EMR vs. EHR
By Steve Blumenthal, JD
HIStalk has asked me to explain the difference between an EMR (electronic medical record) and an EHR (electronic health record). Clearly, HIStalk needs to get out more. But I’m a nerdy lawyer and analyzing defined terms ranks up there with reading blogs about who’s being cast in the “Star Wars” reboot.
Let’s start with the source of most healthcare IT terminology, the feds—specifically, ONC. ONC’s website (healthIT.gov) says that an EMR is “a digital version of a paper chart that contains all of a patient’s medical history from one practice.” On the other hand, an EHR is “a digital version of a patient’s paper chart.” So, clearly an EMR and EHR are differ…. Wait a sec. Is it me, or do those definitions look remarkably similar?
I think I’ve figured it out. An EMR and EHR are both a digital version of a patient’s paper chart, but an EMR only has one practice’s patient chart. So, if I never see a physician other than my internist at Vanderbilt, Vandy’s electronic record system is an EMR with respect to me. However, my daughter has seen two doctors in different practices within Vandy’s health system, so Vandy’s electronic record system would be an EHR (not an EMR) with respect to her. No, that can’t be right.
Wait, ONC has more to say. An EHR is “more than just a computerized version of a paper chart in a provider’s office.” Whew, that clears up everything. An EHR is more than an EMR. Now I can go home and finally hang the curtains in the guest bedroom.
On second thought, that didn’t clear up anything. The curtains will just have to wait another year.
“EHR systems are built to share information with other health care providers and organizations—such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics—so they contain information from all clinicians involved in a patient’s care.” I think we’ve found something. “Built to share information” is the key. I feel an analogy coming on.
An EMR is an earthworm, a useful creature that burrows into the earth, carrying organic material down into lower levels, breaking down dead plant material, and aerating the soil. But an earthworm is not transformative. Its life is spent toiling in the soil as an earthworm (and usually ending underneath a person’s shoe or in a bird’s gullet). On the other hand, an EHR is a caterpillar, a worm-like larva that will eventually transform into a beautiful butterfly (or somewhat less attractive moth or fruit fly). An EHR is designed for great things—collecting and distributing data from EMRs and other sources like butterflies cross-pollinating fields of flowers.
The difference between an EMR and an EHR isn’t what they are today. Let’s face it, given the interoperability issues with most EHRs today, they’re pretty much toiling in the same soil as EMRs. The difference lies in what an EHR is designed to become. That’s why the “Base EHR” definition in ONC’s EHR certification regulations says that an EHR must, in addition to including patient health information, have the capacity to do more—to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality, and exchange electronic health information with other sources.
It’s actually kind of inspirational when you think about it. If you’ve got a kid, you’ve read “The Very Hungry Caterpillar.” Sure, the caterpillar eats a couple tons of food that could otherwise have been used to feed impoverished children, but then he spins a cocoon and, a short time later, becomes a beautiful butterfly. So maybe we’re spending a lot of resources on EHRs right now, but the payoff will be amazing in the end.
Unfortunately, the process of changing from a caterpillar into a butterfly is, well, disgusting. As “Scientific American” puts it, “First, the caterpillar digests itself, releasing enzymes to dissolve all of its tissues. If you were to cut open a cocoon or chrysalis at just the right time, caterpillar soup would ooze out.”
Steven E. Blumenthal is an attorney with Bone McAllester Norton PLLC of Nashville, TN.