EMR

The terms electronic health records (EHR) and electronic medical records (EMR) are often used interchangeably. In January 2005, Modern Healthcare explored the ongoing confusion over and pointed out that neither the public nor healthcare professionals can come to a consensus on the differences between the two.

See also: more in-depth discussion of EMR definitions

Electronic Medical Record (EMR) or Electronic Healthcare Record (EHR)

EMR benefits

Electronic Medical Records have many benefits over an analogous paper record.

Privacy and security

Electronic objects enhance privacy by providing different levels of security access to different governmental groups and individuals. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly granting access, or malicious tampering. A digital data trail is very durable and more difficult to erase than a paper trail.

• privacy breaches possible (JM Appel. Why shared medical database is wrong prescription. Orlando Sentinel, December 30, 2008. http://www.orlandosentinel.com/news/opinion/views/orl-opappel3008dec30,0,4065787.story)

Financial

Computer systems are more efficient and can save time and money. EMR systems can

• eliminating the paper chart (Ref: A Cost-Benefit Analysis of Electronic Medical Records/Wang et al)
• * Automated upload of data into computer, no need for temporary paper interface (Smith LB, Banner L, Lozano D, Olney CM, Friedman B)
• hard drives take up less space than shelves of paper
• file claims faster
• reduce billing errors, find optimal billings for Medicares and other insurances, can inform patients of generic drugs or if their insurance doesn't cover it
• reduce manhours required: automated dictation
• shared database saves on record handling (http://www.allscripts.com/casestudies/nffm.pdf)
• lower malpractice insurance premiums (http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm) (http://www.msdc.com/EMR_Benefits.htm)
• E-prescribing reduce number of phone calls and visits (http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf) and (http://www.drfirst.com/e-prescribing.jsp) and (http://www.emrconsultant.com/education/e-prescribing)
• increase return on investment (ROI)[1]
• automatic notifications of test results, appointment times, etc.

• See also: more in-depth discussion of EMR benefits

Clinical

EMRs make the hospital staff more productive.

• Nurses are more efficient (Evidence on the Costs and Benefits of Health Information Technology, Stuart Hagen and Peter Richmond, Congressional Budget Office, May 2008)
• Clinicians can view all angles of radiology pictures (Joan Breuer, Ph.D. 01/22/2010 20:00)
• Graphs
• Reduce medication errors and check for drug-drug interactions (http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf Key Capabilities of an Electronic Health Record System) and (D. Johnston et al., Patient Safety in the Physician’s Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID=101965.) and (http://www.himss.org/content/files/davies_2002_maimonides.pdf)

• Increase underused preventative measures (Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345:965-70.)

• reduce duplicate laboratory tests Key Capabilities of an Electronic Health Record System

[N Engl JMed. 1990;322:1499-504. [PMID: 2186274]] (Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987;107:569-74. PMID: 3631792)

• reminders increase compliance(Gilad Kuperman, M.D., P.h.D., Richard Gibson, M.D., P.h.D. Ann Intern Med. 2003; 139:31-39.) and (Timm JA, Chick KL, Peterson JA, Epps SI, Bleimeyer RR, Harris M. Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist. AMIA Annu Symp Proc. 2008 Nov 6:1154.) and (Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741-7.)

• Patient portal allows for most up to date information about healthcare

EHR system Selection

See more for in depth discussion of EHR system selections

EHR provider

See more for in depth discussion of EHR providers

• 1. Waiting Room Solutions
  2. OmniMD
• Vendor Selection Criteria
  1. Request for Proposal
  2. Comparing Vendors
• EMR Components
  1. Problem List
  2. Medication List
• EMR Training
  1. Physician Help Desks
  2. Post-live Physician Training & Support
• Strategies for Improving EMR Adoption
  1. Recent Changes to Support EHR Adoption in Solo/Small Practices
• Clinician Sign-out applications
• Free and Open Source EMRs
• Integrating Medical Devices into EMRs
  1. EMR Introduction and Background
  2. EMR Current Practices
  3. EMR Connectivity Requirements
  4. EMR (EHR) Available Solutions and How to Choose the Right One
• Remote Access
• Considerations for Specialists
  1. Special considerations for Pediatric Practices
  2. Special considerations for Ophthalmologists
• Models for Adoption by Small - Medium size practices
  1. Application Service Providers - ASP
  2. Utility Model
• EMR and Biometrics
• Socio-technical Issues
  • Privacy of Patient Data: Genetic Non-Discrimination
  • Definitions of Terms related to Patient Privacy, Confidentiality, and Security
• Business Case for Improving Usability
• New Technologies
  1. WiSPER™ (Wireless Standardized Portable Electronic Records)
  2. Vocera -- Hands-free, wireless communication device
  3. Aionex PatientBoard -- a HIPAA-compliant, secure, web-based, patient status board
  4. FastAccess -- a biometric facial recognition solution to the repeat login problem
  5. Biometric Resource -- information about existing and cutting edge biometric technologies

• 1. Omron Wrist Blood Pressure Monitor
  2. Iniatite Systems Identity Hub
  3. Internet Based EMR: Benefits & Costs
• Strategies of Clinical Data Entry
  1. Natural Language Processing (NLP)
  2. Coding Data
• Historically Important Electronic Medical Record Systems