An electronic health record (EHR) (also electronic patient record or computerised patient record ) is an evolving concept defined as a longitudinal collection of electronic health information about individual patients or populations. It is a record in digital format that is capable of being shared within across different health care settings, by being embedded in network-connected enterprise-wide information system. Such records may included a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, and billing information.
It is important to note that an EHR is generated and maintained within an institution, such as a hospital, integrated delivery network, clinic, or physician office.
Its purpose can be understood as a complete record patient encounters that allows to automate and streamline workflow in health care settings and to increase safety through evidence-based decision support, quality management, and outcomes reporting.
Advantages of electronic medical records
EHR systems increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR systems with computerized provider order entry (CPOE) have existed for more than 30 years, fewer than 10 percent of hospitals as of 2006 have a fully integrated system.
Reduce healthcare costs
One of the major sources of rapid growth in healthcare costs comes from medical imaging. Medicare Part B spending on imaging rose from $6.80 billion in 2000 to $14.11 billion in 2006. Access to a patient's images in an EHR is an effective way to avoid duplicating expensive imaging procedures. Other cost savings include the reduction of medical errors that can otherwise lead to further expensive care.
Improve quality of care
An EHR system can help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine enable proliferation of ongoing improvements in healthcare efficacy.
Promote evidence-based medicine
EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices.
These benefits may be realized in a realistic sense only if the EHR systems are interoperable and wide spread (for example, national or regional level) so that various systems can easily share information. Also, to avoid failures that can cause injury to the patient and violations to privacy, the best practices in software engineering and medial informatics must be deployed.
EHRs also have the advantages of electronic medical records (EMR). In general, medical records may be on "physical" media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure.
Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage. When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance.
In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR is offset by the cost of only a few unnecessary tests or admissions.
Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors. Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies.
In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR systems ("interoperability") would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.
Disadvantages of electronic medical records
Critics point out that while EHRs may save the "health system" money, physicians, those who buy the systems, may not benefit financially. EHR price tags range widely, depending on what's included, how robust the system is, and how many providers use it. Asked what they paid in an online survey, about a third of respondents paid between $500 and $3,000 per physician. A third paid between $3,001 and $6,000, and 33 percent paid more than $6,000 per physician for their EHR. Physicians do tend to see at least short-term decreases in productivity as they implement an EHR. They spend more time entering data into an empty EHR than they used to spend updating a paper chart with a simple dictation. Such hurdles can be overcome once the software has some data, as physicians learn to use easy templates for data entry, and as workflow in the practice changes, but not every practice gets that far.
Studies also call into question whether, in real life, EHRs improve quality.
Lack of adoption of EHRs in the United States
As of 2000, adoption of EHRs and other health information technology (HITs) (such as computer physician order entry (CPOE)) was minimal in the United States (outside of the VA system). Fewer than 10% of American hospitals had implemented HIT, while a mere 16% of primary care physicians used EHRs. In 2001-2004 only 18% of ambulatory care encounters utilized an EHR system. In 2005, 25% of office-based physicians reported using fully or partially electronic medical record systems (EMR), an almost one-third increase from the 18.2% reported in 2001. However, less than one-tenth of these physicians actually had a "complete EMR system" (with computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes).
The healthcare industry spends only 2% of gross revenues on HIT, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%.
Incentives in the United States
Until recently, with the American Recovery and Reinvestment Act of 2009, providers were expected to take the full risk of investing in healthcare IT. Notably, healthcare payers, such as the government through Medicare, also have potential for significant cost savings if providers adopt EHR systems.
The 2009 economic stimulus package (HITECH Act) passed by the US Congress aims at incenting more physician to adopt EHR. The act promises incentive payments to those who adopt and use "certified EHRs" and, eventually, reducing Medicare payments to those who do not use an EHR. In order to receive the EHR stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EHR system.
In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was created. Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information.
Standards
- ANSI X12 (EDI) - transaction protocols used for transmitting patient data. Popular in the United States for transmission of billing data.
- CEN's TC/251 provides EHR standards in Europe including:
- EN 13606, communication standards for EHR information
- CONTSYS (EN 13940), supports continuity of care record standardization.
- HISA (EN 12967), a services standard for inter-system communication in a clinical information environment.
- Continuity of Care Record - ASTM International Continuity of Care Record standard
- DICOM - an international communications protocol standard for representing and transmitting radiology (and other) image-based data, sponsored by NEMA (National Electrical Manufacturers Association)
- HL7 - a standardized messaging and text communications protocol between hospital and physician record systems, and between practice management systems
- ISO - ISO TC 215 provides international technical specifications for EHRs. I
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