Ask anyone what the difference is between an EMR and EHR. Chances are you will get mixed responses.
My definition of an EMR is that it is a historical record of encounters or interventions where healthcare professionals can see data and information, as it was, at the time it was recorded.
For data, the ideal scenario is to be able to view data on the form versions that were in service at the time the data was collected. For information, an EMR must accommodate a wide range of EMR attachments (MS Word, PDF, spreadsheets, voice/audio recordings, faxed material, pictures).
All encounter/intervention data and information appended to an EMR must be tagged with a date/timestamp and electronic user “signature”. The user should have no discretion re date/time tagging with the result that data collected off-line three days ago and input today will have a Today/Now time stamp. This is consistent with the general rule that “if it’s not in the chart, then it does not exist”. As for user “signatures”, these can be applied automatically but EMR system recordings need to accommodate dual “signatures” where one person is recording data on behalf of another.
Purpose of an EMR
The purpose of an EMR is to provide decision support to healthcare professionals in respect of the rendering of healthcare services to an individual patient, and accommodate data exchange.
It’s important to understand that EMR recordings at a practical level consist of a mix of digital and non-digital data/information. The usual presentation is reverse chronological order with hyperlinks that post forms that post data or post patient record attachments (the latter are often generically called “attached documents”). The presentation must be seamless.
Once in, the content must not be editable. Some EMRs accommodate after-the-event “sticky notes” . These are a good idea for preventing medical/administrative errors.
Access to EMR content should be on a strict need-to-know basis. This poses a serious problem where organizations on the one hand go to great lengths within EMRs to restrict and control access to data but then allows users to view documents stored in 3rd party Enterprise Content Management (ECM) environments under different access rules.
For HIPAA, a prudent policy is to log all accesses to EMR content – this means taking note of viewing of content accesses, not just content viewing/editing accesses. If, as, and when an inadvertent disclosure of patient data occurs, it is important to be able to know who had access to specific content over a specific timeframe.
Recent legislation requires that EMR content be made available to authorized 3rd parties (i.e. patients, insurance, regulatory organizations). Each “subscriber” is likely to need a different subset, and, for the time being at least, there are two standards for clinical data exchange (CCD, CCR) and many “flavors” of each.
EHRs serve a different purpose from EMRs. Whereas an EMR has a singular focus on individual patients, EHRs consolidate data across multiple patients and play an pivotal role in b2b data exchange. This requires that publishers package data for shipment to EHRs using “industry standard” formats and that the data be protected during transport.
Most recently, hybrid EMRs/EHRs seem to be coming on the market.
These are typically used by managed care organizations that have their own clinics, but there is no technical reason why a community of member agencies could not satisfy their EMR needs at a hosted EMR/EHR facility.
Most hybrid EMRs/EHRs require the use of common workflows/forms at the EMR which greatly restricts their value. The happy scenario is where each member agency can build/maintain their own workflows and forms but enjoy advantages of scale.