EMR? EHR? Why Should I Care?

There’s an interesting debate underway on one of the LinkedIn discussion boards about whether or not patients should have access to their electronic health data. Depending upon who is answering, it ranges from of course, to why not, to no way. And what is an EHR anyway? How is it different from an EMR?  And why should I care?

EMRs are becoming more prevalent

Learning the alphabet soup of health technology is going to matter more and more as the new health reform law kicks in. My health records – and yours – are already stored on a physician’s PC, on a hospital’s server, or an insurance company’s mainframe. Are implanted microchips behind the ear next?

If you’re like me, it’s all kind of confusing and overwhelming. Dr. Welby certainly didn’t have to deal with this. And while many people use the terms EHR and EMR interchangeably, they’re not the same thing. One is about health records, the other about medical records. The industry is still working on standardizing terminology but it’s important to know the difference between them.

So after some confusing and lengthy searches, here’s what I can pass on:

EHRs are the electronic health records owned by the patient. An EHR contains a summary, or continuity of care record, encompassing multiple care delivery organizations. So my EHR might include my latest checkup at the internist, a record of my prescriptions for asthma management, a details of my visit to an orthopedist for my knee problem, and the rehab plan of care from the therapist across town. It might also contain results of an MRI I had taken at the hospital, and whether surgery was recommended.

My EHR would look vastly different than yours. But if I move from New York to Chicago, I can take my EHR with me and a new provider could see my medical history. It might even be a web-based record, stored on Google Health, or Microsoft’s Health Vault – or even someday, on a smartcard I can carry in my wallet. And if something isn’t right, I have the chance to access my record and fix it.

Electronic Medical Records, or EMRs are the “provider-side” of the Health IT equation. They are the legal record of the care delivery organization (CDO). Essentially EMRs replace the paper patient charts and files so many of us are used to seeing. According to The Healthcare Information and Management Systems Society (HIMSS), EMRs might contain everything from prescription information to clinical documentation and are “used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization…as well as across inpatient and outpatient environments.“

These are the records in the computer systems of caregivers, hospitals, clinics; systems that hopefully use a common interface so they can “talk” to each other. These records are more complete than EHRs and must be in place before an EHR can be generated.

Still with me on this?

So here’s the debate: EMRs are owned by the care delivery organization – your MD’s practice or the hospital, for example. You might be able to see some of the information contained in an EMR but you can’t change it, or take it with you. Many providers don’t’ think a patient should have access to all that “clinical” data, because it may be subject to mis-interpretation by a lay person. EMRs might even contain information about medical errors, or mis-diagnoses. Those are things that could come back to haunt a provider.

So an EHR would only contain a summary of what’s in the EMR – basically only what the doctors, hospitals, or other providers want you to see.

Is that reasonable? Personally, I think if it’s my information, I should have a right to see it; perhaps sitting down with a physician to explain anything I don’t understand. Others feel the summary is enough for most people. Think credit report; you don’t see all of the information the big three reporting companies have on you – just an aggregate. But enough so that if you see an error, you can have it corrected.

I also have issues about my personal health information being stored by Google or Microsoft (or any web-based entity for that matter). Geez, hackers have already gotten credit card, bank, and social security data; I have no doubt some clever 20-somethings could find a work-around for health records.

Do you want your information to go to the highest bidder, or be used for insurance fraud? I sure don’t. I’d rather carry a thumbnail drive with me to every doctor or hospital visit, or have a smart card that can be swiped and the data transferred. Maybe it’s impractical right now, but I have no doubt it’s coming soon. There are already iPhone apps for some functions. Wonder what Dr. Welby would think of all this?

What do you think? Should you have free access to all of your data? How about web-based storage? Let’s continue the discussion.

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6 thoughts on “EMR? EHR? Why Should I Care?

  1. Great article, Liz. I definitely learned something. The loss of control over my health info is scary. On the other hand, I love the idea that if I’m in an emergency situation, doctors could refer to my records, find my history, other conditions, medications, etc, and make better decisions about my care. I like the fact that specialists could refer to each other’s “paper” trail (e-trail) since specialists so rarely talk to each other. So I’m undecided! But at least I know more about what I don’t know! : )

  2. Good post. I certainly want to be careful about selecting my EHR provider, but this doesn’t lead me to preferring private personal storage for the data. Few people practice reliable data safety – so the odds that the data would be there when you want it are fairly low (either due to corruption of the data on the device, physical trauma to the device, or loss). A personal storage solution puts a huge burden on the patient and would have to be coupled with a mechanism to recreate the data from the EMRs.

    Most personal data leakage arises from the loss of unencrypted backup tapes, the loss of inadequately protected laptops, or the penetration of enterprise networks (like the infamous TJMax wireless access case).

    I would prefer a service based EHR solution – hosted by one or more provider where the patient has to prove their identity using adequately strong mechanisms to retrieve the data.

  3. Great post! It is good to see that you make the same distinction we do as ICMCC between EHR and EMR (see http://blog.icmcc.org). However, even if the EMR is the medical core of my EHR I do think that I should have access to that full core and should be able to point out eventual mistakes or differences of opinion (http://recordaccess.icmcc.org/category/WHO/).
    If we want to achieve participatory health, we should share all information. Only when the information is totally shared you can create such a partnership (http://www.icmcc.org/2009/05/14/presentation-whcc-europe-2009/).
    So I/we think that all the information should be accessible to me as the patient, only then I can decide that a summary will do. And then I have the full power to decide who will have access to my data, both EMR and EHR.
    BTW I hate thumbnail drives (http://blog.icmcc.org/2010/02/22/conceptual-changes-data-in-a-cleaninghouse/).
    I much would like to start a conversation with you!

    1. thanks for your comment. I hate thumbnails too – and they are prone to getting lost. However I hate the idea of my (or anyone’s) data being hacked even more. It poses a genuine dilemma for programmers and security experts. I am puzzled why a doctor or facility would want to prevent a patient from seeing his/her full information as well. We cannot be fully informed individuals or make the best possible decisions about our care without all of the information.

      Look forward to continuing the dialog.

  4. I absolutely want access to my own records, but could see the safety and privacy issues that would create. It’s a tough one because if I can see it, can’t other people (with less-than-noble reasons), too?

    Great post. Great blog. Thanks for writing!

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