Consider for a moment these three terms: electronic medical record (EMR), electronic health record (EHR), and personal health record (PHR). If you’re familiar with these terms then you have, at some point, likely become familiar with the fact that they are often used interchangeably. Why is this? They probably don’t mean the same things, right? The reason for the confusion can be traced back to how the terms are differentiated. Generally, when defining something one looks for what is essential about that thing and works up from there to create a definition that will allow it to be easily distinguished from other, similar things. These three terms however, are not defined by what they essentially are, but rather how they (the records) are used, shared and controlled. And this seems to lend itself to the terms being used imprecisely more often than not.
First, let’s generally consider what the three terms are and how they are alike. The three have much in common: they are all types of records (i.e., collections or repositories of data), and these records broadly contain health-related information. It’s probably safe to assume that both electronic health records and electronic medical records contain some health-related information that is personal in nature, so this would mean there is some overlap with personal health records. Another area of overlap would be that two of the three, electronic health records and electronic medical records, are “electronic,” although any further similarities quickly come to an end since one has the designation “health” attached to it, and the other “medical.” Similarly, personal health records and electronic health records are both health (not medical) records, but one is “personal,” and one “electronic,” perhaps indicating the importance of the nature of the record rather than the medium of storage. The confusion grows worse if one assumes, quite reasonably, that personal health records can and do come in electronic form. And lastly, both EHR and EMR are often used to refer to the systems of storage (software, databases and so on) that house such records. With all this, it’s easy to see why things have become so muddled.
Definitions based on how the records are used, shared, and controlled have been introduced and are slowly gaining adoption. In 2008, the Office of the National Coordinator of Health Information Technology (ONHIT) commissioned their partner organization, the National Alliance for Health Information Technology (NAHIT) to come up with proposed definitions to help codify health information technology terms. Their goal was to develop “a consistent language that can support a system of public policies, private development, and outreach/educational initiatives that will allow the majority of Americans to experience the actual value of an electronic health information infrastructure.”
Electronic Medical Records
The report states that an electronic medical record is “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 health care organization.” According to this definition EMRs are generally “tethered,” meaning they belong to one doctor, hospital or provider. Patients often prefer this due to concerns about privacy and the release of information to third parties such as insurance companies. It’s important to keep in mind that the ONHIT has determined the cornerstone of a sound health IT infrastructure is interoperability. In other words, information flow must be reliable, consistent, accurate and secure. Being tethered to one provider means that EMRs are not capable of exchanging information interoperably. For this reason the report’s authors believe “the term EMR is on course for eventual retirement.” An EMR is an improvement on the traditional paper chart, and improves the overall health care process, but it does not utilize standards-based interoperable data, therefore falling short of “meanigful use.”
Electronic Health Records
The key difference between an electronic medical record and an electronic health record is this ability to meanigfully exchange or share information. Therefore, an electronic health record is “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 health care organization.” Rather than originating from and being tethered to one provider, the information in an EHR is drawn from multiple providers and is meant to be “a comprehensive, longitudinal record of an individual’s pertinent health history.” In other words, a chronicle of an indvidual’s health care experience from the cradle to the grave. Another key difference, touched on in the quote above, is that although an EHR is managed and used by authorized providers, it is considered patient-focused rather than provider-focused.
Personal Health Records
Lastly, we have the personal health record. A personal health record differs from an electronic health record mainly in terms of control. The information in a PHR may originate with an EHR or other sources, but the management, use and access of that information is under the control of the individual. As the report states, a PHR is “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.” The information contained in a PHR may differ somewhat from that of an EHR as well because individuals can add data themselves. Examples of this would be exercise or dietary information or non-prescription medication. This, along with the individual being in control, reinforces the idea that a personal health record is indeed personal.
These definitions are tied to meaningful use adoption and the above mentioned concept of interoperability, which, although underway, has been problematic and slow to take hold. This means the same is true of EMR, EHR and PHR adoption. Meanigful use is also being rolled-out in stages over a number of years, with the core objectives of Stage 3 still under development. For the most part, these records do not yet exist as they are defined, that is to say in their idealized versions, with the exception of the EMR. Although the upside of this is that the definitions of these terms are likely to be refined and made more precise as meaningful use moves forward.
The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Terms, April 28th, 2008.