ELECTRONIC MEDICAL RECORD

An electronic medical record (EMR) is a computer-based record of an individual's

medical history. In the technological age we are living in today, the trend is
leaning more and more toward medical practices keeping an electronic medical rec
ord of their patients rather than a paper record.
In health informatics, an EMR is considered by some to be one of several types o
f EHRs (electronic health records). In general usage EMR and EHR are synonymous.
The term has sometimes included other systems which keep track of medical infor
mation, such as the practice management system which supports the electronic med
ical records.
The federal government has defined the EMR as containing four basic functions:-1
) computerized orders for prescriptions.
2) Computerized orders for tests
3) Reporting of test results
4) Physician notes.
An individual doctor's practice, facility or insurance company's system determin
es on its own which of those records will be kept, making it more or less comple
te. Federal definition has not resulted in a standard.

Electronic medical records are readily accessible, increasingly standardized for

seamless use where and when required, and greatly reduce the likelihood of erro
r in either entry or interpretation of medical information. Having a patientâ s med
ical and contact information readily available can be potentially life-saving du
ring critical medical events such as severe allergic reactions or heart attacks.
By reducing errors and saving time, electronic medical records may therefore he
lp reduce the large number of deaths attributed to medical error in the United S
tates each year.
In order to enter medical information into an electronic medical record, special
software is required. The electronic medical records software industry is rapid
ly growing, and such software is becoming increasingly sophisticated. While basi
c software allows for entry of physician orders and notes and nursesâ notes, more
advanced software may include error-checking programs, the capacity to synchroni
ze with hand-held data devices, and other advanced features that increase the ut
ility of records.
As electronic medical records are more widely used, concerns regarding the prote
ction of patientsâ confidential medical information and privacy have increased. In
1996, the US Congress passed the Health Insurance Portability and Accountabilit
y Act (HIPAA), and a more stringent Privacy Rule went into effect in 2003. HIPAA
sets required national standards for medical records, guarantees patients the r
ight to see their own medical records, and requires providers to inform patients
how their medical information is used and disclosed.

Benefits of EMRs
â ¢ Replace paper-based medical records which can be incomplete, fragmented
(different parts in different locations), hard to read and sometimes hard to fin
d. Provide a single, shareable, up to date, accurate, rapidly retrievable source
of information, potentially available anywhere at any time. Require less space
and administrative resources.
â ¢ Potential for automating, structuring and streamlining clinical workflow
.
â ¢ Provide integrated support for a wide range of discrete care activities
including decision support, monitoring, electronic prescribing, electronic refer
rals radiology, laboratory ordering and results display.
â ¢ Maintain a data and information trail that can be readily analyzed for m
edical audit, research and quality assurance, epidemiological monitoring, diseas
e surveillance
â ¢ Support for continuing medical education.
The EMR used in the study had the following medication safety features at the po
int of care:
1) Printable and legible prescriptions with medication instructions
2) Space to list all medications together
3) Easily retrievable medication records
4) Available features to detect adverse drug-allergy, drug-drug, drug-nutrient,
drug-vitamin, and drug-dietary supplement interactions
5) An option to print medication information (both indications and side-effects
) handouts written at the 6th grade reading level.
As of 2006, adoption of EMRs and other health information technology, such as c
omputer physician order entry (CPOE), has been minimal in the United States, in
spite of studies showing revenue gains after implementation. Fewer than 10% of A
merican hospitals have implemented health information technology while a mere 16
% of primary care physicians use EHRs.
The majority of healthcare transactions in the United States still take place on
paper, a system that has remained unchanged since the 1950s. The healthcare ind
ustry spends only 2% of gross revenues on information technology, which is meage
r compared to other information intensive industries such as finance, which spen
d upwards of 10%.
Interoperability is the ability of different information technology syst
ems and software applications to communicate, to exchange data accurately, effec
tively, and consistently, and to use the information that has been exchanged.
Important factor in interoperability, are not a critical first step to s
haring data between practicing physicians, pharmacies and hospitals. Many physic
ians currently have computerized practice management systems that can be used in
conjunction with health information exchange (HIE), allowing for first steps in
sharing patient information (lab results, public health reporting) which are ne
cessary for timely, patient-centered and portable care. There are currently mult
iple competing vendors of EHR systems, each selling a software suite that in man
y cases is not compatible with those of their competitors.
A major concern is adequate confidentiality of the individual records being mana
ged electronically. Multiple access points over an open network like the Interne
t increases possible patient data interception. In the United States, this class
of information is referred to as Protected Health Information (PHI) and its man
agement is addressed under the Health Insurance Portability and Accountability A
ct (HIPAA) as well as many local laws.
The organizations and individuals charged with the management of this informatio
n are required to ensure adequate protection is provided and that access to the
information is only by authorized parties. The growth of EHR creates new issues,
since electronic data may be physically much more difficult to secure, as lapse
s in data security are increasingly being reported. Information security practic
es have been established for computer networks, but technologies like wireless c
omputer networks offer new challenges as well.
A related concern is the potential privacy risk posed by interoperability. One o
f the most vocal critics of EMRs, New York University Professor Jacob M. Appel,
has claimed that the number of people who will need to have access to such a tru
ly interoperable national system, which he estimates to be 12 million, will inev
itable lead to breaches of privacy on a massive scale. Appel has written that wh
ile "hospitals keep careful tabs on who accesses the charts of VIP patients," th
ey are powerless to act against "a meddlesome pharmacist in Alaska" who "looks u
p the urine toxicology on his daughter's fiance in Florida, to check if the fell
ow has a cocaine habit."
To attain the wide accessibility, efficiency, patient safety and cost savings, o
lder paper medical records ideally should be incorporated into the patient's rec
ord. The digital scanning process involved in conversion of these physical recor
ds to EMR is an expensive, time-consuming process, which must be done to exactin
g standards to ensure exact capture of the content. Because many of these record
s involve extensive handwritten content, some of which may have been generated b
y different healthcare professionals over the life span of the patient, some of
the content is illegible following conversion.
The material may exist in any number of formats, sizes, media types and qualitie
s, which further complicates accurate conversion. In addition, the destruction o
f original healthcare records must be done in a way that ensures that they are c
ompletely and confidentially destroyed.
According to the Agency for Healthcare Research and Quality's National Resource
Center for Health Information Technology, EMR implementations follow the 80/20 r
ule; that is, 80% of the work of implementation must be spent on issues of chang
e management, while only 20% is spent on technical issues related to the technol
ogy itself.
Such organizational and social issues include restructuring workflows, dealing w
ith physicians' resistance to change or alternatively, software engineers' evolv
ing research in deep modeling of the physician's knowledge and workflow domains
as well as IT personnelâ s' resistance to design and implementation flexibility nee
ded in the complex healthcare environment, and creating a collaborative environm
ent that fosters communication between physicians and information technology pro
ject managers.
Limitations in software, hardware and networking technologies has made EMR diffi
cult to affordably implement in small, budget conscious, multiple location healt
hcare organizations. Until recently most EMR systems were developed using older
programming languages such as Visual Basic and C++; however with many systems no
w being developed using Microsoft .NET Framework and Java technology EMRs can be
securely implemented across multiple locations with greater performance and int
eroperability.
Under data protection legislation and the law generally responsibility for patie
nt records is always on the creator and custodian of the record, usually a healt
h care practice or facility. The physical medical records are the property of th
e medical provider or facility that prepares them. This includes films and traci
ngs from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound,
etc.
The patient, however, according to HIPAA, owns the information contained within
the record and has a right to view the originals, and to obtain copies under law
. Additionally, those responsible for the management of the EMR are responsible
to see the hardware, software and media used to manage the information remain us
able and not degraded. This requires backup of the data and protection being pro
vided to copies. It will also require the planned periodic migration of informat
ion to address concerns of media degradation from use.
Pricing for EMR systems is highly dependent on each practice's unique needs. Bec
ause every medical practice has distinct requirements, systems usually need to b
e custom tailored. This is due to the majority of EMR systems being based on tem
plates that are initially general in scope. In many cases, these templates can t
hen be customized in co-operation with the vendor or developer to better fit dat
a entry based on a medical specialty, environment or other specified needs. Ther
e are also EMR systems available that do not use templates for data entry and th
erefore can be easily personalized by each individual user. Alternative data ent
ry methods are including concept processing, voice recognition, and transcriptio
n.
The electronic medical record (EMR) is slowly replacing the paper chart
for documenting patient details. As the adoption curve for EMRs rapidly increase
s, so will the need for clinical terminologies. Currently, administrative classi
fications such as ICD-9-CM, CPT and HCPCS serve not only billing and reporting p
urposes, but also are used by healthcare providers for documentation and capturi
ng patient procedures and problem lists. But the use of clinical terminologies,
such as SNOMED CT, will assume the interface role in EMRs and thus replace these
administrative classifications at the point of care.
These billing terminologies will then be relegated back to the coders and payers
for use, enabling the clinicians to document using richer and more granular ter
minologies. During this transition phase to the clinical terminology, training w
ill likely be required as healthcare providers adjust to using terminologies in
more robust ways. Early adopters will play a role in this training and help to d
emonstrate the many advantages of richer documentation. The use of clinical stan
dards in EMRs is one of the key evolutions in informatics.
The electronic medical record (EMR) will constitute the core of a computerized h
ealth care system in the near future. The electronic storage of clinical informa
tion will create the potential for computer-based tools to help clinicians signi
ficantly enhance the quality of medical care and increase the efficiency of medi
cal practice.
These tools may include reminder systems that identify patients who are due for
preventative care interventions, alerting systems that detect contraindications
among prescribed medications, and coding systems that facilitate the selection o
f correct billing codes for patient encounters.
Numerous other decision-support tools have been developed and may soon facilitat
e the practice of clinical medicine. The potential of such tools will not be rea
lized, however, if the EMR is just a set of textual documents stored in a comput
er like a "word-processed" patient chart.
To support intelligent and useful tools, the EMR must have a systematic internal
model of the information it contains and must support the efficient capture of
clinical information in a manner consistent with this model. Although commercial
ly available EMR systems that have such features are appearing, the builders and
the buyers of EMR systems must continue to focus on the proper design of these
systems if the benefits of computerization are to be fully realized.