EMR

An electronic medical record (EHR) (also electronic healthcare record (EHR) or clinical information system (CIS)) is a data repository that digitally collects the medical reports of patients, exchanges such information with other healthcare provides, and makes a personal health record (PHR) for the patient to share with their doctor and other providers.

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. However, privacy breaches are possible.

Financial

Although initially implementing EMRs can be expensive [1], computer systems are more efficient and can save time and money. EMR systems can eliminate the paper chart. [2] Typing orders directly eliminates paper waste. Hard drives take up less space. Shared databases reduces the need for paper. [3]

Billing is also easier, as files are claimed faster, and bills are done optimally. Patients can be informed of generic drugs and doctors can know if insurances do not cover patients. Insurance and malpractice premiums can also be lowered. [4]) [5] The computer also can point out different drugs that can save hospitals money [6].

Man hours are also reduced. Dictation is automatic, e-prescribing reduces number of phone calls and visits, [7] [8] [9] and patients are automatically notified of test results and appointment times.

Clinical

EMRs make the hospital staff more productive. Nurses are more efficient. [10] A computer system reduces medication errors and checks for drug-drug interactions [11] [12] [13] [14], reduces redundant lab tests, and reduces time needed in information exchange. [15]

Reminders can increase underused preventative measures, [16] reduce duplicate laboratory tests, [17] [18] and increase compliance [19] [20] [21] The patient internet portal allows patients to know the most up to date information about healthcare. [22]

EMRs also make it easy for large scale data exchange. National diseases registries exchange data more easily, and patients can pool all their medical data from multiple providers. [23]

EMR Components

Problem List

Medication List

EMR Training

Physician Help Desks

Post-live Physician Training & Support

Strategies for Improving EMR Adoption

Recent Changes to Support EHR Adoption in Solo/Small Practices

Clinician Sign-out applications

Free and Open Source EMRs

OpenEHR

Integrating Medical Devices into EMRs

EMR Introduction and Background

EMR Current Practices

EMR Connectivity Requirements

EMR (EHR) Available Solutions and How to Choose the Right One

Considerations for Specialists

Specialists can have different EMR needs.

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

WiSPER™ (Wireless Standardized Portable Electronic Records)

Vocera -- Hands-free, wireless communication device

Aionex PatientBoard -- a HIPAA-compliant, secure, web-based, patient status board

FastAccess -- a biometric facial recognition solution to the repeat login problem

Biometric Resource -- information about existing and cutting edge biometric technologies

Omron Wrist Blood Pressure Monitor

Iniatite Systems Identity Hub

Internet Based EMR: Benefits & Costs

Strategies of Clinical Data Entry

Natural Language Processing (NLP)

Coding Data

EHR system selection

See more for what Marl Mench thinks of EHR system selections

List of EMR companies

EMR models for small and medium sized practices

Vendor selection criteria

Selection of a vendor product is certainly important and potentially problematic. Physician resistance is one of the major barriers to adoption of electronic medical records. Although some elements, such as diagnoses and medication lists, are relatively easy to implement, others are very difficult. [24] It is important to look at demonstrations or do trial runs before deciding on an EMR.

Functionality

The vendor's EMR must meet some minimum requirements. Its source code must comply with regulatory laws, such as the Health Insurance Potability and Accountability Act, the Patient Safety and Quality Improvement Act (PSQIA), and the Certification Commission of Healthcare Information Technology (CCHIT) criteria.

The EMR software must have essential features [25][26]. These include

standardized vocabulary standards, such as Unified Medical Language System (ULMS), SNOMED, NDC, LOINC, WHO Drug Dictionary, MeSH, CPT, DRG
note creation: templates for documentation, dictation, voice recognition, hand writing recognition
patient problem list compliant with Final Rule
patient medication list
reminders and alert system to assist clinical decisions
user-friendly interface for viewing and sharing of data
security: access control for data
advanced reporting and analysis, data query and search functions
accessibility for the disabled, such as vision and hearing impaired
wireless access, internet access, outreach for public education
efficient data transfer between departments (pharmacy, lab), interfaces (PCs, analog data), and institutions (personal health records (PHR), surveillance data)

Implementation cost

The total cost of ownership (TCO) and invest required to fully implement the vendor system is important. Although initually expensive, a good EMR system should pay for itself in time. A vendor should have a track record for successful system implementations. A company should have a detailed plan for implementation and training. All costs should be clearly identified: hardware, software, interfaces, text conversions, maintenance, human resources, networks, peripherals such as computers and printers, training, technical support, and facility renovation to accommodate EMR system changes. Specific software considerations include licenses fees, software upgrade and development timeline, and data integration from legacy systems.

Hardware and technical requirements

It is important to identify all hardware and software requirements to implement a full-scale EMR system. A vendor should meet the technical requirements of OS platforms, language, and databases. The system and licensing system should also be able to meet future technological standards in hardware and software. The debugging process should be efficient. The EMR system must also be scalable to a large number of users.

It is up to the buyer to decided whether to go with non-proprietary system or an established industry system, whether to have on-site or remote hosting; there are advantages and disadvantages to each. A hosted server requires the vendor to have adequate computing facilities. A remote server needs to have alternative plans for outages. Mobile and wireless clients also need consideration.

Information extraction should be fast and efficient.

Long term vendor partnership

The software company itself should be stable, growing, and profitable over a long time period. Its past history should include other successful contracts to similar health systems, a reputation for frequent check-ups, and few uninstalls. A vendor should provide regular and periodic updates. The EMR software must have provide sufficient, long-term, on-site customer support. The vendor should be quick to respond during emergencies, and have backup in case the system malfunctions. The legal agreements should include specifications and quantifiable measures of support, with appropriate penalties if evaluated negatively.

For an in-depth discussion of vendor selection criteria

Request for Proposal

Comparing Vendors

Historically Important Electronic Medical Record Systems

EMR

Contents