©
2006 HIMSS Analytics
TM
2
All rights reserved. No part of this paper may be reproduced, adapted, translated, stored in a retr
ieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of HIMSS Analytics
.
Source: HIMSS Analytics Database (derived from the Dorenfest IHDS+ Database
TM
)
Executive Summary
Many people in the US healthcare industry
,
our government
, and the press
use the terms
electronic medical record
(EMR) and
electronic health record
(EHR) interchangeably
. However,
these te
rms
describe completely different concepts
, both of which are crucial to the success of
local, regional, and national goals
to improve patient
safety
, improve the quality and efficiency of
patient care,
and reduce healthcare delivery costs. EHRs are relian
t on EMRs being in place, and
EMRs
will never reach their full potential without interoperable EHRs in place. It s important to
understand the differences, and to
reduce
confusion in the
market.
T
he EMR is the legal record created in hospitals and ambula
tory environments that is the
source
of data for the EHR. The EHR represents the
ability
to easily share medical information among
stake
holders and
to have
a patient s
information follow
him or her
through the various modalities
of care engage
d by that individual
.
Stakeholders are composed of patients/consumers, healthcare
providers, employers, and/or payers/insurers, including the government.
But before we can move to effective EHR environments, provider organizations
must
implement
complete EMR solutions
. At this point
,
few hospitals have EMR solutions that can effectively
reduce medical errors or improve the quality and efficiency of patient care. The Clinical
Transformation
Staging Model has been developed by HIMSS Analytics to assess the status of
clin
ical system
/EMR
implementations in care
delivery
organizations. This model demonstrates
that US hospitals have a long journey ahead of them to achieve the EHR visions being espoused
in Washington
,
D.C.
and in the 200+ neo
-
CHIN
Regional Health Information O
rgan
i
zation
(
RHIO
)
initiatives in various states of development across the country.
EMR v
s. EHR
:
Definitions
The market has confused the electronic medical record (EMR) and the electronic health
record (EHR).
G
overnment
officials
, vendors, and consultant
s
have propagated this
confusion, in some cases unintentionally. The
definitions that HIMSS Analytics proposes
for these terms are
as follows:
Electronic Medical Record:
An application environment composed of the clinical data
repository, clinical decisio
n support, controlled medical vocabulary, order entry, computerized
pr
ovid
er order entry,
pharmacy,
and clinical documentation applications. This environment
supports the patient s electronic medical record across inpatient and outpatient environments, and
is used by healthcare
practitioners
to document, monitor, and manage health care delivery
within
a care delivery organization (CDO)
.
The data in the EMR is the legal record of what happened to
the patient
during their encounter at the CDO and is owned by
the CDO.
Electronic Health Record:
A
subset of each
care delivery organization s
EMR
,
presently
assumed to be
summaries like
ASTM s
Continuity of Care Record (CCR)
or
HL7 s
Continuity of
Care Document (CCD
),
is
owned by the patient
and has
patient input a
nd access that spans
episodes of care across multiple CDOs within a community
, region, or state (or in some countries,