An electronic medical record (EMR) is a computer-based patient medical record. An EMR facilitates
- access of patient data by clinical staff at any given location
- accurate and complete claims processing by insurance companies
- building automated checks for drug and allergy interactions
- clinical notes
- sending to and viewing by labs
The term has become expanded to include systems which keep track of other relevant medical information. The practice management system is the medical office functions which support and surround the electronic medical record.
Although an EMR system has the potential to permit invasion of medical privacy, if security policies are monitored effectively EMRs are as secure as banking records, for example.
Electronic records fall under the purview of medical informatics, a combination of computation and computer science and medical record keeping.
According to the Medical Records Institute, five levels of an Electronic HealthCare Record (EHCR) can be distinguished:
- The Automated Medical Record is a paper-based record with some computer-generated documents.
- The Computerized Medical Record (CMR) makes the documents of level 1 electronically available.
- The Electronic Medical Record (EMR) restructures and optimizes the documents of the previous levels ensuring inter-operability of all documentation systems.
- The Electronic Patient Record (EPR) is a patient-centered record with information from multiple institutions.
- The Electronic Health Record (EHR) adds general health-related information to the EPR that is not necessarily related to a disease.
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:
- ASTM CCR - Continuity of Care Record - a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various EHR or Electronic Medical Record (EMR) systems, allowing easy interoperability between otherwise disperate enities.
- ANSI X12 (EDI) - Used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information.
- CEN - EN13606, the European standard for the communication of information from EHR systems, and HISA, a services standard for inter-system communication in a clinical information environment.
- DICOM - a heavily used standard for representing and communicating radiology images and reporting
- 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.
- ISO - ISO TC215 has defined the EHR, and also produced a technical specification ISO 18308 describing the requirements for EHR Architectures.
- openEHR - public specifications and implementations for EHR systems and communication, based on a complete separation of software and clinical models.
Pricing for Electronic Medical Record (EMR) systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems must be custom tailored.
Caveats and Concerns
It should be noted that there are issues surrounding the generation and management of Electronic Medical Records, also know as EMR (or EHR).
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 obsolecense 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 Personal 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.
As of 2005, one of the largest projects for a countrywide EMR is the NHS project in the United Kingdom. The goal of NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010.
The province of Alberta's Wellnet project is a large-scale operational EMR system.
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