Should you implement an EMR or an EHR? Do you know the difference? Is there a difference?

In theory, and by definition, there is a difference and it should play into any provider’s clinical software selection. At the same time, marketing messages and technical terminology have clouded provider’s understanding of the two software definitions.

Recently, National Alliance for Health Information Technology (NAHIT) established definitions for electronic medical records (EMR), electronic health records (EHR) and personal health records (PHR).

NAHIT Has Defined EMR and EHR
The NAHIT has produced the following definitions for EMR and EHR:

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

By these definitions, an EHR is an EMR with interoperability (i.e. integration to other providers’ systems). More on this later…

Who Needs Which?
Marc Anderson, CEO of the AC Group, says it comes down to the words “medical” and “health.”

An EHR will provide a more comprehensive view into a patient’s health and history by pulling information from other systems, providing clinical decision support and alerting providers to health maintenance requirements. It will help providers report and measure quality indicators for pay-for-performance incentives.

Meanwhile, an EMR is a more silo’d record of a single diagnosis or treatment, most likely used by a specialist. If your responsibility is taking care of one unique problem - perhaps an orthopedist setting a bone - then a stand-alone EMR may well be sufficient. Certain specialists may not need information about patient history as much as they need specialty-specific workflows and templates.

The Market is Still Figuring it Out
Despite the NAHIT definitions, we think the market is still figuring out which definitions to adopt. An analysis of Google Trends data shows that roughly four times more searches are performed for “electronic medical record” than for “electronic health record.” At the same time, “electronic health record” seems to be gaining in search frequency.

Google search frequency index by health care IT keyword phrase.

One interesting exception to the data: searches originating in Washington, DC are split evenly between “electronic medical record” and “electronic health record!”

Software Vendor Marketing Migrates Slowly
The Google search trend data indicates an increased usage of EHR, but EMR remains more prevalent. The same is true when we look at the usage of terminology by software vendors.

In a review of 300 clinical records systems, 207 vendors market their software as an EMR, while 59 use the term EHR.

Why such limited adoption of EHR amongst vendors? First, it simply takes time and effort to change over marketing terms. Moreover, from a very practical standpoint, many vendors will want to continue to use the EMR label while it is the most commonly used - and “Googled” - term for clinical records systems.

Marketing Aside…
Regardless of who’s using which terms, the key decision process for selecting an EMR/EHR is to map out your organization’s requirements and methodically assess systems against those criteria.

Justin Barnes, Chairman of the HIMSS Electronic Health Record Association (EHRVA) and VP of Marketing and Government Affairs at Greenway Medical Technologies, believes “the future of health care IT is interoperability.”

And while Barnes is an advocate of the EHR terminology, he distills the following three criteria for selecting a medical records system:

• Current-year interoperability certification standards (CCHIT, HL7);
• A unique workflow that matches your practice and specialty, and;
• Excellent usability at the point of care.

If you purchase an EMR or EHR with these three requirements, you should receive a significant ROI on your investment, and position yourself to receive incentives from payers.

Well What’s a PHR?
NAHIT has provided the following definition of a PHR:

ePHR: An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created, gathered, and managed by the individual. The integrity of the data in the ePHR and control of access to that data is the responsibility of the individual.

To be most effective, a PHR should include cumulative health information ranging from past and current illnesses, demographics, allergies, prescriptions and more. Given the nature of the PHR, it’s the individual’s responsibility to decide what information is stored, and who has access to it.

Microsoft’s HealthVault and Google Health are two prominent examples of PHRs. Whether these systems are widely adopted, and properly updated by patients, is yet to be seen.

So What Should I Implement?
Even with complete definitions in place, it can be difficult to evaluate EMRs/EHRs and determine which system to buy.

At the same time, most providers will make their decisions based on their IT budget and their career stage. A young physician will almost certainly want to lay the IT foundation for participating in the future vision for healthcare interoperability. They will likely be supported in this effort by their health system.

Meanwhile, a more mature physician that wants to “go paperless,” but is not an aggressive adopter of IT, may well opt for a stand-alone EMR system and forgo the costs and challenges of integration.

In the end, these individual decisions underly what is a deliberate, but very slow, adoption of health care technologies.