Do I Need an EMR or EHR System?

It seems almost futuristic: a patient arrives at the hospital and checks in using an airport-style kiosk. His full medical record, including multiple diagnostic test results and doctors’ notes, is accessible on his bedside screen and on connected computers throughout the hospital. A nurse administers medication and checks his vital signs; the information is automatically included in his file and conveyed to all involved medical personnel. When his hospital stay concludes, all information regarding his updated history is relayed to his doctors with a few keystrokes – no printing, faxing, or mailing necessary – where it will be incorporated into his chart and fully updated before the next time he visits the office. Seems too good to be true? It may be…

CardioPerfect Workstation

The introduction of electronic health record (EHR) and electronic medical record (EMR) systems into our healthcare structure has been met with mixed reviews. While the use of EHR and EMR systems are becoming widespread in private practices, clinics, hospitals, and nursing facilities, some users express dissatisfaction with their systems for various reasons, such as inefficiency, technological dependency, and high costs. Others appreciate the EHR/EMR’s performance as it delivers the results they expect – improved workflow, decreased human error, and better staff communication and patient tracking. Read on for a comprehensive review of electronic medical and health record systems to help you decide whether implementing an EHR/EMR would help or hinder your facility.

EHR vs. EMR – what’s the difference?

hile the two terms are similar and are frequently used interchangeably, there is a difference between an EHR and EMR. As its name suggests, an electronic medical record – EMR – is the technological version of a medical chart in an individual doctor’s office. The EMR allows physicians and staff to track patient data over time, schedule regular appointments and screenings, and follow the progress of treatment plans. While the EMR is designed to stay within the practice, an electronic health record – EHR – provides a complete focus on the patient’s total health. EHRs are designed to be transferred from one healthcare provider to another, using information from various sources – primary care physician, hospital, laboratory, skilled nursing facility, specialist – to ensure that all aspects of patient health and care are addressed in implementing a treatment plan. Individual providers contribute their EMR to generate the broader EHR, sharing information to benefit the patient without the hassle and confusion of sharing and compiling multiple hard-copy reports from different sources.¹

Benefits of an EMR/EHR system

ADview 9000

The concept of electronic medical and health records was established to improve the efficiency and workflow of healthcare providers. The fact that they are digital simplifies office work in numerous ways. Changes to the record are automatically updated in the record for enhanced in-office and inter-office (with an EHR system) communication. Typed notes decrease the risk of human error due to the stereotypically incomprehensible doctors’ handwriting. Office time and space are used more efficiently; doctor’s notes and test results are automatically filed, reducing the need for filing and filing furniture as well as the possibility for misfiling or loss of files, which can result in a lawsuit or permanent loss of information.  While files are easier to transfer – no printing, copying, or collating necessary – they are typically as or more secure in an EMR/EHR system as they are in physical filing cabinets.

Connex Wall System

With an EMR system, an individual physician’s office is able to track results of diagnostic tests and patient progress on-screen. Many systems allow for side-by-side or overlaid comparisons between test results for more clarity, especially in communicating with patients. The system will often feature interpretation (or compatibility with interpretive software) for a built-in second opinion, analysis of test results and patient progress, and simplified data in the form of charts and graphs. In the field of cardiology, for example, a patient may undergo numerous and/or repeated tests with complicated results. Resting EKGs like GE’s MAC™ 1600, stress systems such as Cardiac Science’s Quinton® Q-Stress®, Holter software packages like Welch Allyn’s, and complete cardiac workstations like CareCenter MD™ and CardioPerfect™ are all EMR/EHR ready; many feature optional or standard analysis, sophisticated communication options, and customizable parameters. A general physician may wish to implement EMR-ready devices such as Welch Allyn’s Connex® wall system for standard physical exams, ADC’s ADview® 9000™ for vital signs monitoring, and Health-o-Meter’s Professional Digital EMRscale, simplifying the process of patient data recording and tracking.

EMRscale

An EMR system within a larger facility may prove to be invaluable, decreasing the risk of medication mix-ups and unnecessary testing; the patient’s information is accessible throughout the facility, with updates automatically included in the report as he or she moves through various departments, from emergency to radiology to operating to patient room and everything in between. Rather than relying on doctors and hospital personnel to manually change a chart and constantly keep track of it, the patient’s history and details of his or her stay “follow” him or her securely throughout his or her time in the hospital. Furthermore, an EHR system makes sharing patient data and compiling a full health profile straightforward and simple. Every doctor and other healthcare provider can easily contribute his or her individual patient chart – the EMR – to one unified entity describing the complete health of the patient.

Drawbacks of an EMR/EHR system

Making the switch from analog to digital cannot be as simple as installing new software on your practice’s computers. The implementation of an electronic system can be difficult, expensive, and frustrating. While there are many benefits to EMR and EHR systems, they are not perfect. The learning process alone can result in aggravation among staff members, errors, and decreased workflow; a mismatch between the staff’s ability and the sophistication of the system can cause untold stress. Learning to use the system can be extremely time-consuming, especially for non-tech-savvy medical personnel. Similarly, actually using the system once it’s been put into practice can be agonizingly slow for a doctor who does not type quickly or is unable to work around small glitches. Standardized question forms may result in the doctor overlooking important information while he or she painstakingly hunts and pecks at the keyboard to answer irrelevant or insignificant data. The slow pace of a doctor in this situation will unquestionably lead to patient frustration, longer wait times, and decreased workflow.

Another disadvantage of electronic systems is the loss of jobs, which are sorely needed in our current economic situation. The medical transcription industry will be eliminated in favor of computerized systems; doctors’ offices will require fewer secretarial and filing employees. Besides for the decrease in jobs, doctors and healthcare facilities face steep costs when utilizing electronic medical systems – from costly systems, to new EMR/EHR-compatible equipment and software, to lost time due to training and glitches, to system upgrades and tech support, the expenses add up quickly.

The technological aspect of EMR and EHR systems pose another set of problems. Different pieces of equipment may be compatible with certain systems only – a scale may connect to one system only while the vital signs monitor is compatible with another – and different systems from one facility to the next may cause loss of information or an inability to connect and create an EHR. Digital systems are vulnerable to minor and/or significant glitches as well as power outages, either of which may result in the long- or short-term shutdown of a practice or lawsuits due to loss or damage of files. The systems are well-protected but are still susceptible to experienced hackers, possibly compromising the security of the files. EMR and EHR system users may develop dependence on the system, failing to remember that human error can occur even with it; as a result, those using the system may be more negligent while entering data.

Should I implement an EMR/EHR system?

In 2009, the United States government passed the Health Information Technology for Economic and Clinical Health Act, also known as the HITECH Act, which mandates that every doctor and healthcare facility use health information technology. The legislation also describes a $21 billion financial incentive program for medical professionals who adopt an electronic system by the year 2014.[2] Since that date is looming ever closer – and the earlier it is implemented, the larger the bonus – it is highly recommended that private practices, hospitals, clinics, and other facilities start using an EHR system so as not to face fines. Like every other major purchase, an EHR – and all of its components – must be carefully researched to ensure that it is appropriate for the individual consumer. Use the guidelines and precautions we’ve provided to find the right technology for you and your staff, then visit TigerMedical.com when you are ready to upgrade your equipment; we are here to help you make this tremendous transition!

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^{1. US Department of Health and Human Services, healthit.gov (http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/)↩}

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^{2. American Society for Gastrointestinal Endoscopy, asge.com (http://www.asge.org/uploadedFiles/Members_Only/Advocacy/HITECH%20ACT%2004-01-2009%20v2.pdf)↩}