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?
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.