1/30/2006
EMR or EHR: Is There Really a Difference?
Leslie Ann Fox, MA, RHIA, Patty Thierry Sheridan, MBA, RHIA, CCS
Thank you to Advance Magazine for permission to use this article

Leslie: I've noticed during the past several months that there is a discussion being played out in health care trade journals regarding the difference between the electronic medical record (EMR) and the electronic health record (EHR). It's an interesting discussion.

Patty: I don't think the public, let alone most health care professionals, realize that there might be a difference. The terms have been used interchangeably since the term EHR was introduced. There are really two factions on this issue and they are completely polarized. One faction believes that the two terms mean the same thing and the other faction holds strong positions on their differences.

Leslie: I think that if one doesn't monitor these things closely, it could appear that terms that describe electronic records in health care evolved and superseded the other. For example, we started with the computer-based patient record (CPR) in the late '80s and it appears to have evolved to the term EMR in the mid '90s. By early 2000 the EMR concept appears to have evolved to the EHR.

Patty: In a recent article published by Modern Healthcare, they noted that there is confusion in the marketplace. I would say so. When I reviewed several vendor Web sites in preparation for this month's column I noticed some interesting copy.

Leslie: It is interesting to see how vendors describe their products. Some sites have definitions that state the EMR and EHR mean the same and they have chosen the acronym EMR to refer to their product while other sites, often targeted at the physician market, warn buyers to make sure they know whether they are purchasing an EMR or EHR. No wonder physicians are confused about what to purchase for their practice.

Patty: "Buyer beware," indeed. The Modern Healthcare article goes on to say that the federal government added to the confusion when it announced its grant to the Certification Commission for Healthcare Information Technology to evaluate certification for EHRs. There really is no such thing as an EHR the author states and moves on to state that the reality is that the Commission is charged with certifying ambulatory EMR products.

Leslie: We have gone on talking about this but haven't provided definitions for EMR and EHR for our readers. Although we prepared a table to accompany this article, let's discuss the concepts in some detail.

Patty: You're right, let's do that now. The clearest definition that emerges in the literature is from HIMSS Analytics, a company owned by the Healthcare Information and Management Systems Society (HIMSS) that collects and analyzes health care organization data relating to IT processes and environments. In a recent white paper, they define the terms as follows: "The EMR is the legal record created in hospitals and ambulatory environments that is the source of data for the EHR. The EHR represents the ability to easily share medical information among stakeholders and to have a patient's information follow him or her through the various modalities of care engaged by that individual. Stakeholders are composed of patients/consumers, health care providers, employers and/or payers/insurers, including the government."

Leslie: The personal health record (PHR) is also part of the EHR. This is an important differentiator of the EHR and helps one to understand where the PHR fits into the EHR environment. The EHR contains patient input across episodes of care and across multiple health care systems. In an EHR, the patient controls access to the information as opposed to the EMR where the provider controls access. EHRs are proposed by the government to be part of the national health information network (NHIN).

Patty: HIMSS Analytics makes an important point of communicating that the EHR environment is dependant upon functional EMRs that allow health care systems to exchange data with one another, regionally and within the community.

Leslie: Using the HIMSS Analytics definition, it would seem that our work first is to implement EMRs in physician offices, other ambulatory settings and in hospitals before we can expect to reap the benefits that EHR connectivity brings to our health care system, including the PHR.

Patty: A fully functioning EMR is described as one that includes a clinical data repository, controlled medical vocabulary, computerized provider order entry, clinical documentation/charting, pharmacy management, electronic medication administration record, major ancillary systems (e.g., lab, diagnostic imaging, cardiology, etc.) and picture archive and communication systems (PACS).

Leslie: Where do electronic document management systems fit in?

Patty: They are part of the EMR in the early stages and play a lesser role as organizations move toward a truly paperless environment. In some organizations they are called the EMR or the legal record and serve as a way to easily access and print documentation for release of information purposes.

Leslie: HIMSS analytical developed a clinical transformation staging model that is described in their white paper accessible at www.himssanalytics.com/docs/WP_EMR_EHR.pdf.

The model outlines seven ranges of electronic record functionality from initial implementation of major EMR components to the paperless EHR. It may help our readers put into context where they are on their EHR journey.

Patty: Given the magnitude of the impact of transforming a paper-based health information system to electronic systems, I think the language around the technology is very important.

Leslie: I agree. Communications about standards, cost, usage, implementation and legal aspects of the EHR need to be clear, and as we discussed today, there is a lot of confusion out there. All stakeholders must understand the discussion.

The lack of clarity in the language around emerging technology is a common problem. Language evolves through common usage, especially when no single oversight body is authorized to determine the definitions. As the technology is implemented, new language will evolve. It is a messy process, and one that the industry should try to manage.

Patty: I am not sure what you mean by a new language evolving. Why do you think the public should care about all of this?

Leslie: Well, for example, in the early days of flying, planes were flown by aviators. Now United Airlines employs pilots, not aviators. Perhaps in time we will simply have different EMR models, like prop planes, single engine, twin engine, sea planes, jet planes, etc. The EHR will be the consumer space shuttle of the future. I think people should care only because the stakes are high and miscommunications can delay progress and create unintended obstacles.

Patty: Time will tell, won't it? But we can do our part now by not using the two acronyms interchangeably.

Leslie: Or at least starting a conversation around it to raise awareness that the EHR is broader than the EMR and that the government's vision is for every American to have their own electronic record. It's helpful to think of the EHR in these broader terms. It's patient centered and that needs to be our ultimate destination.

References:

1. Garets, D. and Davis, M., Electronic Medical Records vs. Elec-tronic Health Records: Yes, There is a Difference; White Paper, August 26, 2005, HIMSS Analytics LLC. www.himssanalytics.com/docs/WP_EMR_EHR.pdf

2. Modern Healthcare Looks at the Difference Between EHRs and EMRs. www.iHealthBeat.org Jan. 3, 2006.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president of Care Communications Inc., a national HIM consulting and staffing company headquartered in Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or pthierry@care-communications.com .