In healthcare, the terms electronic medical records (EMRs) and electronic health records (EHRs) are often used interchangeably, despite having different uses, benefits, and drawbacks. The Office of the National Coordination for Health IT (ONC) notes that there is a significant difference between the two terms.
The question is, what is the difference between EMRs and EHRs, and what role do they play in the roadmap towards national interoperability?
What does EMR Mean?
Electronic medical records are digital versions of paper records found in clinical settings like physician offices, clinics, and hospitals. EMRs collate notes and information collected by clinicians and staff in these clinical settings to assist with diagnosis and treatment. Additionally, EMRs help track data over time and identify opportunities for clinicians to help patients improve health care quality, like preventative screenings and visits.
Put simply, an EMR is a digital version of a patient’s chart, with medical and treatment history from one practice. In practicality, this means that EMRs stay in place and does not get shared unless requested by the patient’s new doctor.
What Does EHR Mean?
Electronic health records go beyond the standard collection of clinical data in a provider’s office to give a more inclusive and longitudinal history of a patient’s health records, because they contain information from all clinicians involved in that patient’s care. Unlike EMRs, which are kept in one place, EHRs are designed to share information with other health care providers, including laboratories and specialists, to follow the patient throughout the healthcare continuum.
The History of EMRs
While it is up to the provider to choose whether they will use an EMR or an EHR, it is important to note that historically, EMRs paved the way for EHRs to have more advanced capabilities. In the 1960s, doctors and healthcare providers used handwritten paper medical records and paper filing systems to keep patient medical history. By the mid-1960s, academic centers began to develop their own clinical information systems for storing electronic medical information. The first electronic medical record system was developed in 1972 by the Regenstrief Institute; but adoption of the system was limited to government hospitals and other larger institutions, given that the technology, like personal computers, was costly.
In the 1990s, the rise and availability of the Internet enabled faster, easier access to health information online, setting the stage for web-based EMRs to emerge in the early 2000s. Coupled with industry-wide recognition that electronic medical record systems needed to be developed, EMRs emerged to access information remotely in an appealing and affordable manner for physician use.
There are advantages to using an EMR, which include:
- Standardized and more efficient record keeping for clinician notes, assessments, lab results, and other clinical documents that can be shared internally with authorized members of a healthcare team at a clinical site
- Reduction in errors related to misinterpreting handwriting or transcription
Despite these advantages, there are a couple drawbacks of using EMR systems, especially in modern times. The first is that EMRs are costly, with additional features such as patient portal or integration with a medical billing partner sometimes costing more money.
Second, EMRs do not always support the consistent, fast care collaboration that is often needed in modern health systems, which can leave some users frustrated and can put care outcomes at risk. However, for some clinicians, like psychiatrists and other specialists who don’t need to collaborate often with other clinicians, EMRs provide a simple solution to keep and maintain patient records electronically.
The Shift from EMRs to EHRs
While both EMRs and EHRs can help healthcare be more efficient and less costly, EHRs are the future of healthcare because they provide additional insights that inform clinical decisions and go beyond clinical data to focus on the total health of each patient throughout the healthcare ecosystem.
As healthcare and care coordination became increasingly more complicated, EMRs no longer suited the needs of clinicians or the administrative needs of healthcare staff.
The shift towards EHRs occurred in the early 2000s, when President George W. Bush doubled the budget for healthcare IT projects and the National Health Information Coordinator was created with a call for industry-wide adoption of EHRs by 2014.
President Obama further supported the drive towards EHRs as part of the American Recovery and Reinvestment Act (ARRA), which directed additional funding and incentives to healthcare professions to adopt electronic health records for “meaningful use.” ARRA allocated $19 million to be used to digitize health care records in the United States, as a way to optimize EHRs and increase data interoperability.
Between 2006 and 2011, adoption of an EHR system increased from 29% to 73%. In 2012, 71.8% of office-based physicians reported using any type of EHR system, which had risen from 57% in 2011 and 34.8% in 2007. According to the Centers for Disease Control and Prevention, use of any EHR system increased by over 295% from 2001 to 2012.
While adoption of EHRs in physician offices increased, hospitals have also greatly increased their use of EHRs. According to an ONC brief, 97% of hospitals nationwide used EHR data in 2017, compared to 87% in 2015. ONC noted that from 2015 to 2017, the greatest increase in the use of EHR data was for identifying high-risk patients, care gaps, approaches to query for patient data, and areas for quality improvement.
EHR adoption, while supported by federal regulations, has occurred because physicians, hospitals, and health systems have seen the immediate and practical role that interoperable health records can have in improving quality of care and the increase in available clinical information to better inform care decisions.
Advantages of EHRs
EHRs are software that can securely document, store, retrieve, share, and analyze information about an individual patient’s care, which is hosted either locally or remotely, with remote systems being “cloud based” or “Internet based.”
EHRs have many advantages compared to EMRs, which can include:
- Viewing a more complete patient medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory test results from one or multiple clinicians or health systems
- Accessing to evidence-based tools that can help clinical decision making
- Automating and streamlining provider workflows
- Allowing a patient’s medical information to move with them and enable physicians to stay apprised of their care with other physicians
However, as with any type of technology, there can be some drawbacks. Some of the challenges of EHRs include data security, maintenance costs, and other administrative issues. The transition to EHRs has also caused some frustration among clinicians who expected electronic records to make care more efficient, but instead felt that EHRs increased their workload and that data access was not seamless.
The Path to Interoperability through Health IT
While EHRs are fundamentally advantageous as healthcare interoperability evolves, care coordination requires more than an EHR or EMR to fully leverage the true potential of healthcare data and information exchanges to better inform clinical decision making. After achieving more widespread adoption of EHRs, Congress passed the 21st Century Cures Act in 2016, which aimed to improve interoperability by enabling data sharing across disparate networks, reducing information blocking, advancing a trusted exchange framework for exchange between health information networks, and promoting patients’ ability to have greater access to their health information.
The Cures Act intended to reduce clinicians’ regulatory and administrative burden to create a health system where health information and data “flows appropriately and securely to patients and their clinicians to coordinate care, reduce costs, and make care faster and less duplicative.”
To do this, ONC launched the Health IT Certification Program to provide assurances that EHRs meet the technological capabilities, functionality, and security requirements adopted by the U.S. Department of Health and Human Services.
Some health IT, like encounter notification alerting technology that Audacious Inquiry provides, works to enhance EHR functionalities, including by better real-time encounter notifications and more granular filtering to ensure that the right clinical information makes it to the correct providers at the right point of care.
For example, many clinicians currently may not be alerted in real time through their EHR or EMR that their patient has presented to the emergency department. If they are alerted, they may not be able to access clinical documents or get the key information that may get lost in the mix of broader data reporting processes. A way to close this gap is leveraging health IT services, like encounter notification technology and alerting, that provide clinicians and care managers with real-time, customizable, and actionable information that easily integrates into their workflows to better manage care coordination.
“While there has been much progress in the way of data standardization and EHR interoperability, it is still a very nuanced topic that can be difficult for health care practitioners to navigate,” Evan Carter, Senior Director for Engagement and MDM at Audacious Inquiry says. “Partnering with solution providers possessing an intimate knowledge of EHR platforms and workflow optimization remains of paramount importance.”
In healthcare, the shift towards a national health IT infrastructure builds upon the use of EHRs to transform healthcare, in coordination with health information data exchange to better connect siloed health care data in real-time. While EMRs are sufficient for some clinicians to meet meaningful use requirements and their clinical workflows, widespread adoption of EHRs is the first step to promoting interoperability.
The Future of Health IT Integration with EHRs
Coupled with the increased use of healthcare data exchange and other health IT tools that provide targeted insights into workflows, EHRs will help to provide better health care by enhancing all aspects of patient care. This includes lower costs, increased efficiencies, improved coordination, and more awareness for and access to preventative medicine—all while promoting a person-centered approach.
As the healthcare industry seeks to move towards value-based and whole-person care, the use of certified health IT like EHRs and other complementary tools will continue to move the needle towards interoperability that will better healthcare quality, administration, and care.
About the Author
Eliana Donner-Klein is Senior Associate for Marketing at Audacious Inquiry, a national industry-shaping health IT company that developed the single most impactful platform for aligning better care across the healthcare continuum. At Audacious, she works to support marketing and business development strategy through market research, case study and content creation, and product marketing. Eliana has been a patient advocate since 2015, working to raise awareness about living with chronic migraine and other invisible illnesses through writing, speaking engagements, consulting, and political advocacy.
Donner-Klein previously worked as an Associate at Sirona Strategies where she focused on a variety of health policy issues including Medicare and Medicaid, value-based care, health information technology and interoperability, telehealth, and the social determinants of health. In addition to her policy and regulatory work, she worked as the communications manager to redesign and run coalition websites, strategic communications campaigns, and thought leadership through events and newsletters.