Electronic medical record

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. [cite web|title=A State Policy Approach: Promoting Health Information Technology in California|publisher=California Legislative Analyst Office|url=http://www.lao.ca.gov/2007/health_info_tech/health_info_tech_021307.aspx|month=February | year=2007]

Definition

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.

Issues

As of 2006, adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States. Less than 10% of American hospitals have implemented health information technology, [cite journal | last = DJ Ringold, JP Santell, and PJ Schneider | title = ASHP national survey of pharmacy practice in acute care settings: dispensing and administration—1999 | journal = American Journal of Health-System Pharmacy | volume = 57
issue = 19 | pages = 1759–75 | year = 2000 | url = http://www.ajhp.org/cgi/content/abstract/57/19/1759?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=57&firstpage=1759&resourcetype=HWCIT
accessdate = 2006-08-04 | pmid = 11030028 ] while a mere 16% of primary care physicians use EHRs. [Johnston, Doughlas, et al. "The Value of Computerize Provider Order Entry in Ambulatory Settings: Executive Preview." WEllesley, MA: Center for Information Technology Leadership, 2003] The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. 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%. [Raymond, B. and C. Dold. "Clinical Information Systems: Achieving the Vision. Prepared for the Meeting "The Benefits of Clinical Information Systems" Sponsored by the Kaiser Permanent Institute for Health Policy, 2001.] The following issues are behind the slow rate of adoption:

Interoperability

In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged. [Adapted from the IEEE definition of interoperability, and legal definitions used by the FCC (47 CFR 51.3), in statutes regarding copyright protection (17 USC 1201), and e-government services (44 USC 3601)]

In the United States, the development of standards for EMR interoperability is at the forefront of the national health care agenda. [http://www.cms.hhs.gov/MissionVisionGoals/Downloads/CMSStrategicActionPlan06-09_061023a.pdf] EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing share patient information(lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs.

The Center for Information Technology Leadership described four different categories (“levels”) of data structuring at which health care data exchange can take place. [Walker J, Pan E, Johnston D, Adler-Milstein J, Bates D, Middleton B. The Value Of Health Care Information Exchange And Interoperability. Health Affairs. Web Exclusive, January 19, 2005.] While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization.

The four levels are [NAHIT Levels of EHR Interoperbility [http://www.nahit.org/cms/index.php?option=com_docman&task=doc_download&gid=3&Itemid=197] Retrieved April 4, 2007] :

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. Fact|date=February 2007

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. [National Center for Health Statistics: [http://www.cdc.gov/nchs/products/pubs/pubd/hestats/electronic/electronic.htm Electronic Medical Record Use by Office-Based Physicians:, United States, 2005] Retrieved July 24, 2006] 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. [CDC's National Center for Health Statistics: [http://www.cdc.gov/od/oc/media/pressrel/a060721.htm More Physicians Using Electrical Medical Records] Retrieved July 27, 2006] 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. [cite journal | author = Gans D, Kralewski J, Hammons T, Dowd B | year = 2005 | title = Medical groups' adoption of electronic health records and information systems | journal = Health affairs (Project Hope) | volume = 24 | issue = 5 | pages = 1323–1333 | doi = 10.1377/hlthaff.24.5.1323 | accessdate = 2006-07-04 | pmid = 16162580 ] 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. [Certification Commission for Healthcare Information Technology (July 18, 2006): [http://www.cchit.org/media/CCHIT+Announces+First+Certified+Electronic+Health+Record+Products.htm CCHIT Announces First Certified Electronic Health Record Products] Retrieved July 26, 2006] and then on July 31 2006, additionally announced that two further EMR and EHR products had achieved certification. [Certification Commission for Healthcare Information Technology (July 31, 2006): [http://www.cchit.org/media/press+releases/CCHIT+Announces+Additional+Certified+Electronic+Health+Record+Products.htm CCHIT Announces Additional Certified Electronic Health Record Products] Retrieved July 31, 2006]

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.

ee also

*Teges
*Synamed
*Continuity of Care Record
*Electronic health record
*European Institute for Health Records (EuroRec)
*MUMPS
*Veterans Health Information Systems and Technology Architecture (VistA)
*List of open-source Electronic Health Record systems
*Composite Health Care System
*Canadian EMR
*Office suites including online office suites
* List of open source EMR vendors

References

External links

* [http://lsdis.cs.uga.edu/projects/asdoc/ Active Semantic Documents project] (LSDIS, University of Georgia)]
* [http://www.openclinical.org/emr.html OpenClinical - Electronic Medical Records]
* [http://www.hhs.gov/healthit/ US Department of Health and Human Services (HHS), Office of the National Coordinator for Health Information Technology (ONC)]
* [http://healthit.ahrq.gov/emr US Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality (AHRQ), National Resource Center for Health Information Technology]
* [http://recordaccess.icmcc.org/ The ICMCC portal on access to electronic medical records.] The portal includes a [http://blog.icmcc.org/ blog] to share and discuss experiences for both patients and clinicians as well as an extended overview of relevant literature.