Electronic Medical Records (emr), Electronic Health Records (ehr), And The Coming Digital Medical Re

By Author: Abraham bernardm
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Health information technology (Health IT) is a rapidly changing field, revolutionizing healthcare and challenging the medical workflow status quo. The last decade has seen unprecedented changes, driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 per HealthIT.gov (2015). This law required that hospitals and health care organizations develop and use electronic health records (EHR). Hospitals must show evidence of meaningful use of EHR by compliance with sets of standards with keen attention to regulatory, accreditation, professional practice, and legal standards per Dougherty, M. (2008). Technologies are developed at an astonishing rate, transforming healthcare into a digital automated workflow, event driven coordination, situational awareness with intelligent (AI) real time orchestration of care. Hospital CIOs are planning fast for post electronic health record (EHR) innovations.
What is an Electronic Medical Record (EMR)?
The electronic medical record (EMR) is ground zero for digital medical workflow revolution. Think of EMR as an electronic chart. The care provider ...
... records patients’ history, physical, vital signs, allergies, laboratory results, immunizations and captures diagnosis and treatments. The chart is never lost, easily searchable, and allows tracking of patients’ ongoing problems, like hypertension. This enables patients to be recalled for preventive screening, checkups and disease related evaluations, helping to automate and improve quality of care per Garrett and Seidman (2011).

Electronic Healthcare Records (EHR). How it differs from EMR.
The electronic healthcare record (EHR) is networking of EMR with other data components of medical care and has more functions and interconnectivity. EMR is just part of the electronic information that documents patients’ healthcare. Imagine the inclusion of hospital networks, lab results, imaging studies, and sharing these to all stakeholders in patient care. When the EHR systems are all connecting, laboratory results and imaging studies do not have to be repeated at emergency rooms or specialists’ offices. Hospital discharge information can be shared with the doctor resuming patients’ office care. Patients can logon to view their medical records and reports, downloading them to a personal healthcare record. Since healthcare is a “team” sport, the EHR has the potential, not fully realized, of providing integrated information to all stakeholders, in all locations, of the entire universe of patients’ health information. All this shared information can generate vast data to be analyzed to improve care. Figure 1 below is a simplified view of EHR (green) showing integration of EMR, lab, X-ray, pharmacy (RX), and personal health record (PHR).

Figure 1. The inclusive Electronic Health Record
The essential functions of enterprise level EHR are powerful, far exceeding EMR. Data generated by analysis of EHR can reveal important insights that can produce positive change in care delivery. Data systems are interconnected in EHR.
Table 1. Functions of Enterprise EHR
System Management, access and security
Interoperability
Clinical Database
Clinical Support
Clinical documentation and data development
Clinical workflow automation
Clinical data retrieval and display
Order management (lab, pharmacy, imaging)
Benefits of EHR
Implementation of EHR has been expensive, disruptive, and difficult. Healthcare providers have spent an estimated $60B to acquire EHR per Handler (2017). According to the Physician’s Foundation Survey (2018), physicians indicate electronic health records are the greatest source of professional dissatisfaction. This is because, from the care providers viewpoint, EHR has been cumbersome to use and diverts focus away from the patient. Demonstrating a return on investments (ROI) has been elusive. Benefits have included reduced use of resources, higher-value care delivered, analytics, improved organizational effectiveness, and reduced labor costs, shown in Figure 2.

Figure2. EHR Value from Jones and Handler (2017)
One of the most important values of the data and structure of EHR is decreasing unwarranted practice variation. For example, there are numerous options open to physicians treating an ear infection. The EHR data driven initiative attempts to standardize healthcare, reducing choices for physicians and patients, directing providers to use the cheapest and most efficacious method of treatment for an ear infection. There has been pushback on healthcare standardization, making it the most difficult to achieve per Jones and Handler (2017). Figure 3 is a time to value chart of goals of EHR.

Figure 3. Slow gains toward practice standardization. Jones and Handler (2017)
Who are the creators of enterprise EHR?
Major creators for enterprise EHR systems include Epic, Cerner (Siemens, OTCMKTS: SIEGY), InterSystems, Meditech, and Allscripts (NASDAQ: MDRX). These companies vary in their ability to execute and complete their vision. In 2015, Epic and Cerner emerge as leaders, per Handler (2017).
Next Generation EHR: Artificial Intelligence
“Artificial Intelligence Will Redesign Healthcare,” The Medical Futurist (2017).

Artificial Intelligence
The new frontier for health IT is the integration of artificial intelligence (AI) techniques and advanced analytics into enterprise level EHR. This uncharted territory is being explored: How will health care organizations and other big tech companies invest in, introduce, manage and safely deploy AI? How will AI applications transform healthcare and healthcare delivery culture? Who is responsible for the quality of AI algorithms?
Beyond EHR is the increasing automation of the entire health care services industry. New technologies are being developed that orchestrate healthcare, such a real time location system (RTLS), situational awareness (arrays of sensors) and automatic responses. This is the time of the digital healthcare revolution.