EMR
An electronic medical record (EHR) (also electronic healthcare record (EHR) or clinical information system (CIS)) is a data repository that digitally collects the medical reports of patients, exchanges such information with other healthcare provides, and makes a personal health record (PHR) for the patient to share with their doctor and other providers.
Contents
- 1 Electronic Medical Record (EMR) or Electronic Healthcare Record (EHR)
- 2 EMR Components
- 3 EMR Training
- 4 Strategies for Improving EMR Adoption
- 5 Clinician Sign-out applications
- 6 Free and Open Source EMRs
- 7 Integrating Medical Devices into EMRs
- 8 Considerations for Specialists
- 9 EMR and Biometrics
- 10 Socio-technical Issues
- 11 Business Case for Improving Usability
- 12 New Technologies
- 13 Strategies of Clinical Data Entry
- 14 EHR system selection
- 15 Vendor selection criteria
- 16 Historically Important Electronic Medical Record Systems
Electronic Medical Record (EMR) or Electronic Healthcare Record (EHR)
EMR benefits
Electronic Medical Records have many benefits over an analogous paper record.
See also: more in-depth discussion of EMR benefits
Privacy and security
Electronic objects enhance privacy by providing different levels of security access to different governmental groups and individuals. However, it also lends itself to some false sense of security in that it doesn’t prevent humans from mislabeling, incorrectly granting access, or malicious tampering. A digital data trail is very durable and more difficult to erase than a paper trail. However, privacy breaches are possible.
Financial
Although initially implementing EMRs can be expensive [1], computer systems are more efficient and can save time and money. EMR systems can eliminate the paper chart. [2] Typing orders directly eliminates paper waste. Hard drives take up less space. Shared databases reduces the need for paper. [3]
Billing is also easier, as files are claimed faster, and bills are done optimally. Patients can be informed of generic drugs and doctors can know if insurances do not cover patients. Insurance and malpractice premiums can also be lowered. [4]) [5] The computer also can point out different drugs that can save hospitals money [6].
Man hours are also reduced. Dictation is automatic, e-prescribing reduces number of phone calls and visits, [7] [8] [9] and patients are automatically notified of test results and appointment times.
Clinical
EMRs make the hospital staff more productive. Nurses are more efficient. [10] A computer system reduces medication errors and checks for drug-drug interactions [11] [12] [13] [14], reduces redundant lab tests, and reduces time needed in information exchange. [15]
Reminders can increase underused preventative measures, [16] reduce duplicate laboratory tests, [17] [18] and increase compliance [19] [20] [21] The patient internet portal allows patients to know the most up to date information about healthcare. [22]
EMRs also make it easy for large scale data exchange. National diseases registries exchange data more easily, and patients can pool all their medical data from multiple providers. [23]
EMR Components
EMR Training
Post-live Physician Training & Support
Strategies for Improving EMR Adoption
Strategies for Improving EMR Adoption
Recent Changes to Support EHR Adoption in Solo/Small Practices
Clinician Sign-out applications
Clinician Sign-out applications
Free and Open Source EMRs
Integrating Medical Devices into EMRs
Integrating Medical Devices into EMRs
EMR Introduction and Background
EMR (EHR) Available Solutions and How to Choose the Right One
Considerations for Specialists
Specialists can have different EMR needs.
EMR and Biometrics
Socio-technical Issues
Privacy of Patient Data: Genetic Non-Discrimination
Definitions of Terms related to Patient Privacy, Confidentiality, and Security
Business Case for Improving Usability
Business Case for Improving Usability
New Technologies
WiSPER™ (Wireless Standardized Portable Electronic Records)
Vocera -- Hands-free, wireless communication device
Aionex PatientBoard -- a HIPAA-compliant, secure, web-based, patient status board
FastAccess -- a biometric facial recognition solution to the repeat login problem
Biometric Resource -- information about existing and cutting edge biometric technologies
Omron Wrist Blood Pressure Monitor
Internet Based EMR: Benefits & Costs
Strategies of Clinical Data Entry
Strategies of Clinical Data Entry
Natural Language Processing (NLP)
EHR system selection
See more for what Marl Mench thinks of EHR system selections
List of EMR companies
EMR models for small and medium sized practices
Vendor selection criteria
Selection of a vendor product is certainly important and potentially problematic. Physician resistance is one of the major barriers to adoption of electronic medical records. Although some elements, such as diagnoses and medication lists, are relatively easy to implement, others are very difficult. [24] It is important to look at demonstrations or do trial runs before deciding on an EMR.
Functionality
The vendor's EMR must meet some minimum requirements. Its source code must comply with regulatory laws, such as the Health Insurance Potability and Accountability Act, the Patient Safety and Quality Improvement Act (PSQIA), and the Certification Commission of Healthcare Information Technology (CCHIT) criteria.
The EMR software must have essential features [25][26]. These include
- standardized vocabulary standards, such as Unified Medical Language System (ULMS), SNOMED, NDC, LOINC, WHO Drug Dictionary, MeSH, CPT, DRG
- note creation: templates for documentation, dictation, voice recognition, hand writing recognition
- patient problem list compliant with Final Rule
- patient medication list
- reminders and alert system to assist clinical decisions
- user-friendly interface for viewing and sharing of data
- security: access control for data
- advanced reporting and analysis, data query and search functions
- accessibility for the disabled, such as vision and hearing impaired
- wireless access, internet access, outreach for public education
- efficient data transfer between departments (pharmacy, lab), interfaces (PCs, analog data), and institutions (personal health records (PHR), surveillance data)
Implementation cost
The total cost of ownership (TCO) and invest required to fully implement the vendor system is important. Although initually expensive, a good EMR system should pay for itself in time. A vendor should have a track record for successful system implementations. A company should have a detailed plan for implementation and training. All costs should be clearly identified: hardware, software, interfaces, text conversions, maintenance, human resources, networks, peripherals such as computers and printers, training, technical support, and facility renovation to accommodate EMR system changes. Specific software considerations include licenses fees, software upgrade and development timeline, and data integration from legacy systems.
Hardware and technical requirements
It is important to identify all hardware and software requirements to implement a full-scale EMR system. A vendor should meet the technical requirements of OS platforms, language, and databases. The system and licensing system should also be able to meet future technological standards in hardware and software. The debugging process should be efficient. The EMR system must also be scalable to a large number of users.
It is up to the buyer to decided whether to go with non-proprietary system or an established industry system, whether to have on-site or remote hosting; there are advantages and disadvantages to each. A hosted server requires the vendor to have adequate computing facilities. A remote server needs to have alternative plans for outages. Mobile and wireless clients also need consideration.
Information extraction should be fast and efficient.
Long term vendor partnership
The software company itself should be stable, growing, and profitable over a long time period. Its past history should include other successful contracts to similar health systems, a reputation for frequent check-ups, and few uninstalls. A vendor should provide regular and periodic updates. The EMR software must have provide sufficient, long-term, on-site customer support. The vendor should be quick to respond during emergencies, and have backup in case the system malfunctions. The legal agreements should include specifications and quantifiable measures of support, with appropriate penalties if evaluated negatively.
For an in-depth discussion of vendor selection criteria