electronic health record (EHR)
An electronic health record (EHR) is an individual's official health document that is shared among multiple facilities and agencies. The role of EHRs is becoming increasing influential as more patient information becomes digital and larger numbers of consumers express a desire to have mobile access to their health records.
Among other types of data, an EHR typically includes:
- Contact information
- Information about visits to healthcare professionals
- Insurance information
- Family history
- Immunization status
- Information about any conditions or diseases
- A list of medications
- Records of hospitalization
- Information about any surgeries or procedures performed
It is also becoming more common to see medical images attached to EHRs.
The benefits of EHRs include:
- The ability to automatically share and update information among different offices and organizations
- More efficient storage and retrieval
- The ability to share multimedia information, such as medical imaging results, between locations
- The ability to link records to sources of relevant and current research
- Easier standardization of services and patient care
- The ability to aggregate patient data for population health management and quality of care programs
- Provision of decision support systems for healthcare professionals
- Less redundancy of effort
- Potential long-term lower costs to medical systems
The governments of many countries are working to ensure that all citizens have standardized electronic health records and that all records include the same types of information. The major barrier for the adoption of electronic health records is cost.
Regulations around EHRs
In order for EHR vendors' products to qualify for use in U.S. government programs such as Medicare and Medicaid, their EHR platforms have to meet certain criteria. The Center for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) created the Medicare and Medicaid EHR Incentive Programs to help make sure EHRs meet certain standards and other criteria. Furthermore, the programs assure healthcare users -- such as hospitals and health systems -- the technology that the EHR system they purchased has the necessary technical capabilities, functions and security in place to meet meaningful use requirements.
Other programs and regulations have also been put in place -- such as meaningful use -- to make sure EHRs meet certain standards and that healthcare organizations are using EHRs in a meaningful way.
In addition, healthcare organizations and EHR vendors must also attest and demonstrate that they have not knowingly and willfully taken action to restrict interoperability of their EHR. CMS and ONC have implemented this attestation requirement in an effort to prevent information blocking.
EHR standards are in place to certify that electronics health records fulfill meaningful use -- in other words, to ensure that EHRs possess necessary technical capabilities and security safeguards.
Another purpose of standards is to help facilitate interoperability. The health IT community has already created the following interoperability standards:
- Health Level Seven International (HL7), a set of international criteria for transfer of clinical and administrative data
- Fast Healthcare Interoperability Resources (FHIR), a web-based series of tools that falls under HL7
- SMART Health IT, an open, standards-based technology platform that enables people to create applications that can run across a healthcare system, including EHRs
How EHRs improve patient care
EHRs are able to improve patient care in a number of ways.
For example, they can aid in diagnosis by giving providers access to patients' complete health information, which provides a comprehensive view and helps clinicians diagnose problems sooner.
Furthermore, EHRs can help reduce medical errors, improve patient safety and support better outcomes. While EHRs do contain and transmit data, they also manipulate patient information in meaningful ways and provide that information to the provider at the point of care.
Hospital CIO outlines the challenges of an EHR installation.
EHRs can also help improve public health outcomes by providing a view of the entire patient population's health information, which lets providers identify specific risk factors and improve outcomes.
The difference between EHR and EMR
EMR stands for electronic medical record. These days, EHR and EMR are used interchangeably and are essentially the same thing. However, government entities such as ONC use the term EHR exclusively.
EHRs vs. paper records: Pros and cons
While many agree that, overall, EHRs offer more benefits than paper health records, EHRs are not without their flaws. Below are some of major differences between paper and electronic records:
- Time: Some providers have reported that EHRs have saved them anywhere from 10 to 20 hours per week in documentation, giving them more time with their patients. However, others argue that EHRs pose a learning curve and force providers to become data entry staff. All of that clicking and typing, some argue, causes physicians to focus on the computer rather than the patient in the room.
- Environment: Going digital with patient records saves a lot of paper because a patient's medical record is usually made up of hundreds, and sometimes even thousands, of pages.
- Security: Some believe that paper records can be more vulnerable to being compromised due to a break in, loss of a paper record due to human error, or damage to paper records because of a natural disaster. However, EHRs have had their fair share of cybersecurity data breaches involving thousands of medical records.
- Cost: Large healthcare organizations may have to pay $1 billion or more to purchase and install EHR systems, and it may take months to implement the technology. There are also associated long-term digital storage costs with EHRs. Paper records require more human administrative maintenance in terms of storing the files and arranging for access to them, and there are physical space costs involved. Any healthcare organization will need a significant cost analysis to examine what is spent vs. saved with EHR systems. Meanwhile, the U.S. government heavily subsidized the initial push to EHRs in the United States by offering hospitals financial incentives to install this technology.
- Access: The process of sharing paper records can be more arduous than sharing digital patient information; it includes finding the paper record -- possibly, in a large warehouse -- and then either mailing, faxing or scanning copies. In theory, sharing EHRs should be easier, but the reality is that practices by organizations and vendors may lead to EHR information blocking.
- Readability and accuracy: With paper records, physicians' penmanship may be difficult to read, which could lead to inaccuracies. Furthermore, with paper records, often there is not enough room for a physician to write everything down legibly. With EHRs, there is basically an unlimited amount of space, and typing and natural language processing eliminate many concerns about illegibility.
Common features of EHRs
There are a series of common and essential features that any EHR system offers. For starters, EHR platforms often set up a patient portal for consumers to access information as well as allow for secure data sharing and data access from other healthcare organizations.
EHRs also typically place patient care orders for clinicians, such as medication orders and diagnostic test requests. In terms of medications, EHRs can manage doses for specific patients and alert physicians to any possible drug interactions. The systems can additionally manage order sets, results and patient consents and authorizations.
Further, electronic health record systems often help coordination clinician workflow management and scheduling. Finally, these systems offer assistance in completing clinical, financial and administrative coding. This feature includes support of service requests and claims for reimbursement.
Top EHR vendors for hospitals
As of late 2017, the hospital EHR market is largely a battleground between two companies: Epic Systems Corporation and Cerner Corporation. Cerner, a public company, was estimating $5.5 billion in revenue for 2018, while privately held Epic's 2016 revenue has been reported at $2.5 billion by the Milwaukee Journal Sentinel.
Other hospital EHR players include Allscripts and Meditech. Allscripts bought McKesson's hospital EHR products in August 2017, strengthening Allscripts' foothold.
Other vendors that have a stronger presence in the ambulatory healthcare and physician practice EHR market include AthenaHealth and eClinicalWorks.
EHRs and security
All EHRs in the U.S. must be Health Insurance Portability and Accountability Act (HIPAA) compliant. This requirement is enforced by the Department of Health and Human Services Office for Civil Rights (OCR).
HIPAA is broken up into two rules: the Privacy Rule and the Security Rule.
The Privacy Rule protects medical records and other personal health information (PHI) via national standards. This applies to covered entities such as health plans, healthcare clearinghouses and healthcare providers that conduct transactions electronically.
The Security Rule protects electronic personal health information (ePHI) that is created, received, used or maintained by a covered entity by establishing national standards.
The Health Information Technology for Economic and Clinical Health Act (HITECH Act) also provides regulations meant to ensure the security of EHRs.
However, HIPAA and the HITECH Act are just the baseline for EHR security. EHRs should also have other security features built into the platform such as an audit trail system, state-of-the-art data centers, access control tools, encryption and more.
Despite the security precautions EHRs can, and often do, take, fear of a data breach is rampant in the healthcare industry. This is not surprising, given that healthcare data breaches where patient records and personal information are compromised happen quite often.
The future of EHRs
Many experts seem to agree that there is work to be done when it comes to the EHR. Some changes experts hope to see in future EHRs include:
- Reducing the data entry burden
- Creating a more comprehensive narrative of the patient
- Enabling better patient engagement
- Allowing for more precision medicine
- Working to include remote monitoring
- Increasing transparency
- Offering more patient-centered care delivery