What is the difference between an electronic health record and an electronic medical record?

Electronic Medical Records.

Electronic Health Records.

Personal Health Records.

This is a common point of confusion among many people. They all sound similar, but not many people know the difference between these terms.

Yep, even the ones in the healthcare industry.

The interchangeable usage of these three terms can confuse patients, healthcare professionals, and even regulators.

There are definitely many differences between EMR, EHR and PHR, but there are also some similarities between them.

Let us dive deep into each of these terms, and understand them one by one.

Electronic Medical Records (EMR): The Local System

Electronic Medical Record is a local and internal system of a healthcare organisation.

Electronic Medical Records are just that — electronic versions of medical records that otherwise live on a piece of paper. EMR is an internal system within a healthcare organisation like a clinic, a clinician’s office or hospital, which allows them to organise their medical records. EMRs also contain notes gathered by the clinician, allowing them to diagnose and treat patients effectively.

Obviously, EMRs are much better than paper records. EMRs enable clinicians to:

• Track patient improvements over time
• Identify patients who need screenings
• Improve their diagnosis and treatment
• Identify patients with particular needs

Simply put, Electronic Medical Records (EMRs) are digital versions of the paper records in a clinic or hospital. 

EMRs are stored locally, and provide fast delivery.

This is also the biggest drawback of EMR! It is confined to a single provider. EMRs do not support the exchange of information. In other words, EMRs are not ‘interoperable’

If a record is not interoperable, what does it mean?!

Not supporting interoperability means this: EMRs do not allow clinicians to send their records to another organisation, neither do they receive records from other organisations.

EMRs are surely an improvement over independent paper records. However, its ‘non-interoperable’ nature prevents it from being used in a meaningful manner.

In today’s world where the internet has revolutionised the way we send and receive meaningful files, it makes very little sense to restrict a medical record within a single organisation!

In this context, it is also important to note that the term EMR could become obsolete in the coming years, and the reason for its death will be its failure to use standards-based interoperable data.

Electronic Health Records (EHR): The Global System

Electronic Health Record (EHR) is an inter-organisational system.

An EHR is quite similar to an EMR — it is also a digital version of a patient’s medical record. However, there is one major difference — while EMR includes data from a single healthcare organisation, EHR includes data from all clinicians and healthcare organisations involved in a patient’s care! This is very useful for all providers and staff, who can access this information to treat a patient.

EHRs go beyond the standard collection of clinical data from a single provider’s office. While EMRs are local and internal, EHRs support the exchange of information — they are interoperable. 

EHRs are built to travel between different organisations. If you have an EHR, it will contain information from ALL THE CLINICIANS that you have ever met. 

Moreover, all authorised clinicians involved in your care can access your EHR.

The difference between an EMR and an EHR is this: EMR contains a patient’s experience in a single practice, while EHR contains a patient’s experience across all practices. Needless to say, EHRs are better than EMRs as they contain a broader view of a patient’s medical situation.

Having an EHR means that when a patient visits a new healthcare organisation, they don’t need to carry any papers at all. Everything will be readily available and accessible when they get there, provided they have authorised that healthcare organisation. Their new clinician will be able to view all their medical records from all the clinicians that have ever been involved in their care. After their new consultation, everything that the new clinician updates in their record will also be added to this patient’s EHR. This will, in turn, be made available to all their other clinicians!

An EHR follows a patient from one healthcare organisation to another — from a primary clinic to a specialist, to a hospital, to a nursing home, or even to another country!

The biggest advantage of a patient with an EHR is that medical practitioners can get cross-provider medical information

• Diagnoses and allergies
• Medications and other treatment plans
• Immunization dates
• Test results and radiology images
• Provider contact information

EHR can result in dramatic changes in addressing a community’s healthcare challenges.

Unlike an EMR, an EHR is not restricted to a single location. An EHR follows a patient wherever they go.

For instance, consider a patient who is going through treatment for opioid addiction. This patient consults multiple healthcare providers at different locations — a family doctor, a testing laboratory, and a psychiatrist. Each of these providers will have a separate set of records for this single patient. It is imperative that each provider has access to the other provider’s updates — without that, providers cannot have a complete view of the patient’s progress.

EHR is very essential to share data among providers and coordinate the best care for patients.

Personal Health Records (PHR): The Patient-Centric System

Personal Health Record (EHR) is a patient-centred organisational system.

A PHR is the same as EHR, but are meant to be owned, set up, and managed by patients. Just like EHRs, PHRs contain information like diagnoses, medications, immunizations, family medical histories, and provider contact information.

This information can come from many different sources:

• From the EHR of healthcare providers like clinicians, testing centres, and hospitals
• From healthcare devices like home monitoring devices, Fitbit, Apple Watch, point of care devices, etc
• From patients themselves entering data manually, like over-the-counter medications, lifestyle choices, etc

No matter where the data comes from — be it from an EHR, a monitoring device, or the patient themselves — the patients can access it. 

With a PHR, a patient can make more informed decisions for their health by viewing their medical records in a private and transparent environment.

PHRs combine demographic data and medical data with behavioural and lifestyle data. PHRs give a 360° view of the patient’s life, providing an exhaustive view that is in line with the philosophy of ‘patient-centric care’

The patient manages their medical information in a private, controlled environment.

Moreover, personal health records make patients more empowered and enable them to manage their medical records more easily. With PHRs, patients become more informed, engaged, and consequently, more healthy.

The patient is in control: this is the main difference between PHRs and EMRs/EHRs. 

EMR vs EHR vs PHR: The Similarities and Differences

EMR, EHR and PHR are very similar.

• All three are repositories of data
• All three of these deal with the medical records of a patient (Although only EMR has the word ‘medical’ in it)
• All three of these are related to the health of a patient (Although only EHR has the word ‘health’ in it)
• All three are electronically managed by a software (Although only EHR and EMR have the word ‘electronic’ in them)
• All three are highly confidential and private in nature since they all deal with the personal medical records of a patient (Although only PHR has the term ‘personal’ in it)

At the same time, there are mountains of difference between these three terms! PHR, EMR & EHR reside in different platforms under different technologies and standards.

• EMR is specific to a particular healthcare organisation.
• EHR is one step ahead of EMR: EHR is organisation-independent. It follows a patient wherever they go. And it helps doctors make informed decisions about their patients. EHRs are controlled and managed by the organisations that contribute to them.
• PHR takes EHR one step further: PHRs are controlled by the patient.

With the rise of wearables like Fitbit and Apple, the future of healthcare is certainly patient-centric, and soon, it will be patient-driven.

As we are moving to a more personalised and patient-centric approach in healthcare, it is only natural to think that interoperability is the need of the hour. This naturally deems EMRs as futile and ineffective, because they don’t allow clinicians to make better decisions. 

Especially in a hyperconnected world like ours, it makes little sense to latch on to a set of records, while being blind to the rest of a patient’s information. This is why EMRs are predicted to become obsolete in the coming years.

The aforementioned definitions of EMR, EHR, and PHR are tied to the concepts of meaningful use and interoperability. As these ideas are refined and implemented, the definitions also may evolve.

Medical Record Privacy and Security: What We Need to Take Care About

Now that we understand the differences between the terms EMR, EHR, PHR, and their respective advantages, we need to remember how sensitive these records really are.

When it comes to privacy and security, electronic records are surely one step ahead of paper records. However, EMRs, EHRs, and PHRs also create serious challenges and threats to security and privacy.

• Data can be hacked, manipulated, or destroyed by internal or external users
• The exchange of data between and among clinicians, government agencies, and other organisations, if not done with the proper authorisation from the patient, can cause severe mistrust among patients
• The usage of mobile devices for exchanging medical data is also a huge concern. Mobile phones are designed as personal devices and are not meant for information exchange by an IT department. Unlike computer workstations, mobile devices can easily be misplaced, damaged, or stolen.

For a patient, any data that comes out of a clinical relationship is private. All medical data is considered to be confidential and must be stored in secure systems. Only authorised personnel should be able to access this information.

Medical Record Security: Audit Trails

To improve medical record security, the most important system is an audit trail. 

Health record systems should have a comprehensive audit trail that tracks all the system activity. 

An audit trail tracks basic information like who viewed a record, who updated a record (and when), who submitted a request, and so on. It even flags suspicious activity like who viewed the records of a patient they are not treating.

Why Do We Need EMR, EHR or PHR?

Transparent health records help doctors and clinicians to improve the quality of their care. But it does not stop there!

Health records allow governments to make public health decisions to address the health challenges of various communities. This can result in improved health and wellness in a locality.

Soon enough, physicians will be evaluated not just on their clinical expertise, but also on their technological competence. Any improvement in the quality of care is a combination of physicians’ expertise, accessible medical data, as well as decision support tools.

An interoperable healthcare ecosystem — one in which doctors, diagnosticians and patients can share information among each other seamlessly — can lead to dramatic improvements in personalised care!