EMR vs EHR redux

Nate Bagley from Software Advice asked me to review his article and it jogged my memory… I wrote this a few years ago.  Only Nate offers some Google data to back up the idea that essentially an Electronic Medical Record (EMR) is a patient’s medical record sourced from one provider; an Electronic Health Record (EHR) is sourced from several providers. This is in line with Nate’s quote from Don Fluckinger, “EHR seems to refer to a record that can be shared back and forth and amended among multiple providers.”

If I get my healthcare from one provider, say Sutter Health, where one electronic record is shared between primary care, nurses and specialists, is that an EHR or EMR?

Until the NHIN or HIEs gain traction, Sutter’s health record cannot be shared with Stanford Hospital literally across the street!

Transferring 30 printed pages of medical records to my doctor

In January 2000, I was hospitalized at Stanford Hospital following a vehicle accident.

In December 2009, I visited a Urologist and when I mentioned my medical history, he said it would be useful to get a copy of my medical records from Stanford Hospital. His nurse began a request for medical records from Stanford, estimated to take six weeks. My doctor’s office is three miles from Stanford hospital so one could walk there and back in an hour to get records, in theory. In practice, it requires a search of off-site archives to retrieve medical records.

I returned home and remembered that subsequent to my hospitalization 10 years ago, I had requested copies of my Stanford medical records for myself.  I dug up the large envelope of 30 single sided printouts.

Now to get the 30 page medical record to my Urologist. My doctor’s office uses EPIC for electronic medical records and as a patient I have a tethered PHR – meaning I can view my EPIC medical record from any computer on the Internet using a web browser. I can also send an email to the doctor and view/create appointments.

I attempted the following, without success, to get the medical records to my Doctor:

• I scanned the pages at home and created a PDF, but the EPIC patient email software does not allow attachments.
• I uploaded the PDF to my personal website and then sent an email to the Doctor with the URL for him to download the scanned medical records. I received a response that the download could not be performed. I suspect that the old/pre-web EPIC email interface does not produce clickable links, but could the doctor not execute a copy/paste from EPIC to a browser?
• I phoned my doctor and was told to fax the documents. Sorry I don’t have a fax machine at home.
• I logged into GoogleHealth, hoping that I could link my clinic’s EPIC system to my Google medical record, but GoogleHealth offers no functionality to upload medical records from one’s own computer, only to import medical records from a variety of vendors. I did not try Microsoft HealthVault, though I suspect the same result. Anyway, it was a long shot. I am sure that linking medical records between Google/Microsoft and medical providers is a long way off

I ended up driving to the doctor office and hand delivering the medical records to his nurse.

Wishing a year of good health to you all!

Who owns the patient data?

When a new medication is developed, pharmaceutical companies conduct a clinical trial: a controlled study of the effect of a medication on selected group of volunteers, perhaps 1000.

Imagine if the benefits and side effects of a new medication could be gauged from not a thousand people but one million of all ages, genders, races and who may or may not already have other diseases complications and may or may not be taking other medications.

One of the benefits of electronic health and medical records is there are vasts amounts of data to be mined and analyzed. Anonymize the patient data and you can create statistics and analysis of the effects of medications, diseases and treatments.

But who owns that patient data? In speaking with a relative of mine who is a physician, he told me that certain very large medical institutions will not release their valuable data for other researchers to use and analyze. They consider that patient data their intellectual property, their treasures.

I posit that the data belongs to the patient, that the patient should be able to control who can access that data even if it is anonymized. The patient, using HIPAA guidelines, should be able to control who has access to his/or her data and not the medical institution.

Using XML to exchange electronic health data, ice no water.

Yesterday evening I had the distinct pleasure of enjoying Scotch on the rocks with Eve. In Pat’s honour we drank single malt, and reminisced over glory days at Sun and our current tribulations with MS Exchange email and calendaring.

As I discussed my forays into HealthIT, Eve alerted me to what Gerry, another fine Sun fellow, is up to:

ProjecthData may well take us where HL7 cannot, to the nirvana of fully interoperable health and medical records.

A RESTful approach sounds great and I look forward to learning more.

Cheers! <clink>

Development of open EMRs/EHRs

John Halamka posted a refreshing entry about development of APIs that allow easier integration with EMRs and EHRs. Since I have been concerned in recent blog entries about how EMRs, EHRs and HIEs will integrate this was refreshing news.

I am going to dive in and examine some of the technologies described: XDR, XDM and XDS.

Some other initiatives I found that promote development of open healthcare technologies:

• ihe – integrating healthcare enterprise
• oht – open health tools
• ohf – open health framework
• openehr
• openmrs

‘Meaningful use’ toward HIEs – questions for Dr David Blumenthal

I read with interest update 3 by Dr David Blumenthal of the Department of Health and Human Services.

Firstly Dr Blumenthal, consistently uses the term EHR (Electronic Health Record).  Per my definition of EHR vs EMR (Electronic Medical Record) an EMR is used by one vendor such as a physician, whereas an EHR is a patient’s collective record of medical data sourced by several healthcare providers.

Questions for Dr Blumenthal:

1. Did you mean that health care providers should implement EMRs,  not EHRs?
2. How will the various EMRs share data between each other (and their regional HIEs/RHIOs )  so that patients can move with ease from provider to provider? Will HITSP provide standards that EMRs can adhere to? Will HL7 be updated?
3. What about medical terminology? Will EMR vendors adhere to LOINC or ICD-10 so that a universal EHR can be created for patients?

HealthInformatics training

I would like to share courses that I researched that offer training in HealthInformatics and Technology (most are online offerings)

1. HIMSS (Healthcare Information and Management Systems Society) : eLearning Academy
2. AMIA (American Medical Informatics Association): 10×10 courses
3. Certified HIPAA security specialist
4. Certified HIPAA professional
5. Compliance specialist (not Healthcare specific other than HIPAA)
6. University of Connecticut
7. UC Davis HealthInformatics
8. CPEHR , CPHIT and CPHIE – three HealthIT certificates

I have opted to take the UC Davis course and will blog excerpts and thoughts here.

HIEs, security and cloud EHRs

Robert

A quick question on your posting as I cannot comment on  your blog

Do you think that Regional Health Information Organizations (for example calrhio.org) will be supplanted by HIEs?

Cloud based EHRs – a response to PracticeFusion

In response to Dr Rowley’s posting

Note: I attempted to comment in the EHRBloggers blog but there were technical glitches with the “word” verification (used to prevent spamming) thus I am writing my comment here

Dr Rowley,
Thank you for your well crafted insight into the benefits of ‘cloud’ oriented EHRs, especially for solo practitioners who may not wish to invest in in-house hardware, software and associated maintenance.
Some responses:
1. Is a solo practitioner or very small medical practice, likely to have the high bandwidth internet connection required for SaaS based EHR?

2. Like any other SaaS solution, does the Dr’s practice grind to a halt because an Internet connection is down (due to the fault of the ISP or any other conditions beyond his control) and the physician cannot request an EMR for a patient?

3. The ‘care co-ordination’ you write about sounds wonderful, my question is what technical standards exist for medical practices to exchange EMR data ? Or is the ‘care co-ordination’ you write about restricted to medical practices that use the PracticeFusion cloud?

Looking forward to the ongoing conversation

EMR or EHR, what’s the difference

I hear the terms EMR (Electronic Medical Record) and EHR (Electronic Health Record) bandied about interchangeably.
So what is the difference.
Based on some reading I offer the following:

EMR – An electronic record of a person’s health related information that is gathered and managed from a single organization
EHR- An electronic record of a person’s health related information that is gathered and managed from a many organizations.

So my EMR is generated by my family physician and his/her nurse, but my EHR includes medical information from visits to specialists as well, perhaps even dentists and podiatrists. An EHR vendor thus needs to provide interfaces that allow data to be easily interchanged. In this regard I am starting to read about LOINC and HL7, though I understand the latter to be somewhat outdated.