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Electronic Medical Records (EMR)

Electronic Medical Records (EMR)

E

lectronic Medical Record (EMR), also known as Electronic Health Record (EHR) is a patient's medical record in an electronic format, accessible by computers on a network for the primary purpose of providing health care and health-related services. Information in an EHR includes mental health and condition of a patient, medical test reports, and financial and demographic information.


Overview

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.

An EMR (Electronic Medical Record) facilitates:

  1. Easy access of patient data by clinical staff at any given location.
  2. Accurate and complete claims processing by insurance companies.
  3. Building automated checks for drug and allergy interactions.
  4. Clinical notes.
  5. Prescriptions
  6. Scheduling
  7. Sending to and viewing by labs

The EMR healthcare Software definition can be classifieds into five levels

  1. The Automated Medical Record which is a paper-based record with some computer-generated documents.
  2. Ability to encompass the variability and complexity of medicines, as well as healthcare information and practices.
  3. The Computerized Medical Record (CMR) which makes the documents of level 1 electronically available.
  4. The Electronic Medical Record (EMR) restructures and optimizes the documents of the previous levels ensuring inter-operability of all documentation systems.
  5. The Electronic Patient Record (EPR) is a patient-centered record with information from multiple institutions.
  6. The Electronic Health Record (EHR) adds general health-related information to the EPR that is not necessarily related to a disease

The purpose of EMR medical software is to maintain the benefits of paper-based medical record while overcoming its limitations. EMR is a single, permanent, legal document featuring the following key characteristics.

A compact structure in the form of a collection of documents.
User-friendly method of examining the records.
Appropriate authorization.
Ability to encompass the variability and complexity of medicines, as well as healthcare information and practices.
Portability to all venues.

Customization

Pricing for EMR systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is due to the majority of EMR systems being based on templates that are initially general in scope. In many cases, these templates can then be customized in co-operation with the vendor/developer to better fit a medical specialty, environment or other specified needs. There are also EMR systems available that do not use templates and therefore can be easily personalized by each individual user.

Public implementations

As of 2005, one of the largest projects for a national EMR is by the National Health Service (NHS) in the United Kingdom. The goal of the NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010.

The Canadian province of Alberta's Alberta Netcare project is a large-scale operational Electronic Health Record (EHR) system.

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.

Standards

Though there are few standards for modern day EMR systems as a whole, there are many standards relating to specific aspects of EHRs and EMRs. These include:

  1. ASTM International Continuity of Care Record - a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various EHR or EMR systems, allowing easy interoperability between otherwise disparate enities.
  2. ANSI X12 (EDI) - A set of transaction protocols used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information, because several of the transactions became required by the Health Insurance Portability and Accountability Act (HIPAA) for transmitting data to Medicare.
  3. CEN - CONTSYS (EN 13940), a system of concepts to support continuity of care.
  4. CEN - EHRcom (EN 13606), the European standard for the communication of information from EHR systems.
  5. CEN - HISA (EN 12967), a services standard for inter-system communication in a clinical information environment.
  6. DICOM - a heavily used standard for representing and communicating radiology images and reporting
  7. HL7 - HL7 messages are used for interchange between hospital and physician record systems and between EMR systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material.
  8. ISO - ISO TC 215 has defined the EHR, and also produced a technical specification ISO 18308 describing the requirements for EHR Architectures.
  9. openEHR - next generation public specifications and implementations for EHR systems and communication, based on a complete separation of software and clinical models.

Various factors involving the timing, the right players, market history, utility, 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.

Caveats and concerns

There are issues surrounding the generation and management of electronic medical records (EMRs), sometimes known as electronic health records (EHRs). There are two primary categories of the EMR; the "born digital" record and the scanned/imaged record.

Born digita :
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.

Scanned/imaged record: The second category is 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.