
AL

Dr. Hobson, thanks for providing a very good parsing of the important but often overlooked difference between EMRs and EHRs -- the ability to talk to and draw information from multiple sources ("interoperability" in a word). Also helpful to have experts out there reminding people why its about more than digitizing a medical record.

Brian Wagner
eHealth Initiative

Brian WagnerJuly 31, 2009

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