Tell it to me one more time, what is an EMR, what is an EHR?

Reading through the 1,800 plus posts in an HIMSS thread, it seems to me most stakeholders in the healthcare industry (consultants, agencies, vendors, regulatory authorities) use terminology that is confusing.

Many EHR vendors sell products I would describe as EMRs,

Vendors and healthcare agencies alike talk about billing systems when they refer to their “EMR”s.

If we could agree that EMR really means “electronic medical record” (demographics, intake, assessment, diagnosis, tx planning, medications, progress notes) but NOT scheduling and NOT billing, problems with terminology might disappear.

What the luckier agencies have is an “EMR + Practice Management”.

But, Practice Management does not work very well either because hospitals are not “practices”.

Finally we have ‘interoperability” – in NHIOs and RHIOs, EHR means a consolidated repository of patient data for the purposes of information sharing, hopefully on a need-to-know basis. These EHRs typically have no “EMR plus Practice Management” functionality but they may have cross-patient statistical/tabular data mining capabilities.

So, what is an EMR, what is an EHR and how does the average agency even figure out what it is they have or are proposing to acquire?

If the “EMR” you have only acts as a repository for clinical, scheduling and billing and fails to provide decision support this is VERY DIFFERENT from an enterprise-level automated resource allocation/leveling/balancing environment that:
# increases staff efficiency,

# increases patient throughput,

# decreases admin/clinical errors,

# improves compliance with internal and external rules and regulations,

# is patient-centric,

# accommodates multi-directional data exchange

# (whatever I forgot to list here)

I suppose some of you are saying, this list looks like a list of strategic objectives. Maybe the right way to go out and acquire an EMR is to first list agency strategic objectives and then only go on a shopping spree?

If you choose to follow my advice, ask any potential vendor (sorry vendors) to help you quantify these objectives.

If you want to avoid being part of the revolving door community who go back into the market every two years for a new EMR, ask your potential now foot-dragging vendor to show you “at their cost” one of your programs ‘piano-playing’ one of YOUR workflows processing YOUR forms.

This demo needs to take place within 3-4 days of the time you first contact the vendor, not in 3-4 months, not “when the next release comes out”.

Let’s see – reading this post, I expect I have managed, in one rant, to antagonize consultants, agencies, vendors, and regulatory authorities.


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, major crimes case management, healthcare services delivery, and b2b/b2c/b2d transactions. (C) 2010-2021 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions Number of accessing countries 2010-2020 : 168
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