Do you know the difference between an electronic health record and an electronic medical record? Well, apparently neither do a lot of other people. That’s what prompted the National Alliance for Health Information Technology to spearhead a project resulting in six definitions that the alliance hopes will become industry standards and eventually eliminate some ambiguity and confusion.
The project’s results were released in a 40-page report in late May, with the following definitions:
- Electronic Medical Record (EMR). An electronic record of health-related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff within one healthcare organization.
- Electronic Health Record (EHR). An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization.
- Personal Health Record (PHR). An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual.
- Health Information Exchange. The electronic movement of health-related information among organizations according to nationally recognized standards.
- Health Information Organization. An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.
- Regional Health Information Organization. A health information organization that brings together healthcare stakeholders within a defined geographic area, and governs health information exchange among them for the purpose of improving health and care in that community.
Jane Horowitz, the alliance’s chief operating officer and head of the project, said between 18 and 63 possible definitions of five of the terms were identified before the project began. Originally, only five definitions were to be crafted. Then participants decided to add “health information organization” to the list to clarify the difference between the process of exchanging information and the oversight of that process.
The alliance convened two workgroups of experts to develop consensus definitions and twice opened the process to public comment.
“Our purpose was to find a common language so that we can help to create more widespread adoption of healthcare IT and the concepts behind it,” Horowitz explained. She said uniform definitions will serve many purposes for clinicians and other providers, policy-makers, and buyers and sellers of healthcare IT. Yet, the project’s goal was to write definitions in layman’s terms. “This is a way to start talking to the you and me of the world, the people who are not clinicians and not technology people, but everyday Americans who use the healthcare system. We need to find a way to talk to them in nonjargon language,” she said.
Probably the most critical two definitions were electronic medical record and electronic health record, two terms that have been used interchangeably. “The real key difference between electronic medical records and electronic health records is the whole concept behind interoperability. That is the ability for your doctor to be able to exchange your information with another physician who could be around the corner or affiliated with a hospital he’s not affiliated with. Or it could be that you’re on vacation and something happens to you, you need to go to a hospital there and your doctor could send your information,” Horowitz clarified.
Steve Emery is the director of product management for Georgia-based HealthPort, an HIT company formed through the merger of SDS (Smart Document Solutions) and Companion Technologies. With regional offices across the nation, HealthPort offers HIT consulting and a host of software products for management of the practice, records and documents, the revenue cycle and more. Emery agreed the difference between the definitions of EMR and EHR has been the most problematic. “I do believe that we did need some clarification, particularly between EMR and EHR. PHR was falling into a definition that made sense — patient control. That’s easy to understand, and it can take many different flavors after that. EMR and EHR, though, were all over the map,” he said.
“The interesting thing is that we’ve been calling our products an EMR because, prior to these definitions coming out, the understanding was that an EHR could either be a chunk of medical data stored somewhere but it didn’t matter whose it was. So EHR was sort of an umbrella term to cover PHRs, EMRs, the data accumulated by clearinghouses and claims processers and insurance payers. Those were all electronic health records — any kind of health information down to the patient level and it was electronic.”
What the new definition means is that HealthPort “may begin to discuss” renaming its electronic medical record product as an electronic health record product, thus reflecting the fact that its EMR actually is more comprehensive and flexible than a product for use by just one physician, office or organization, Emery said.
And does Emery believe the industry will conform to the new definitions? He believes compliance will be tied to CCHIT certification, the Good Housekeeping Seal of Approval for HIT products. The certification is bestowed by a nonprofit commission founded to accelerate credible HIT adoption.
“CCHIT will be the driving force,” Emery said. “If you look at who has become CCHIT certified, what it boils down to is the larger vendors and the vendors that are a little more organized and serious about carrying that cachet. They’ll call themselves EHRs and say that they’re ‘real’ EHRs given the definition. But I think the rest of the industry, and it’s probably the lion’s share of the industry in terms of numbers of products out there, is not CCHIT compliant.”
Should the federal government attach accurate use of the definitions to reimbursements, that might work, “but that’s years away,” Emery added.
Horowitz agreed that tying the definitions to CCHIT is “a very, very key step in all of this,” and something the alliance will be working to make happen.
NAHIT is a partnership of senior health information executives working to advance the adoption of HIT systems. The definition project was funded by the United States Department of Health and Human Services’ Office of the National Coordinator for HIT.