Friday, April 6, 2012

Introduction to EMR (EHR)

Considering my experience in EMR, I think a good place to start is talking EMR.
An EMR, for those who don’t know, is an electronic medical record. An electronic medical record virtually replaces all paper patient charts in a medical practice or hospital. Another term frequently used is an EHR or electronic health record. EMR and EHR are technically two different things but in common usage the terms have become synonymous. For the purpose of this blog, I will call it an EMR and assume that an EMR and EHR are the same.

We’ll start with a simple introduction to EMR.  In general electronic medical records all have the same basic features such as places to enter/store patient demographic profile, patient medical history, documentation for each patient visit, scheduler or calendar, and so on. An EMR program and all the patient data contained within can either be stored on a server (computer) in your office or it can be web-based. A web-based EMR holds the same type of information, but the data is stored on the software company’s servers and you access it over the internet.  

There are pros and cons for both. For example, if your EMR is stored onsite at your office, you need to take precautions against disasters that would cause you to lose information – like flood. Web-based EMRs generally have these precautions figured out. Web-based EMR companies use a facility called a data center to house their servers (and all of your information). EMR companies have multiple copies of all the information called back ups and some EMR companies have multiple data centers which means that if one data center has a problem – the other data center can take over and continue servicing the customers. On the other hand, web-based isn’t perfect either. If your internet goes down, you cannot access the patient records.

EMR became a huge topic of conversation back in 2005 when Hurricane Katrina destroyed parts of the south. Millions of medical records were lost in that disaster and many realized that EMR, particularly web-based, would have prevented the loss of that information. In 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA 2009) in to law. Within ARRA, the HITECH act dedicated billions of dollars to health care IT such as EMR.

The manifestation of ARRA’s HITECH act is known as Meaningful Use. In a nutshell, doctors and hospitals can be paid incentive dollars by the government for implementing and using an EMR. If they refused to use an EMR, government insurances like Medicare will begin cutting their payments within 5 years. This is why so many people are talking EMR these days.

Still, there is more to it. It is not just the fear of natural disaster that prompted the EMR madness – it is patient wellbeing and ever-rising healthcare costs. EMR has features that help doctors and reduce mistakes. For example, most EMRs have features that help doctors write prescriptions and send those prescriptions to the patient’s preferred pharmacy. Writing a prescription on an EMR helps protect patients and keep costs down in two big ways.

First, doctor handwriting is messy (I think they learn how to scribble in 3rd year med school). That messy writing can result in mistakes – either when the pharmacist fills the wrong medication or the patient takes it incorrectly…just because no one could read it. Secondly, EMR prescription writing software has built in warnings that will let the doctor know if s/he is prescribing something that the patient is allergic to or if s/he prescribes something that will have a negative interaction with the patient’s other medications. This is a huge help to doctors. 

Today, we have so many medications on the market , no doctor can remember everything. So EMR helps to prevent medical mistakes and thereby reduces the cost of healthcare. EMRs are good in other ways too. They keep all of the patient’s information in one place and it is always properly filed. This too helps to prevent medical mistakes from missed information such as family history of certain conditions that can be a warning sign for things to come for the patient.

So, that was a good start to what’s what with EMR. In the next post, we will get in to some more meaty stuff and I will talk about ways to successfully implement an EMR in a medical practice (it may sound like a no-brainer… but it’s more challenging that most realize). 


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