EMR vs EHR – What is the Difference?

What’s in a word? Or, even one letter of an acronym?

Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.

In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.

What’s the Difference?

Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:

  • Track data over time
  • Easily identify which patients are due for preventive screenings or checkups
  • Check how their patients are doing on certain parameters—such as blood pressure readings or vaccinations
  • Monitor and improve overall quality of care within the practice

But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”

The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.

And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.

Benefits of EHRs

With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:

  • The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
  • A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.
  • The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
  • The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.

So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a world of difference.

Was this blog post helpful for you? Please comment below and let us know if there are other ways we can help spread the word about the EHR/EMR difference.

83 Comments

  1. sparker101 says:

    Yesterday I spent 10 minutes filling out information on 5 sheets of paper before I could be seen by a dermatologist for the first time. It’s the same information I’ve filled out on similar forms every time I go to see a doctor. While I welcome EMRs and EHRs, how and when will they make it possible for me to see a new doctor without having to fill out the paperwork? Is there going to be some way I can give them a password to access my information online?

    • MIKE says:

      Jacob, Their are many initiatives already in process to ease controlled access to Electronic Health Records. Unfortunately the portion you’ve indicated as troubling (admission info) is not mormally included as part of this. The admission and billing information needs to be as current as possible for the Health Care Provider’s financial and liability protection, while the Electronic Health Records are strictly historical data.
      As I said before many initiatives are already in effect providing for the electronic sharing of individual health information. This allows for the emergent sharing by registered healthcare professionals of your critical healthcare data extended for your continuing care.

      • robert says:

        Mike:

        While it’s true that most EHR/EMR software fail to automate and streamline the patient registration process; technology is available that allows patients to complete these documents prior to the clinic visit or at the time of service. Parklane Systems Kics is a web-based forms editor that allows a clinic to create user definable forms, surveys, questionnaires and documents requiring signature(s) The captured data may then be migrated into supporting billing and or EHR/EMR applications.

        http://www.parklanesys.com/kics/

      • Jennifer says:

        In order to provide treatment, legally, you must provide a health history and a signature verifying that your information is accurate. Imagine if one physician had entered a medication allergy incorrectly and you never had the opportunity to view this information or correct it. It’s irritating, but, essential to the physician providing care to obtain written verification of YOUR understand if you health and history.

      • David says:

        Mike,

        It was my understanding that demographics were to be part of the EHR. This upkeep of this data would be part of the patients responsibility I would presume. Is it just a question of “we aren’t there yet?”

        David

    • Michael Johnson says:

      It’s going to be years and years until the EHR is robust enough to share information across multiple healthcare organizations. I’m a EMR/EHR (same thing really) consultant and I’ll be the first to say we’re 10 years away from large organizations sharing information – probably 15 years for having a nationwide system. If one hospital takes 18 months to connect 2 hospitals on one EMR, what do you think it will take the entire US?

      I’ll be happy to answer any questions, mjohnson@newmedianetllc.com

      Michael

      • Olivier says:

        Michael, thank you for sharing the comments.

        I have been working on the topic for a while, largely outside the US. So two comments come to mind

        - EHRs in the sense that they are accessible outside the limits of a given office are very different from EMRs, and are extremely useful for individual and public health, including in the so-called “emerging countries”

        - the US healthcare environment may indeed take 10-15 years to see a common use of EHRs, due/thanks to its competitive and relatively uncoordinated structure. Several European countries are many years ahead and all these years could be saved in the US if decision makers were looking more at best practices abroad. Iceland has a unique coverage of EHRs (http://ehealth-strategies.eu/database/documents/Iceland_CountryBrief_eHStrategies.pdf). The universal Carte Vitale has been introduced in France in 1998 – granted it is more an identification and insurance card than a real, complete, EHR ((http://en.wikipedia.org/wiki/Carte_Vitale). Let’s quickly dismiss an objection: the issue is not size. It is not more complicated to create 300 million EHRs than 60 million EHRs when agencies are managing petabytes / hexabytes of data.

        Regards

  2. Jacob says:

    I used to hear these terms used all the time and figured that they meant the same thing.
    With “Medical” history the general public tends to associate the health problems/issues that go along with that. With “Health” history, the medical information is assumed go along with that as well.

    I didn’t realize that in the medical field EHR’s and EMR’s entailed such different information. For efficiency, tracking and identification purposes it makes sense that EHR’s would be of much higher value to Health Care.

    Helping patients know the difference between the two is most beneficial when it comes to communicating with the doctors and nurses. There are medical terms and situations where the patients have no idea what to say or what the medical staff may be telling them regarding certain situations. EHR’s and EMR’s are a perfect example of that, especially when one word makes a difference.

    Where you mentioned “A patient can log on to his own record..” I thought that this was something granted only to medical staff (even if it is our own information). Is there a link where we can see our information online? or is this something done only at hospital networks?

    If so, that brings up an unfortunate question, would there be a problem with privacy issues if we accessed our information online?
    If this is something we can do at the hospital, that would obviously take care of the privacy concerns.

    • KathyinMN says:

      Jacob, patients have a right to access their own medical information. HIPAA actually guarantees this right. Many clinics and hospitals have granted patients online access to their information, to make the flow of health care easier, particularly when your health care providers are not located within the same system, or if some still use paper records. For me personally it means I don’t need to swing by my regular clinic to get a copy of my lab work before seeing my OB-GYN. I can go online and print off a copy (and then I also have a copy for myself, in case I change clinics).

      If you think about it, having patients involved in their own health care just makes sense. And the only way to do it, and to do it well, is to have them have access to their information.

      • Michelle says:

        The right to view your medical records really is a moot point until the ease with which to do so becomes the norm. I, personally, am extremely excited for the future of healthcare and the health information exchangeability on the horizon. Yes it may be a ways off, but once the infrastructure is complete and all the players (healthcare providers, hospitals, and patients) are connected, its going to be a beautiful thing.

        • Armando Olivares says:

          I appreciate the magnitude of developing a fully functional EMR/EHR programs.My question: Is there a milestone in the development effort to include/integrate a Patient Portal, that provides patients ability to provide feedback or updates on their health issues? Thank you for response.

  3. Yes, philosophically there’s a difference. I like this short EMR wiki page definition of the difference: http://emrandhipaa.com/wiki/What's_the_difference_between_EMR_and_EHR%3F

    Although, on a practical level, most regular doctors see no difference in the terms EMR and EHR. Although, most doctors prefer to use the term EMR.

  4. Lodewijk Bos says:

    Gentlemen,
    It’s nice to see this document coming from the ONC office to clarify the definition problem, like I have been doing for quite some years. I is however a pity that you have not taken it a step further by stating that EHRs are designed to be “actively” accessed by all people involved in the patients care—including the patients themselves. Adding the word “actively” would assure patient involvement and make sure that patient information obtained from monitoring (either by devices or ODL) is automatically linked to the proper medical information. For more see here: http://www.icmcc.org/2010/10/18/patient-expectations-in-the-digital-world-tallinn-2010/.

    Lodewijk Bos
    President ICMCC

  5. Ashok Mathur says:

    Thank for providing a definitive definition and clarification. Totally agree that we are evolving to EHR world which is far more powerful than the legacy, on premise, closed behind firewall legacy EMRs. New web based (rather than older client server) EHR architecture will find much easier to provide all the (connectivity and) information sharing benefits of EHRs.

  6. Danton Sealy says:

    I too thought the words were interchangeable. It makes the concept of the digital electronic medical record vs. the electronic health record very clear!

  7. John Moehrke says:

    Thank you for this clarity. It does help understand how ONC uses the terms. I like the differentiation between medical and health. This difference does make sense.

    I don’t agree that EMR couldn’t possibly participate externally. This seems to be an approach to classify ‘old’ software vs ‘new’ software. I think this is an ok classification, but should not be bundled with the difference between EMR and EHR. It is important to know if a system has interoperability capability or not.

    It is also not clear in your definition the type of access a Patient (or consumer, or client, …) has to the system. It seems that you are being inclusive in your definition of EHR to include Health Information Exchanges and Personal Health Record applications. This is a nice increase in scope, but it will take quite a bit of retraining for people to understand that EHR is this big of scope. Meaning, you will likely need to do far more outreach.

    • Mike Nusbaum says:

      I agree with John’s comments. It is very useful to distinguish between EHR’s and EMR’s based on the content contained in the record, but I would caution against contraining each of these definitions according to the way they are used or shared. For example, a clinician’s EMR record of a patient’s treatment could find its way into an EHR which contains a much broader set of data, cradle-to-grave.

      As for the definitions themselves, I am pleased to see that they align with those used in Canada (and in many cases, elsewhere in the world). In a global interoperability context, this is extremely important.

      • Jay Altman says:

        Good point, Mike. That is also my viewpoint on all the current push to use only CERTIFIED EHR products for ALL healthcare providers. I have produced for more than ten years now the first, true EMR program for dentistry (The Complete Exam), but can not get it certified as an EHR product without adding a whole lot of additional programming to make it compliant with the large array of requirements for a MEDICAL overall health record. Most all of those requirements I am talking about are of no use to a dentist whatsoever, at least not in the sense of being necessary in his own patient records. I think a well produced EDR (Electronic Dental Record) should be able to be certified for use by dental health care providers as long as it could add its dental medical records to the patient’s overall EHR maintained somewhere outside the dental office, such as in an HIE. I think that the failure to allow EMR software to add records to an overall EHR external to the immediate provider’s IT system is a stumbling block to faster implementation and acceptance of electronic record keeping that can achieve the inter-operability and universal accessibility to those records that is the obvious goal of the push toward EHR adoption by all healthcare providers. I do agree that my EDR/EMR product should be able to access the EHR maintained elsewhere for the dentist’s information, and be able to even import some of that information into the loacl EMR in the dentist’s office. Information exchange and accessibility is the key, not making every EMR product become an EHR product.

    • KMiller says:

      I agree with your statement on the “old” software vs “new” software as the software is a major component to creating, submiting, maintaining, updating and storing the EMRs and EHRs. I would like to see more standards and details surrounding which software is considered a standard (i.e.Epic, etc.)?

  8. BeaHerr says:

    I also notice that there is just as much paperwork to fill out when I visit a doctor, as a new patient or a returning patient (especially as the medical offices keep upgrading their computer systems). I do not think it will change too quickly “sparker101″. As a national printing firm, we are still printing the same amount of intake forms now as we had been for medical facilities back-in-the-day.

    • Mandy says:

      This is why it is so important when picking a doctor to make sure they have an EHR system, then you will not have to do this every time. I have a doctor that has EHR (and picked him for this reason) and do not have to deal with that anymore, nor waiting for results from specialists, referals and so on.

  9. Even though there seems to be a world of “health” difference between EMR and EHR, I don’t feel that providers or the public at large know the difference. In fact until this Blog post I did not know the difference. What you say makes good sense. I just never thought about the difference. You would think that as Huntsville AL Chiropractors, we would be onboard and among the first to embrace the term “health” vs “Medical” records. However an informal simple survey among local chiropractors in the Huntsville Al area demonstrated that I am not alone in my thinking. That means that you and I both have a big job to do in informing and teaching the public. What was it that Mark Twain said? “The difference between the almost right word & the right word is really a large matter–it’s the difference between the lightning bug and the lightning.” Dr Greg Millar

  10. Susan says:

    I still feel that the difference between the EMR and EHR is rather formal that practical, even after reading the post it is still quite vague to me.
    As to electronic data, with all the covenience of elecronic records I still feel there is a need for full paper copies of patients’ medical histories. As I see it, a simple mistake by an empoyee that processes the medical or health data or a system glitch may erase your total history. And what do I do if that happens?

    • Phillip Middleton says:

      To address your comment on potentials for system failure and the use of paper docs, it is well understood in industry that periodic archiving practices (i.e. ‘stone mountain’) is one of the most effective ways to deal with the risk of system failure affecting dated records. Additionally, backups of records to a secure server/system helps provide the near real-time redundancy needed to facilitate more rapid data rebuilds in case of such a failure or user-induced error. If you are subscribing to an EMR that makes it *that* simple for a user to cause a catastrophic failure, that is, without safeguarding layers – why would you continue to use such a useless sytem?

      On this same note, the one thing in my opinion missing in most clinics, small and large alike, is adequate and proactive risk analysis (i.e. providing measures and summarizing trends) and management (i.e. instituting testing/audits and controls) whose goal it is to prevent IT and other events from occurring. I’ve listened to counter arguments ranging from ‘we can’t afford it’ to ‘this is overkill’ to ‘why do I need to manage risk?’. The funny thing is – implementing these measures are actually cost *effective* as well as critical, to both to the provider and to the system. Clinics simply must become more risk management savvy.

      As to your comment on the practicality of EHR, I think that the definition is more than practical, given that the currency of EHR can be measured in the magnitude of holistic scope and accuracy of the information which is reflective of the health of a person *up to* a given point in time (Although somewhat semantical, notice I did not say *at*, there is both clinical and quantitative meaning behind this.). My reasoning is this – clinical mistakes (however mild or severe) have another dimension in real-life not captured well, if at all, in the public mind. Many errors in the care of a patient are far more subtle or hard to detect, and are perhaps more complex given the facets of the relationship between patient and caregiver.

      The dimension to which I attribute this is ‘interconnection’. That is, the degree, type, and scope of relationships within a clinical triad. The triad comprises the patient, an immediate provider, and the network connection of providers who are additionally responsible for treating the patient for related or unrelated illness/disease. There are two main parameters (among others) which may suffice to describe ‘interconnection’ – 1) degree of a common, 2-way communication within the triad, and 2) degree of common literacy about the health of a particular patient (how much does the patient know and understand as well as the caregiver about the patient). The breakdown in 1 or both of these parameters provides a suitable medium for health-relevant errors to propagate, whether mild or catastrophic.

      Take for example a typical clinical environment, such as infectious disease, oncology, any surgical discipline, or better yet, psychiatric medicine in which a common treatment scenario is by necessity, more or less ‘empiric’. How often do interventions simply fail to produce their desired outcome? Would this have been any different with a more comprehensive understanding (so, literacy) of the patient (by both the patient, the immediate caregiver, and/or active collaboration with other caregivers within the patient’s network)? Would this have been any different if the communication within the triad were bidirectional, open, and accurate?

      This is where I think EHR as a definition distinguishes itself from the proprietary EMR mess that has all but failed to solve the real-time solution to these problems. I applaud the group for extending itself in this manner.

      • Sarah says:

        None of this addresses the one thing that would vastly improve accuracy of patients’ records and greatly reduce duplication of tests – requiring healthcare providers who dictate the test results and other data to take a course in the use of microphones and environmental-noise awareness while transmitting vital data. As a medical transcriptionist trying to hear that data on the other end, I am appalled at how carelessly this is treated.

        I asked my doctor if med school included any sort of training for dictation, and he said it did not. He agreed that this should be given more attention but doubted that it ever would because most doctors resent paperwork and recordkeeping and want to get it over with as fast as possible.

        I have listened to doctors who dictate while running water, stapling, standing at a subway station with trains coming and going, riding in a convertible with the top down, standing beside medical equipment with alarms going off, ignoring phones constantly ringing right beside them, eating, laughing, yawning….and YOU figure out what they were saying while all these other interruptions were happening.

        Sometimes you can fill in the blanks. Sometimes it’s something like lab values where you can’t do that. A diagnosis of multiple sclerosis somehow got into my husband’s medical record a few years ago, and no one seems to know who diagnosed him with that. I have a pretty good idea. Since he does have spinal stenosis, that can sound like multiple sclerosis if mumbled, or if the doctor let his recording device get too full and the voice files get too compressed for good sound quality. It’s scary to think that some simple thing like that can cause a devastating diagnosis on someone’s record that shouldn’t be there.

        There are other things like a simple human error that can let other people’s records get mixed with yours such as one digit being entered wrong in a medical record number (MRN). If the other patient (to whom that MRN belongs) is a different gender and a vastly different age than you, it will probably be caught quickly. But if they are the same gender and approximate age, you’re in trouble.

        Decades ago, my job as an MT was called “medical secretary.” Doctors dictated to their secretary, and she could immediately ask him if she didn’t understand something he said. She could also see the patients as they came and went and could note obvious things like young or old, male or female, so if the doctor started dictating a 17-year-old male the secretary knew immediately he was not talking about the 40-something lady that just left.

        It is IMPERATIVE that patients be able to see their records – all of them – because based on what I know from my years of experience as a medical recordkeeper, it is an aberration – not a routine occurrence – if your health or medical record is entirely free of error.

        Doctors will dictate the birth date but then take a bite of food while saying the year or the month, and it comes out wrong. Or they give the correct birth date but then refer to the patient as an XX-year-old that is wrong, and the account is a verbatim account so you must type exactly what the doctor says. I’ve had doctors dictate huge sets of lab results then say to forget them because they were from another patient. How often do they do that and miss the fact that they were from another patient?

        A possible solution – one that I know will never happen – would be to require all who dictate medical information to spend one day per year at the other end of the microphone trying to figure out, organize, and format medical information for patients they have never met from other states. They will at least have one advantage over the average MT – a medical education that is probably close to or equal to the person on the other end of the microphone.

        • Carole Shander says:

          This is very funny reading, but not so funny when you have to deal with it. I was a medical secretary and had my share of dictation problems, but not as extreme as yours. And as you pointed out, could always ask the doctor, as he was the only one I worked for. I also knew all of the patients, which made it much easier. But I did get a good laugh reading your comment!

        • Leslie says:

          I too am a transcriptionist presently and for the second time since EMR/EHR has come into play along with Dragon software and Powernotes I am watching technology take over what we have done so well for years. That is making all that jumbled up, chomping, banging and whispering with words thrown in and creating a patient’s private medical record. The end product I am seeing produced from the new technology, because of various reasons I suppose, such as user error to users lack of time, is horrendous insofar as grammar, punctuation and format. But we do not have a say over this new change as it is where the field is headed. We as MTs must move on.

  11. Marie V says:

    So an EHR is basically a compilation of all of your EMRs?

  12. Electronic Health Records says:

    I guess most people don’t pay attention to the differences between EMR and EHR.

  13. Rudolf says:

    as a physical therapy marketing and physical therapist clinic owner, we always ask patients to fill up EMR and EHR.

    I’m glad this blog clarifies the difference between the 2.

  14. ChristyJ says:

    I have been using emr and ehr interchangeably for a long time, but its good to know :)

  15. Ground Rents says:

    In my hospital we use EHR’s and have been doing so for a no. of years however I can see the appear which EMR’s give.

  16. I agree with BeaHerr and unfortunately you may be right. I can’t wait until we can use QR codes for customer information and email instead of fax but I may be just dreaming.

    • MIDWEST PHYSICALTHERAPY ROCHELLE IL says:

      There are many Physical therapy and MD’s websites which allow you to download Registration Forms to be filled and take this with you on your first visit. Some offices have a KIOSK Screen where you can give the info.

  17. Sugar says:

    Hello. I read your article and I have been wondering this for a long time. I always thought it was mind, body, and spirit, in regards to a patients health, but I was unsure that healthcare providers cared about the importance of the human than making money from our suffering. Thanks for a great read.

  18. George says:

    I think you are comparing apples to apples. Health record or medical record, it is all the same. There is a real problem with integrating the various electronic records keeping programs out there; it is economically driven by those companies as is everything else. The same is true for insurance billing. Just ask the solo practitioners out there that struggle with this issue which occupies an inordinate amount of time on the part of office staff. The electronic records are great for keeping track of patient’s medical histories, but much of that information must be manually entered into the computer system. This is a labor intensive method that physicians are responsible for, decreasing efficiency by a large margin effectively increasing appointment scheduling and wait times. Most of these systems do a very poor job with integrating dictated records which ultimately would increase efficiency.

    • Anna says:

      Thank you George!! This has not simplified the private practice one bit. If there is no centralized system to retrieve these documents, you must still go through the process of gathering data from every provider out there. It’s spending more time with the computer, than with the patient, so that we can make sure the discrete data fields are filled in.

      It requires way more personnel to run these EHRs/EMRs (splitting hairs in my world), and I am watching good doctors leave private practice because this is so cost prohibitive. You not only need the IT people for the general computer issues, you need the folks to maintain those templates for the EHRs, and the security IT folks to make sure no one is hacking these systems. These guys have serious job security, as people try to hack EHRs all day long. The bonuses given out by the government doesn’t even cover 1 IT specialist’s salary. They are either going to large corporate systems, going to different countries, or leaving medicine altogether. The majority are primary care physicians, in which we already have a HUGE shortage of in the country. And as usual those PCPs that do comply will get a smaller bonus from CMS in the end for their MU than the specialists.

      Add to all of those things I listed above the fact that there are many companies out there providing these programs, and no one forcing their hands to make compatable updated programs for true EHR records across the board, the entire system is costing us more than it’s worth. Medicare and Medicaid, and corporate hospitals may benefit, but the folks that are more rurally located in our country lose out. Just my 2 cents, as I getting to be the old war horse in medicine.

  19. John Lary, M.D. says:

    Whether you call them EHRs or EMRs, they still have a long way to go before they begin to improve on old-time dictated paper records. EHRs are, in many respects, worse than paper records. They do generate a lots of useless information that can be easily shared (via a paper fax) — but what good does that do? In the old days, I received a copy of an emergency room record that told me the pertinent complaint, pertinent findings, lab results, and final diagnosis. Since someone had to dictate every word of the report, there was little or no useless “fluff” in the reports. Now, whenever a patient go to the ER, I get a 4 page fax filled with fluff (the hour and minute the nurse first saw the patient, that bed rails were raised, the hour and minute the patient went to X-ray, the boilerplate statement that the doctor explained, in language that the patient could understand, the nature of his condition and treatment, and that the patient voiced his understanding, boilerplate statement that the patient did not feel threatened at home, and on and on and on. Paradoxically, the new EHR records contain LESS clinically-useful information than the old pre-EHR reports.
    In the old days, every medical report I received needed to be sent and contained nothing but clinically useful information. In the old, pre-EHR days, doctors didn’t send out ANY reports to other treating physicians unless there was some important change in the patient’s conditions. Now, with EHRs able to generate a “memory dump” medical report (sent by fax) at the touch of a button, I receive lots of multi-page medical reports from lots of other treating physicians that, when read, just say (using lots of words) that there was no change in the patient’s condition and no changes in therapy. Is this an improvement? I say, No!
    What we need is some kind of internet database containing (1) a list of all medications, dosages, and directions (with dates last dispensed), (2) a COMPETENT list of medication allergies and reactions, (3) list of chronic diseases being treated (the doctor can usually figure this out from the medication list), (4) copies of all hospital discharge summaries and consultants’ reports, (5) copies of all imaging reports, and (6) copies of all laboratory reports. The database should NOT contain the other 99 percent of what is in current EHRs. And, that database needs to be available to all medical personnel WITHOUT BARRIERS (the government is great at erecting barriers). I don’t expect to live long enough to see this.

    • Ken Turner says:

      This note summarizes much of what is wrong with modern health records. Very few office visits and consults clearly state what is wrong with a patient and what the consulting physician plans to do about it. In the days before emr and ehr direct statements of the problems and what needs to be done about them were the rule. We have given up clarity to CYA and to meet government regulation. How unfortunate!

  20. Dr. J. Weissman says:

    I think the analysis here is simplistic, to say the least. Most EHR/EMR are the same. To state that EMR are equivalent to paper charts or that EHR have the ability to communicate with other EHRs not made by the same EHR company or maintained by the same IT department is patently false. We are still printing out EHR notes and mailint the printouts across town to other EHR system users.
    What is true is that most EHR do not communicate the important facts as well as a properly composed letter or clinic note. Nor do they easily communicate important nuances. In some cases one is provided long lists of checklists intermixed with awkward computer-generated text.
    The responsibility for good communication used to reside with the writer. Now the reader bears the burden of interpreting poorly displayed and formatted EHR data. This should not surprise anyone who realizes that most modern EHRs and EMRs grew out of billing software.

    Dr. J. Weissman
    Atlanta, GA

  21. Dr J Mattttern says:

    I have to agree that EHR is great in theory but the reality is far away for private practitioners. The inefficiency of data entry, loss of productivity, cost of hardware, maintenance, risk of security breach, and all with declining reimbursements certainly are just a few of the disadvantages. As a 5 doctor practice that is currently instituting “EHR” to the tune of 200,000 dollars +10% per year maintenance, I can say without a doubt that they are not ready for prime time. They may be useful in a large institution, or physicians that are intimately involved with them, but for the average practice, they are a waste of time and effort at this point. Unless you have a full time IT department it is a nightmare.(did I mention cost increases?)

    As for patient access, it is not like they could possibly hand you a flash drive to import their history as the systems couldn’t possibly understand each other. A central database of information sounds great, but not a week goes by that there isn’t a news story of a breach releasing hundreds of thousands of records already(Nevada).

    I will be surprised if these bugs are worked out in the next 10 to 15 years. However, I am sure that by government mandate they will all be forced be implemented.

  22. Beth says:

    who cares what the difference is. these new programs implemented and required by all physicians (or they would’ve been penalized) put me out of a transcription job. I worked very hard for years to achieve a stable income and clientele only to have it replaced by a computer. Furthermore, physicians dont really have to ditch their MTs but the EMR/EHR software companies persuaded them to do so or there will be another penalty. Very very disappointing for we MTs and going in the wrong direction for job creation.

  23. Andy Salunga says:

    I realize that sometimes the use of one acronym over another has few practical ramifications. However, when ACA reimbursements are driven by inter- versus intra- healthcare organization health record exchange, I would urge you to strive to ensure we’re using the correct term.

    As a former military member who’s used to acronyms that often overlap, and now a student who has just begun a graduate certificate program in Healthcare IT (HIT), I think this is one case where you really need to get it right and ‘correct’ it.

    One example is the use of the acronym HIMSS EMRAM. I know we pick our battles, but it seems worth the effort to get the acronym changed to EHRAM, in order to avoid conflict/push back against EHR- versus EMR-focused adoption stages.

    Thank you.

  24. Alma Gordon says:

    I have have a complete understanding of the terms electronic health records and electronic medical records. I am currently working on a doctorate dissertation that involves healthcare terminology of information systems. This article was very helpful. Thanks.

  25. TellasisPatel says:

    I am not a medical professional, but I can see the value of developing EMR/HER. Will there be any provision in those records to make corrections so that wrong information is not perpetuated? For examples, I wrongly believed that I was allergic to Penicillin and so filled in several Doctors’ Office forms incorrectly. Later, I came to learn that it was not true. How can I or someone retract that information? Secondly, results of IMPROPERLY COLLECTED patient sample after testing and reporting will remain on electronic patient records which can harm current and future patient-care. How such information will be removed from, or LOUDLY flagged in medical records? We or Doctors just scan for useful information and will likely miss to notice the fact that a bad sample was analyzed and reported. Since it is on the record, Doctor may not dare to ignore it and keep on mistreating the patient. In my opinion, this is a very serious problem and it must be addressed promptly. Thank you.

  26. STANDARD-IZE says:

    Standardize- that is the key. Or the nex step.

    With the industry mushrooming- chaos and out of control messaging would be the big tangle coming up ahead.. seen it in other emerging industries.

    Try to get it right from the start.

    Then comes the headache of rules and regulations that keep changing -requiring constant updates!

  27. Marty Gister, RN says:

    Here is the biggest red herring with all of these pie-in-the-sky dreams of what could be done with either EMR or EHR.

    There are somany software systems out there to create and make use of EHRs and even at the major hospitals I work with, they represent a 6-7 figure investment to get installed and functioning. Even more when you consider the training that must occur with all the staff that must be involved from the physicians, nurses, lab personnel and other ancillary services all the way down to the increase in IT staff and billing personnel.

    Imagine you run a large medical center that has just invested a few million dollars into all these things instead of investing that same money in to equipment, etc. that will actually directly help you better treat your patients. Sounds wonderful….now the patients can get their records on a flash drive, DVD or some other media for their primary care physician or other provider they need to be seen by, right?

    WRONG!! Most likely, unless every last physician you see is using the exact same install of the system that the hospital uses, their software will most likely NOT EVEN BE ABLE TO READ that disk you brought from the hospital. The only way they will be able to see any of the records from the hospital will be by the hospital printing them out and mailing/faxing them over.

    Doesn’t really do anything close to what has been promised politically. And before you think that as long as the office has the same software as the hospital, that it would all work together, that would again be incorrect. Unless the office has purchased the exact same add-ons, configured the system exactly the same way, used exactly the same terminology…..they still will not be able to understand each other.

    What is the solution? Do we advocate putting 10′s of thousands out of work by legislating a specific software package? Probably not the best plan.

    To me, the easiest would be to require that the software have some kind of “standard” by which they could read each others records. As that makes the most sense, I know that there are many companies in business today simply to try and make that happen. Considering that all of the possible systems are all proprietary, that is not as easy as it seems. Even so, ultimately, who should pay the massive cost that would be involved in making this happen?

  28. Rr. AJ says:

    the term EHR is an idealistic, unrealistic term for medical records. Doctors are SICK CARE providers, we do need to care for our patients with education , screenings, etc.. but Doctors take care of the sick. No matter how much you exercise, eat right, etc… you can still become ill and /or drop dead. If you think you can avoid getting ill you are 100% wrong. But it does make you feel you have some power over your health. People are told not to smoke and yet we have a president who smokes. All we Doctors can do is: do our caring, intelligent best to take care of our patients illnesses when the time comes.

  29. Dr. David C says:

    As a doctor, I hate EMR! I takes 3-10 times longer to chart on a patient. You can’t just quickly scan a chart to see pertinent information. There is ton’s of useless info and data in a chart you have to wade through. I spend at least 30-60 at the end of everyday “cleaning” up charts.
    Although nobody wants to admit this, or let patients know this, all the EMR programs allow you to create pre-filled templates of examination results. Doctors just press a button and it’s all done, sometimes without entering hardly any patient specific results. This creates a real mess inaccurate charting.
    We are being forced into EMR by the government and insurance companies before these programs are adequately developed to make them easy to use. We spend far more time charting with EMR than we did with old fashioned paper.
    And god forbid you are any kind of specialist…..you’re EMR program will be a hair pulling experience.

    • PB says:

      Visits to the doctor are now like going to the DMV – no eye contact and the patient has to sit there passively while the doctor is glued to his laptop. It is soul-destroying and it is bad medicine. While visiting the doctor with my elderly parent and seeing this happen, I asked, “Is this the new paradigm in medicine? The doctor never actually looks at the patient?” He replied, “Thank Dr. Obama.”

  30. LeeAnn says:

    Electronic records – medical or health – will not be going away, but remember… the most important thing is that the data included by ACCURATE!

  31. Natalie says:

    I am surprised that no one that has commented here has even come close to my main concern: PRIVACY. Do we REALLY need this much transparency? I really do not think so. Is it really necessary for a physician to know what happened to me medically 20 years ago? 5 years ago? Only if the medical condition is still current. I make a total point of NOT having my medical records available with a new doctor. I want the focus to be on the present complaint, not its history or supposed history.

    I request my records from physicians/hospitals from time to time. They are loaded with inaccuracies. Why would I want them passed on?

    I do agree that there are emergency situations where it would be good to know a person’s allergies, but wrist bands do a great job of that and are immediate.

    The only service I can see in such meticulous records is in “catching” people who try to get multiple prescriptions, and from what I hear from friends in the medical field, they give themselves away quite quickly anyway.

    Am I the only one remembering the movie “The Net?”

    • Sheri says:

      Amen, Natalie! I’m a pharmacist and I am really concerned about the privacy issue when so many people will be able to access anyone’s medical records. I have a disabled child who will never be able to get a job if her medical records are breached and seen by prosepctive employers. I am afraid that once privacy is breached there will be a lot of people who cannot get or keep a job due to what is written in their supposedly private medical records.

  32. Dorothy says:

    I am looking forward to my doctor taking on the EHR. I would like to know the results of my blood tests before my next appointment so i am prepared to ask any questions I may have regarding the results. It also helps to be able to look back and see when you visited the doctor for what reason and what took place, without having to contact the doctor office and wait for that information. I am all for it being implemented immediately!

    • Anna says:

      Your labwork will only be available before your visit if your doctor participates with a lab that provides this service. I have been getting my labs for years prior to my appointment. All you have to do is have the doc write “copy to patient” on the requsition. If they do this, the lab will mail these to you the same time they get them to the doc.

      You may not be thrilled about this system if someone is able to hack your information from that lab’s EHR. I have friends that are thrilled that the government implimented this giant waste of resources (funny the gov’t funded VA system is centralized), as they are tasked with thwarting hackers. They are busy all day long.

  33. Shiela says:

    Is the difference between EMR and EHR addressed in the HIPPA laws? Is EHR protected by HIPPA? If not, medical records would not be guaranteed private.

  34. Douglas Ledet says:

    Nice concept, BUT, does the patient really want the “physical therapist” to read about their STDs?

  35. Kevin says:

    I see that the overwhelming sentiment on this page is that electronic records are a good thing. But what about us Luddite patients who LIKE paper records. There is no reason that my medical, or health, records should be available to anyone outside my doctor’s office who thinks it might be interesting to read them. I feel that paper records, with basic security and destruction policies, provide my doctor with what he needs, preserves my privacy, and lets me get the care that I am paying for. (Yes, “I” am paying for.)

  36. Dinah says:

    “EHRs do all those things—and more.” Such a comfort to know that Affordable Care Act Bureaucratic Advisory Panels will have access to “all those things—and more.”

  37. PB says:

    My EMR’s were taken from the office on a functionary’s laptop, left in a car, and stolen in a break-in. Until this happened I had no idea that my records ever left the office. These records are not secure; any Tom, Dick, or Harry could be carrying them around and losing them through carelessness, causing you endless amounts of aggravation. You have to freeze your credit for at least a year, monitor what’s happening with it, be aware of identity theft, all because someone took your records on a laptop somewhere they shouldn’t have. When they tell you your records are secure, don’t believe them. I filed a HIPAA complaint, but so what.

  38. TonyNY says:

    Getting the Healthcare Industry electronic only makes sense if there was 1 central EMR / EHR database that every facility uses.

    There are so many competing software companies out there just robbing the clients blind. I’ve held numerous positions throughout the decade specializing in one specific emr. I’m trying to get out of this specialty just because of all this confusion going on.

    Healthcare Records needs to be centralized. There cann’t be competing software companies. One offering a sql database, the other oracle, the other just hosts the database online. All the different interface builds, etc…. its stupid.

  39. Amy Smith says:

    In my community of people in recovery from substance use issues or mental health difficulties, we KNOW this is a HUGE deal and a big difference. Privacy, of course, is a major concern; many people in recovery no longer wish to be identified as former patients of either of these systems and there is no need to do so. There is also the serious issue of stigma- the bias of most medical professionals, particularly in emergency treatment. I could give you hundreds of documented stories of individuals turned away from ER’s who were presenting with acute physical distress, only to be turned away after someone spotted a behavioral health diagnosis in their record. Told they were attention seeking or drug seeking. Add these grave concerns to the ever-increasing tendency towards involuntary treatment in both communities, primarily with protocols with very poor outcomes and multiple devastating adverse effects, and you may be able to grasp our concerns.

  40. George Madison says:

    The distinction being drawn between EMR and EHR is, at best, silly.

    EMRs are not exclusively within the walls of a single provider or health care organization. Never has been. They are merely electronic versions of a medical record. Allowing for sharing of EMR data between providers, and with the patent, is a process of bridging networks and systems.

    But this type of semantic silliness is not new. Nor is it helpful.

    • Peter Garrett says:

      Hi George. We appreciate your input on this discussion. The origins of this post come from the significant amount of search engine traffic for the differences between “electronic health records” and “electronic medical records.” There are an average of 700 searches each month in the U.S. for “EMR vs EHR” and its variations. We created this blog post so that ONC’s official response will be shown in Google to answer the question implied by those Google search queries.

  41. Keith Rull says:

    Very good description of the difference between EMR and EHR. I think a lot of folks tend consider both one and the same because they think Health and Medical is one and the same.

  42. Sarah says:

    EHR is patient’s health history means patient health record is over all patient record -
    and patient medical record history both are different but you can use a term called electronic record management for all this.

  43. charlee says:

    As a long-term IT person, whose headed and particpated in major systems implentation see the current mandates, and especially how they are being imlemented, as \actually detrimental tho the HEALTH record of an individual. Which can and does too often mean detrimental to the health of the indivudal.

    As it stands now, the MEDICAL record alone is likely to be highly inaccurate. I suggest all those interested do with their medical record (or health record) what they do with their credit record. Adding more information does not necessarily make for better information (look at the Internet overall).

    Tellin gdoctores they must move toelectronic records without providing the means to do it well, puts a burden on strained practices. Now when I see a practioner – and there have been several in different disciplines – the person often spend far more time with their laptop then they do examining and talking to me (or others that I am caregiving for). There is, perhaps, a generation problem. The older doctors take longer and seem a bit fumbly. THe younger ones, especially the assistants, who tend to be younger and more adept ad experienced with electronic devicves, are quick. But maybe sacrifing even more accuracy. One of them had to have me spell headache:-/

    Successful technology transitions take more than new software and/or hardware. The health IT industry needs to see beyond the immediate buck and look at the long term implications for patient health.

    Given the state of things overall, I am not optimistic.

  44. Dale Glenn says:

    I have spent most of my career installing and managing EHRs (EMRs) and while I am fully in support of the concept of holistic health and medical records, our vision is somewhat larger. Rather than splitting word hairs, lets redefine the word medical to include all things that promote good health rather than just treat disease.

    What we need is new a new system of medicine, not new definitions.

  45. Ena says:

    This information was very useful in understanding the difference. I am a student of Health IT and studying of CEHRS certification. So this information helped to clear the difference and it gave me a clear view to understand the meaning of both EMR and EHR.

  46. Helping patients know the difference between the two is most beneficial when it comes to communicating with the doctors and nurses. There are medical terms and situations where the patients have no idea what to say or what the medical staff may be telling them regarding certain situations. EHR’s and EMR’s are a perfect example of that, especially when one word makes a difference.

    I agree with this point of view.

  47. Heather says:

    Actually, i am doing small services which is related to therapy billing software and i’m also research on health related issues because i have interest on such kind of work here also i viewed some new things that is related to EMR and EHR. I really appreciated this post. Thanks!!!

  48. CDG says:

    Great information on the differences between the two terms. I would have assumed that comparing the terms, most people would interpret “health” as long term well-being, whereas “medical” is more focused on the present/ intervention to improve an individuals health.

  49. Doctors still continue to use the term EMR, while being fully aware that the mean EHR. The reason is, almost all ONC certified software products out there are really EHR software.

  50. HARLEY says:

    what is PracticeFusion and pharmas doing together? Have you seen their recent press release. http://www.forbes.com/sites/kashmirhill/2013/10/24/practice-fusion-reviews-whoops/

  51. Thomas VdA says:

    Very useful and clear. Thanks!

    In Europe (Belgium in specific), the problem doens’t exist in filling in too many forms, but it’s a struggle if one switches from one HCP to the other to get diagnosed correctly (because of the lack of knowledge on the patients past).

  52. Tony Vallejos says:

    Hello, I have several question that maybe you can answer
    Can you describe the relationship/differences between electronic medical records (EMR), electronic health records (HER), personal health records (PHR), and clinical information systems?

    Can you give me a sample of data standards?

    Thank you

  53. Chris Horner says:

    I don’t think any of the people posting here are physicians. I am a physician. Let me tell you, EMR/ EHR are useless. They are not helpful for patients at all. I have been using one for 2 years and find myself spending more time staring into my computer than talking to my patients. I am getting rid of it. Patients do not realize that they are being short changed by the system. Its a win win for everybody but the patients. The doctors can bill a higher code, the IT companies make money and the poor patient is neglected. Its time to get rid of EMR or EHR (whatever that is called)

  54. Murtala Atta says:

    This further differentiation makes a ton of difference,the problem I am facing and have always voiced out is the “interoperability”btw other EP’s and hospital as well as patients not been tech savvy or not wanting to create there portal for the dear of big brother.In this tech age times this Opportuinity can only be appreciated for it brings your healt records in real time.After successfully reporting Stage 2 MU it was quite a fierce ordeal in getting patients to sign up for there portal and exchanging EHR with other vendors was almost impossible.Some big hospitals or EP’s don’t even know what a secure portal to exchange records is all about.
    There should be enlightenment on the need for vendors to harmonize there platforms to meet the objectives and goals of exchanging of EHR.my

  55. Carol Gilligan says:

    Does anyone know…..Can/should therapist’s psychotherapy notes be included in an EHR?

  56. Byron says:

    I am a software engineer with over 16 years of experience and have about 3 years of cumulative experience building EMRs (starting about 10 years ago). The distinction this article is making is false. Even 10 years ago, EMRs had the ability to share information via SOAP web services, SFTP and HL7 interfaces. This article says that an EMR is only for the organization using it to store the medical information and not intended to share the information. Again, this is simply false and since the early days of building EMRs, there has always been the ability to share the information. Whether or not the vendor/creator of the EMR decided to build this functionality is irrelevant. This article is thus stating that simply building the ability to share information makes an EMR become an EHR. That’s a pretty silly distinction. In my experience, an EMR is typically only for users of the health organization to use. It’s for the doctors and nurses to log into and record information about the patient and their visits. The EHR is a newer term, but often offers the ability for the patient to also log into the system, view and modify their own record. So, a patient can upload data about their vitals, allergies, medical history, etc. But in any case, EMR and EHR are not distinguishable based on sharing of information. There are many EMRs being sold today that by this definition are EHRs, but they’ve been called EMRs for years and have had the ability to share data with other EMRs for years.

  57. Chris Chaney says:

    Actually PB, President Bush started the push for electronic health records. He established the Office of the National Coordinator of Health Information Technology (ONCHIT) to promote universal use of the EHR and Computerized physician order entry.

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