An electronic medical record (EMR) is a medical record in digital format.
In health informatics an EMR is considered by some to be one of several types of EHRs (electronic health records), but in general usage EMR and EHR are synonymous.
The term has sometimes included other (HIT, or Health Information Technology) systems which keep track of medical information, such as the practice management system which supports the electronic medical record.
In the United States, the development of standards for EMR interoperability is at the forefront of the national health care agenda. EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing share patient information(lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs.
The Center for Information Technology Leadership described four different categories (“levels”) of data structuring at which health care data exchange can take place. While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization.
The four levels are:
|1||Non-electronic data||Paper, mail, and phone call.|
|2||Machine transportable data||Fax, email, and unindexed documents.|
|3||Machine organizable data (structured messages, unstructured content)||HL7 messages and indexed (labeled) documents, images, and objects.|
|4||Machine interpretable data (structured messages, standardized content)||Automated transfer from an external lab of coded results into a provider’s EHR. Data can be transmitted (or accessed without transmission) by HIT systems without need for further semantic interpretation or translation.|
Various factors involving the timing, the right players, market history, utility, and governance play a key role in the overall enrichment of the standard and certification development. The standardization and certification even though seem to bring uniformity in the EMR development, do not guarantee their acceptability and sustainability in the long run. In 2005 the US Federal Government awarded a contract to CCHIT - Certification Commission for Healthcare Information Technology to develop certification criteria for EMR. Starting in early 2007 vendors began to utilize these certification criteria for their EMR systems.
There are a two primary categories of the EMR; the "born digital" record and the scanned/imaged record.
The "born digital" record, which is information captured in a native electronic format originally is information that may be entered into a database, transcribed from an electronic tablet or notebook PC, or in some other manner captured from its inception electronically. The information is then transferred to a server or other host environment, where it is stored electronically.
The second category are records originally produced in a paper or other hardcopy form (X-ray film, photographs, etc.) that have been scanned or imaged and converted to a digital form. These records are best described as "digital format records", as their content is not able to be modified or altered (with the exception of the use of a third party software to make "overlay notations") as electronic records are. Most medical records generated preceding the year 2000 are of this category.
The process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact and accurate capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by any number of healthcare professionals over the life span of the patient, there exists a high probability of some of the content being illegible following conversion. In addition, the material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. Consideration should be given to developing a procedure to sample and verify images at a high ratio to determine the accuracy and usability of the scanned images prior to disposal of the physical records, if they are disposed of at all.
Further, all electronic repositories of information are subject to the need for periodic conversion and migration to ensure the formats they were captured in remain accessible over the life of the patient, and in some cases beyond, to the expected life of their heirs. Additionally, those responsible for the management of the EMR are responsible to see the hardware, software (applications) and media used to manage the information remain viable and are not subject to obsolescence or degradation. This will require generation of backup copies of the data and protection being provided to these copies in the event of damage to the primary repository. It will also require the planned periodic migration of information to address concerns of media degradation from use. These are all costly, time consuming processes that must be planned and budgeted for when making decisions to convert physical medical records to digital formats.
Another major concern is adequate protection of privacy of the individuals whose records are being managed electronically. This class of information (in the US) is referred to as Protected Healthcare Information (PHI) and its management is addressed under the Healthcare Insurance Portability and Accountability Act (HIPAA) as well as many State-specific privacy laws. The organization/individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. Few EMR companies are truly secure and this remains a serious concern. Patientprivacyrights.org is a patient 'privacy' advocacy group that audits EMR companies and rates them for security policies and how well they safeguard patient information. Microsoft Healthvault is one of the first applications to be certified.
Lastly, EMR technology is a new frontier. It has attracted some notoriously unsavory individuals. Some of these companies have been shut down or 'disappeared', but not before extracting a high price from trusting physicians. DrNotes is an infamous example of the worst kind with a very colorful history. Doctorsinperil.org is an organization that helps doctors avoid unscrupulous companies. This organization aggregates complaints against EMR companies, verifies the authenticity and posts the results. Companies with brilliant marketing and polished demos don't necessarily fare well here where endusers speak up and the 'rubber meets the road', so to speak.
|Creator||Preferred Vendor||Latest stable version||Cost (USD)||Software license|
|e-MDs Razor EMR||e-MDs||6.3||from $2,995||Proprietary|
|CureMD EMR||CureMD Corporation||10||(custom pricing)||Proprietary|
|Medscribbler||Scriptnetics Inc.||5||from $2,899.99 (custom pricing)||Proprietary|
|SOAPware||SOAPware EMR Systems||AutoMED Software 516.369.7091, Medisys 304-204-3400||5.x||from $1,999.99 (custom pricing)||Proprietary|
|MediNotes e EHR||MediNotes||AutoMED Software 516.369.7091, Medisys 304-204-3400||5.2||from 5,000.00||Proprietary|
|JonokeMed||Jonoke Software Development Inc.||4.05.01||?||Proprietary|
|HealthHighway EMR||HealthHighway Inc.||?||3.1||?||Proprietary|
|OmniMD EMR||OmniMD||?||?||from $325/month (custom pricing)||Proprietary|
|Creator||Preferred Reseller||Latest stable version||Cost (USD)||Software license|
Operating system compatibility:
|Client||Windows||Mac OS X||Linux||BSD||Unix||AmigaOS|
|e-MDs 'Razor' EMR|
|MediNotes e EMR|
|Client||Windows||Mac OS X||Linux||BSD||Unix||AmigaOS|
Adoption of electronic medical records by US doctors is increasing slowly. The latest data from the National Ambulatory Medical Care Survey (NAMCS) indicate that one-quarter of office-based physicians report using fully or partially electronic medical record systems (EMR) in 2005, a 31% increase from the 18.2 percent reported in the 2001 survey. However, the survey also states that just 9.3% of these physicians actually have a "complete EMR system", with all four basic functions deemed minimally necessary for a full EMR: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes. Barriers to adopting an EMR system include training, costs and complexity, as well as the lack of a national standard for interoperability among competing software options. Advocates of electronic health records hope that product certification will provide US physicians and hospitals with the assurance they need to justify significant investments in new systems. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards and certify vendors who meet them. On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR and EHR products. and then on July 31 2006, additionally announced that two further EMR and EHR products had achieved certification.
In the United States, the Department of Veterans Affairs (VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture or VistA. A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders, including medications, special procedures, X-rays, patient care nursing orders, diets, and laboratory tests.
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