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Information on Electronic Health Records (EHR), Electronic Medical Records (EMR) and medical record related technology.
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The Electronic Health Record (EHR) is becoming a widely used term but is also often referred to as:
Computerised Patient Record (CPR)
Computer-Based Patient Record (CPR)
Electronic Medical Record (EMR)
Computerised Medical Record (CMR)
Electronic Health Care Record (EHCR)
The EHR though is different from an EPR in that it is longtitudinal and not site specific. This definition of the EHR is well accepted:
An electronic longitudinal collection of personal health information, usually based on the individual or family, entered or accepted by health care professionals which can be distributed over a number of sites or aggregated at a particular source, including a hand-held device. The information is organised primarily to support continuing, efficient and quality health care. The record is under the control of a known party or the consumer and is stored and transmitted securely.
Equally the following is used:
An electronic health record is any information relating to the past, present or future physical and mental health, or condition of an individual which resides in electronic system(s) used to capture, transmit, receive, store, retrieve, link, and manipulate multimedia data for the primary purpose of providing health care and health-related services. (Murphy, G. F. et al. (1999), Electronic Health Records: Changing the Vision, Harcourt Brace & Co., Philadelphia, p.5.)
A computer-based patient record has been defined as:
An electronic patient record that resides in a system specifically designed to support users through availability of complete and accurate data, practitioner reminders and alerts, clinical decision support systems, links to bodies of medical knowledge, and other aids. ( Dick, R and Steen, E. (1997) 'The Computer-based Patient Record: an essential technology for healthcare.' National Academy Press, Washington, USA, p.35.)
The electronic patient record (EPR) can be defined conceptually as :
Electronic Patient Record (EPR) describes the record of the periodic care provided mainly by one institution. Typically this will relate to the health care provided to a patient by an acute hospital. Electronic Patient Records may also be held by other health care providers, for example, specialist units or mental health NHS Trusts. (Royal College of General Practitioners Health Informatics Taskforce, Scope EHR, http://www.schin.ncl.ac.uk/rcgp (1998), RCGP.)
The EPR is therefore periodic and site specific while the EHR generally refers to a record incorporating a patient's health care details from conception to death.
An Electronic Health Record system needs both a technological and a human infrastructure to create, store, alter, retrieve and archive EHR records successfully online.
The human centred infrastructure includes the processes of privacy, consent, and authorisation as well as the difficult human machine interfaces relying on vocabulary, standards for data, coding, terminology, classifications, messaging and information storage as well as the visual, tactile and auditory devices necessary to interface.
The addition of decision support systems of varying sophistication from online text books and simple alerts to complex rule based expert systems is another dimension to a system of records.
In turn there flows from a systematised collection of records both administrative and statistical information useful for pubic health, fiscal, research and planning purposes.
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Supports consumer involvement
• Protects personal privacy and reinforces confidentiality
• Provides a consumer view of information
• Accommodates consumer decision support and self care
• Ensures accountability of health professionals
• Accesses information for the consumer
Supports consumer health care
• Forms the basis of a historical account
• Anticipates future health problems and actions.
• Describes preventative measures
• Identifies deviations from expected trends
• Accommodates decision support
Supports communication
• Supports continuing, collaborative care and case management
• Accesses medical knowledgebases
• Allows automatic reports
• Supports email generation and electronic data interchange (EDI)
• Enables record transfer
• Enables record access when and where required
• Supports selective retrieval of information
Supports management and Quality improvement
• Enhances the efficiency of health care professionals.
• Supports continuing professional assessment
• Facilitates management tasks and reduces routine reporting
• Demonstrates and improves cost-effective practice
• Accommodates future developments
• Provides a legal account of events
• Provides justification for actions and diagnoses
Supports population health care
• Supports policy development
• Provides evidence for development and evaluation of programs
Supports enquiry and learning
• Supports clinical research
• Assists with clinical audit
• Supports medical education
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Electronic Health Records has come a long ways since it's inception in the late 1970's. In the recent years there has been a significant increase in discussions through the federal and state governments about making Electronic Health Records mandatory for healthcare organizations in the United States. In early 2006, President George W. Bush asked congress to "make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors". Many state governments have already started legislation for making the use of EHRs mandatory.
A study by EMR Experts, Inc. in December 2006 showed that there are over 200 Electronic Health Record software vendors in North America. To help healthcare organizations purchase quality EHR systems the U.S. Department of Health intitated funding for a non-profit certification group called The Certification Commission for Healthcare Information Technology (CCHIT). On July 18 2006, CCHIT announced certification of 18 ambulatory EHR products. On October 23, 2006, CCHIT announced their second certification list consisting of an additional 17 ambulatory EHR products.
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1. 'A Health Information Network for Australia - Report to Health Ministers by the National Electronic Health Records Taskforce', July 2000, ISBN 0 642 44668 7, Commonwealth of Australia.
2. 'A National Approach to Electronic Health Records for Australia', National Electronic Health Records Taskforce, Issues Paper, March 2000.
3. 'Electronic Medical Records eBook', December 2006, EMR Experts, Inc., http://www.emrexperts.com/emr-ebook/index.php
4. 'CCHIT Announces First Certified Electronic Health Record Products', Certification Commission for Healthcare Information Technology, Press Release, July 18, 2006, http://www.cchit.org/media/press+releases/CCHIT+Announces+First+Certified+Electronic+Health+Record+Products.htm
5. 'CCHIT Announces New Certified Electronic Health Record Products', Certification Commission for Healthcare Information Technology, Press Release, October 23, 2006, http://www.cchit.org/media/press+releases/CCHIT+Announces+New+Certified+Electronic+Health+Record+Products.htm
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