Electronic Medical Record (EMR)
Computerized Patient Record System (CPRS)
The problem with these terms is that often industry pundits strongly differentiate between them, proposing that there is some major difference between an EHR, an EMR and a CPRS. For the most part, those who draw strong distinctions here are selling something: "A you definitely do not need an EHR, you want an EMR, which is clearly better and we happen to sell." or vice-versa. In reality one could argue that EHR, EMR and CPRS are just different names for the same thing.
They are all legitimately different, however, from what is typically called a Practice/Hospital Management Systems (PM or PMS or HMS). These systems track clinical information, but typically only that information which is required to run the business of a hospital or a practice. Even this line is blurry, however, since many Practice Management Systems are capable of doing things that would typically be thought of as purely clinical. (For instance a PMS might track lab results)
It is important to note that in many parts of the world, including the United States, the business of medical practices and the business of hospitals are very different. Practices are a place where a single clinician can set up shop and begin providing care in what is known as an Out-Patient setting. Hospitals are typically groupings of much greater resources, and are typically In-Patient. The distinction between In-Patient and Out-Patient (Ambulatory) is quite simple: whether patients typically spend the night. An In-Patient facility, (a hospital) primarily coordinates between patient "beds" and other clinical resources (Physicians, MRI/CAT/XRAY machines, the hot tub.. etc..) An Out-Patient facility typically thinks in terms of time, the primary coordination is to make sure that the patient and the clinician are in the same room at the same time.
As a result, Electronic Health Records (and also Practice Management Systems) vary greatly between In-Patient and Out-Patient settings. For instance, in the United States (which has a private payer model for healthcare finance - for the time being), this distinction has given rise to two different methods of communicating charges to payers (x12 837i vs 837p).
Hospitals are typically more concerned with coordinating the care provided to a patient who is in a bed. They must either move resources between "beds" or move "beds" between resources. Most of the tasks surrounding patient care require some information to be recorded, either in a paper chart or in an EHR.
Hospitals might want to ensure that medical images are available in digital format. Many studies have shown that Computerized Physician Order Entry (CPOE) systems, which are part of a comprehensive EHR, dramatically reduce medical errors, especially those relating to medications. A hospital EHR should probably also have a clinical reminders system, to ensure that important clinical tasks do not fall through the cracks.
Again, the general focus of a hospital EHR is to ensure that clinical resources and patient meet. So it focuses around tracking
Where is the patient now?
What resource needs to come to the patient?
What resource should we move the patient to?
When will this patient vacate this space, so that another patient can be treated?
How many spaces (beds) do I have available?
An Out-Patient or Ambulatory EHR focuses on appointments.
When is the patient arriving?
What was done or discovered during this encounter?
When is the patient coming back?
An EHR is supposed to track the relevant clinical information in both of these systems. Often, clinicians expect separate systems to work together to accomplish this. They will buy one program to run the pharmacy, for instance, and another to track patient data. Usually this design results in projects to integrate the two products so that they act as one.
The point of an EHR is to be comprehensive, many argue that systems that rely on both paper systems and electronic systems have the worst of both worlds. Others believe that a hybrid approach (which is actually most typical) is the most effective.
Physicians often point out, correctly, that studies have shown mixed results regarding whether EHR's improve the care delivery in an single-provider setting. Many of the benifits of an EHR are more apparent in settings were multiple people are required to work together to corrdinate care. It should be no surprise that hospital EHR deployment is far more common than practice based deployment.
The most important thing to remember about EHRs is they are intended to serve the clinicians need to better manage information. The problem is that different clinicians have very very different clinical needs. Getting a large group of clinicians to agree about what they want is pretty much impossible (getting one to agree with what he or she said on different days is hard enough.
A friend of mine summarized it this way:
"Doctors have no idea what they want, and programmers give it to them"
However, the EHR industry is become better and better defined. There are hundreds of small vendors in the space and they are slowly consolidating. There is a new certification system (CCHIT) that is establishing firmer standards about exactly what an EHR should do.
Still, the true definition of an EHR will be somewhat nebulous as medical science discovers more and more relevant information that it should hold. Soon, the entire contents of a persons DNA will be stored in an EHR system. Obviously this makes an EHRs an important area for privacy research. While privacy concerns are important, there is a lot of FUD (Fear, Uncertainty and Doubt) about the real risks of having information stored in EHR systems.
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