EMR vs. EHR vs. PHR: There is a Difference

HITS: Beyond the Headlines >> Written by By Andis Robeznieks / HITS staff writer

EMR vs. EHR: Yes, there is a difference
Story originally published December 29, 2005

As President Bush's program to spur adoption of heath information technology gained momentum in 2005, the debate over what to call the electronic products being promoted became louder and more intense among participants in the field -- while the general public responded with either apathy or confusion.

The "electronic health record" vs. "electronic medical record" issue appeared to reignite this past year. The results were some painfully earnest arguments that were sometimes difficult to penetrate and often resulted in glazed looks on the faces of people listening or reading them.

"The public hasn't made a distinction" between EHRs and EMRs, said Pat Wise, R.N., a retired U.S. Army colonel and the Healthcare Information and Management Systems Society's vice president of EHR initiatives. "They probably think they're synonymous."

She added that most physicians don't know the difference either, explaining that HIMSS recently convened focus groups of 10 to 12 physicians in paper-based practices and "not one of them knew what an electronic health record was."

Promising to offer concise definitions, Wise said that EHRs "are what the nation aspires to and what President Bush calls for," but EMRs are mostly what we have right now.

She explained that an EHR is made up of two components: a personal health record which includes patient-inputted information on symptoms or disease-management data; and an EMR or an EMR summary.

"An EMR (Electronic Medical Record) is owned by the organization, practice or corporation that you received your healthcare from -- be it St. Elsewhere, County-Municipal, or Doc Smith," Wise said. "You don't want every little bit or byte they have on you. You want summary data, and that summary becomes part of your electronic health record." Explaining further, Wise said an EMR can contain episodic information from your two-week stay in a local hospital or the visit to an emergency department in another state after you bumped your head on vacation. "When you're discharged from St. Elsewhere, you know they don't hit the 'delete' button and wipe out everything," she said. "And, while that information is theirs to own, it's also expected that it's theirs to protect."

An EHR is a cradle-to-the-grave summary record that may not contain all the information collected over a lifetime of receiving healthcare, but it can contain pointers to where more information can be found, Wise said.

Two factors are now helping to add confusion to the EHR-EMR debate: the federal government and computer spell-check programs.

Wise said the federal government erred when it granted a $7.5 million contract to the Certification Commission for Healthcare Information Technology to evaluate certification criteria for electronic health records. "In all actuality, they're certifying vendors' ambulatory-care EMR products, because there is no real EHR yet," Wise said. "So now the marketplace is totally confused."

Spell-check programs are giving the term "EMR" some staying power as well, because many computers will automatically change "EHR" to "HER," forcing people who don't know how to override their spell-check function to use EMR by default.

"My job title is 'vice president of EHR initiatives,' imagine how long it took to get spell check to ignore that," Wise said. Dan Michelson, the chief marketing officer for Chicago-based IT vendor Allscripts, said it's such a common problem that the company has produced a set of standard instructions which it sends out to people as a public service.

Here is a copy of those instructions:

"It sounds funny, but it's safe to say we have all made the mistake by now of having 'HER' show up instead of 'EHR' in a Word document, PowerPoint, e-mail, etc. It's not just Allscripts (of course), it's a problem for everyone in the industry. Pretty silly thing, but pretty embarrassing.
So ... here's how to keep it from happening for all Microsoft Office applications:
· Open any Microsoft Word file.
· Go to "Tools" and then select 'AutoCorrect.'
· In the window where it says 'Replace,' enter 'EHR'.
· Once you enter 'EHR', you will see an entry below it that has 'EHR' in column 1 and 'HER' in column 2. Click on this row and then select 'Delete' at the bottom.
· Then, where it says 'With,' enter 'EHR' and click on 'Add.'
· Click 'OK.'
This will fix the problem for all Office applications ... but hold on!
To fix this in Outlook, you need to take two more steps:
· Open Outlook and write a message and include 'EHR' in the content.
· Turn on spell check (if it isn't on already) and when 'EHR' comes up as a spelling error, select 'Add' to put this in your dictionary.
"There. That's it. This will keep 'HER' from showing up."

What do you think? Write us with your comments at hitsdaily@crain.com.

HIT Strategist Health Business: :12/29/05
New IT system features 'e-office visits'
By ASTARA MARCH

WASHINGTON, Dec. 28 (UPI) -- Fifty-four thousand patients in a large medical practice near San Francisco are logging on to a Web site to get lab results, renew drug prescriptions or cancel a doctor's appointment, showcasing a successful health IT microcosm that computer experts hope the entire nation can eventually emulate.

The patients in that California practice are using a nascent system called the Personal Health Record (PHR), a system that will introduce next year the "virtual office visit" for simple ailments like the common cold in place of a trip to the doctor's office.

Paul Tang, vice president and chief medical information officer for the Palo Alto Medical Foundation who helped develop the system, told United Press International that PAMF created the tool to give patients more transparent access to their personal health information and help them become more active participants in the healthcare process.

"The healthcare system needs to take advantage of electronic tools," Tang told UPI. "It will allow us to make better decisions and help patients become more actively involved in managing their own health. If we can make electronic health records and personal health records universal, we can transform healthcare and really improve the wellbeing of the U.S. population," he said.

Tang noted that fast access to lab results has especially drawn accolades from patients with chronic conditions. "It's one of the features patients tell us they like best," Tang said. "Access to their lab results gives our patients feedback on how their behavior and lifestyle choices affect their condition and tells them how well they are managing their diseases. If they don't have this feedback, a good proportion will only take half of the pills they've been prescribed," he said.

Other patient favorites include being able to communicate with a doctor through online secure messaging and having access to information on diagnoses, medications, immunizations and health maintenance schedules, such as mammograms, Tang noted. With patients' permission, ER physicians and doctors' offices around the country can obtain this information as well, he added.

Tang noted that PAMF keeps the doctor/patient lines of communication open 24 hours a day.
"Patients find the convenience of being able to send us a message anytime and from anywhere particularly useful," he commented. "They can send their doctor a question whenever the question occurs to them, 24 hours a day. Most of the time the doctor gets back to them in half a day, although we say that we'll respond within one to two business days."

He added that the PHR's range of capabilities is still evolving, with two new features to be launched next year.

So-called "e-Visits" will allow patients to interact with their doctors online for simple problems such as colds and allergy symptoms instead of having to come to the office.

The online disease-management feature will involve patients with conditions such as diabetes sending data from home monitoring instruments to their doctors on a frequent basis and getting feedback on the next steps they should take to maintain their health, Tang said.
"Online disease management will be more convenient and our patients will get better care than if they came to the office every three to six months," Tang said. "Their conditions will be much better controlled and they will have fewer complications because we can track their progress more closely and catch problems early."

Currently, PHRs offer a range of other functions, such as allowing patients to ask billing and non-medical questions; view a personal health summary of all their interactions with PAMF since their first visit; see what tests have been ordered; see graphs of their progress controlling weight, cholesterol, diabetes, high blood pressure or other chronic conditions; and check their risk of developing acute problems such as heart attacks or strokes.

Tang said that, although paper-based practices can use PHRs, the system works best when a practice already has an electronic health record system and all the relevant patient information can be linked.

He added that the government's Office of the National Coordinator of Health Information Technology, headed by David Brailer, is developing infrastructure that will connect PHRs nationwide.

When the system is complete, patients will be able to allow doctors in any emergency room or office in the nation to access records from all their physicians and will be able to see an overview of all their caregivers' results and conclusions, Tang said. He said he believed privacy issues will be handled via a password system.

© Copyright 2005 United Press International, Inc. All Rights Reserved