An Electronic Health Record (EHR) is a medical record or any other information relating to the past, present or future physical and mental health, or condition of a patient which resides in computers which capture, transmit, receive, store, retrieve, link, and manipulate multimedia data for the primary purpose of providing health care and health-related services.

EHR records includes patient demographics, progress notes, SOAP notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.

An electronic medical record (EMR) is a computer-based patient medical record. An EMR facilitates:

• access of patient data by clinical staff at any given location

• accurate and complete claims processing by insurance companies

• building automated checks for drug and allergy interactions

• clinical notes

• prescriptions

• scheduling

• sending to and viewing by labs

• helps keep track of other relevant medical information

CAVEATS & CONCERNS

It should be noted that there are issues surrounding the generation and management of Electronic Medical Records, also know as EMR (or EHR).

There are a two primary categories of the EMR; the "born digital" record and the scanned/imaged record.

The "born digital" record, which is information captured in a native electronic format originally is information that may be entered into a database, transcribed from an electronic tablet or notebook PC, or in some other manner captured from its inception electronically. The information is then transferred to a server or other host environment, where it is stored electronically.

The second category are records originally produced in a paper or other hardcopy form (x-ray film, photographs, etc.) that have been scanned or imaged and converted to a digital form. These records are best described as "digital format records", as their content is not able to be modified or altered (with the exception of the use of a third party software to make "overlay notations") as electronic records are. Most medical records generated preceding the year 2000 are of this category.

The process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact and accurate capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by any number of healthcare professionals over the life span of the patient, there exists a high probability of some of the content being illegible following conversion. In addition, the material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. Consideration should be given to developing a procedure to sample and verify images at a high ratio to determine the accuracy and usability of the scanned images prior to disposal of the physical records, if they are disposed of at all.

Further, all electronic repositories of information are subject to the need for periodic conversion and migration to ensure the formats they were captured in remain accessible over the life of the patient, and in some cases beyond, to the expected life of their heirs. Additionally, those responsible for the management of the EMR are responsible to see the hardware, software (applications) and media used to manage the information remain viable and are not subject to obsolescence or degradation. This will require generation of backup copies of the data and protection being provided to these copies in the event of damage to the primary repository. It will also require the planned periodic migration of information to address concerns of media degradation from use. These are all costly, time consuming processes that must be planned and budgeted for when making decisions to convert physical medical records to digital formats.

Another major concern is adequate protection of privacy of the individuals whose records are being managed electronically. This class of information (in the US) is referred to as Personal Healthcare Information (PHI) and its management is addressed under the Healthcare Insurance Portability and Accountability Act (HIPAA) as well as many State-specific privacy laws. The organization/individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties.

Records and Information Management (RIM) Professionals are concerned about long-term access to electronic format records the world round. There are problems with ensuring imaging of is done to meet standards to ensure legibility and adequate QC is performed prior to destroying source documents. There are concerns the format they are captured in remains accessible over the lifetime of the patient.  Periodic migration needs to be planned to address issues of media obsolescence and degradation.  This is costly and time consuming when done properly, including bit parity checks to verify information isn't lost.  There is a potential for formats to become obsolete and a need to convert images to another format, ensuring that no information is lost.
 
Storage is becoming less expensive but the size of EMR is huge. Take into account notes, charts, test results, x-rays, other media (sound recordings, data strips, video) much of which is in proprietary formats belonging to the makers of the equipment... and patients can live 100 years.  Imagine the data file generated over this timeframe and the complexity involved in managing it.

There a myriad of concerns in HIPAA related to privacy concerns for PHI, and additional issues in various states related to personal privacy many of these systems fail to address.

Persistent availability is a MAJOR concern.  With paper based medical records, proper protection and storage can even address fire, water damage or other catastrophic events.  Paper records will endure in readable format as long as properly filed and maintained.

Work should be done to capture medical information generated electronically in systems designed for that purpose, and measures taken to secure, convert and migrate them to ensure long-term access.  There are potential benefits to random access simultaneously by a number of individuals in disparate locations to a repository of images of existing paper-based records.  But these records should not be destroyed until measures exist to ensure images will be migrated, converted and properly secured from improper access by unauthorized parties.