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Archive 1

EHR Vs EMR

I do not agree that EHR and EMR should be merged as a single entry in wikipedia.

Electronic Health Record is increasingly being used to descibe a shared longitudional health record that is composed of relevant summaries and clinical information collected from other Electronic Medical Records or entered directly into the EHR. EHRs are currently being implemented in the UK and Canada. A national EHR is under consideration in Australia. EHRs are oriented toward sharing of clinical data across diverse stakeholders.

Electronic Medical Record is a detailed records of clinical events and interactions. EMR Commercial-off-the-shelf (COTS) software has been available from vendors such as Cerner, IDX, OACIS. These producst typicaly include order-entry, results reporting, electronic prescribing, clinical decision support, charting, clinical notes. An EMR represents the day-to-day events of a patient. In a stand-alone setting, a doctors surgery may run stand-alone EMR software (or shared amongst the pratice) to manage pathology/radiology requests and results, prescribing, clincial notes as well as follow-up, diary functions etc.

In summary, EHR is ideally a shared longitudional health summary record. EMR is a detailed day-to-day medical record. As they have different meanings they should not be merged.

References:

EHR Definition, Attributes and Essential Requirements Version 1.0 - HIMSS definition of EHR.

Healthcare informatics article on the the difference between EHR and EMR.

--Pgillogley 01:22, 26 February 2006 (UTC)

I agree. EHR is recognized as a distinct entity - typically operating across a large geographical area and a large number healthcare institutions. While there are many models, the only one that has gained much traction is a centralized database, where HL7 messages from various institutions are normalized, identified and then stored in a massive data repository.

Contrast EMR has in my experience two different but related meanings - either the system run within a hospital that will show a medication chart, lab results - or for a doctor in the community. Either way - this shows detailed information. Often a summary of an entire encounter may be summarized into a single electronic document, which is then stored in the EHR.

Within the Healthcare IT industry EHR and EMR are distinct (though often confused) terms.

--Kelsey Grant 08:13, 23 March 2006 (UTC)


I also agree they should be separate. I found a useful layperson's summary of this topic that seems on target:

- EMR (Electronic Medical Record): Owned and controlled by the healthcare provider, it contains information about the services provided by a single provider to a patient.

- PHR (Personal Health Record): Owned and controlled by the patient or care-giver. It contains an overview of ALL key aspects of the patient's healthcare from ALL providers including medications, conditions, procedures, allergies, past locations of car, etc

- EHR (Electronic Health Record): The combination of an EMR+PHR in which the data is shared between the two systems.

I found this in a briefing given by the head of MEDEM who was helping launch the iHealthRecord system. http://www.connectlive.com/events/medem/# It also seems to agree with the Medical Records Institute's synopsis on this topic. http://www.medrecinst.com/uploadedFiles/MRILibrary/StatusReport.pdf

--[User:LarsonBennett] 16 April 2006

I support some method of explaining the differences between the alphabet soup now developing (ie: EHR, EMR, CCR, PHR, EPR, CMR....). Please consider that there is great value to the nonmedical, non-IT user of Wikipedia in merging the articles Electronic health record, Electronic medical record and Continuity of Care Record into a common article with subsections explaining the distinctions and expanding each topic. Fragmentation of a field is a real problem in Wikipedia, and makes it difficult for users to get fully informed about a topic if they aren't aware of the terms and nuances. Instead of an encyclopedic approach, many small and often incomplete articles are written. Reading these 3 articles, it is hard to see the similarities and distinctions that the discussers in this talk section know about. Given the lead sentence of each article being so similar, I don't think a disambiguation page with a sentence on each topic would be helpful either.
So, why not take a single term (I suggest Electronic health record since it is growing in popularity and use), and redirect all other terms to the EHR article? Then EMR and CCR (and any other new terms introduced by the industry) could be defined and related to EMR as subsections of the EHR article. The EMR article is more comprehensive than the EHR article at this moment, so adding it to EHR would be a nice enhancement.--Ryanjo 02:56, 27 July 2006 (UTC)


I think that EMR and EHR should definitely be merged. Everything we have written under the "issues" section is equally applicable to EMRs as it is to EHRs. For example, privacy, interoperability, etc. applies to both. The differences between the two designations are wonky and not worth the added confusion of creating two separate articles. Although I am fairly new to Wikipedia, I think it seems silly to have two pages with such similar intents. I dislike the fact that the content of the two pages are so dissimilar--EMRs have more in common with EHRs than not. These definitions are changing all the time; I have heard industry folks use them interchangeably, or with different understandings of their meaning. I know you found good-looking distinctions online, but in reality the distinctions are nebulous. --Kawanazii 19:08, 7 August 2006 (UTC)kawanazii
It is reasonable to have EMR as a subset of EHR. It is commonly accepted industry practice to refer to an EMR as a product limited in scope solely to the electronic patient chart. EHR, on the other hand, is a much more comprehensive term and refers to the electronic chart along with supporting modules such as scheduling, disease management, decision support, HL7 lab connectivity, security and audit, patient portal and, in some instances, practice manegement. CCHIT certification requirements exceed the scope of EMR. Interoperability is a separate and distinct designation that is encompassed within an initiative called IHE (integrating the healthcare enterprise). IHE includes basic sharing of lab results in a universally accepted format (LOINC) and un-codified text. The ultimate goal is semantic interoperability, or true machine to machine transferrable codified data. An open source data model, such as Medicapaedia, mapped to standards such as SnoMed, CPT, ICD-9 and LOINC may be the surest and fastest solution to this immense challenge.

David Winn, M.D., FAAFP Founder and CEO, e-MDs —Preceding unsigned comment added by 70.129.204.236 (talk) 03:33, 6 April 2008 (UTC)

The merger question (as you can see from this discussion section) has been hotly contested for several years. Kawanazii & I announced a merge in 2006, but were thwarted by an IP user, possibly one of the several IP addresses who craftily insert commercial links to favored EMR products or sponsored websites. As a fallback position, to give Wikipedia readers a comprehensive article about the various electronic forms of medical data (ie: EHR, EMR, CCR, PHR, EPR, CMR....), I suggest all editors who want to contribute to information on electronic healthcare recordkeeping focus their work to enhance this EHR article.Ryanjo (talk) 17:02, 6 April 2008 (UTC)

Major format and content revision

I added some new sections, including content from electronic medical record to help make distinctions, and did some formatting an added an image from the health informatics page. All the previous content is there! --Ryanjo 02:12, 30 July 2006 (UTC)

Merge with Electronic Health Record is imminent!

Hi, I agree with you that the EMR and EHR articles should be merged. How do we go about doing that? --Kawanazii 19:12, 7 August 2006 (UTC)

I think I'll post on the EMR discussion page that it will be merged into the EHR page if no objections, since the content of the EMR page is already in the EHR page, plus more. If no protests in a day, replace the text of the EMR page with the Redirect command, targeting the EHR page (see Wikipedia:Redirect). Regards, --Ryanjo 22:10, 7 August 2006 (UTC)
I that thats a bad idea, but I am not going to defend my position, because I am used to it not mattering on the Wikipedia. - 69.47.132.138 03:15, 9 August 2006 (UTC)

I'm sorry, but you cannot merge EMR into EHR and have EHR as the remaining page. EMR is used far more often to describe the software that is being discussed than EHR is. If in any doubt about that, check out the Wordtracker or Overture search tools and you will see that far more people are searching for Electronic Medical Records than anything else. 200.49.144.222 23:21, 10 August 2006 (UTC)

I think this issue (use of EMR & EHR) is best addressed by this merge than by two separate articles:
Ryanjo 01:03, 11 August 2006 (UTC)

Smart merge and/or term clarification

Dear all, please see Talk:Electronic medical record#Smart merge and/or term clarification for continuation of the merge discussion with a view to making a clear resolution. — Donama 13:39, 27 September 2006 (UTC)

Rename to "Electronic health record"

This article should be renamed (as per WP:TITLE and WP:CAPS) to "Electronic health record"). Is that okay by all? — Donama 04:36, 29 September 2006 (UTC)

Agree. Ryanjo 23:47, 29 September 2006 (UTC)
  • Support, there is no legitimate reason for it to be capitalized. It is only capitalized now because it is frequently expressed as an acronym (EHR). Unfortunately, many articles on Wikipedia are incorrectly capitalized for the same reason. The capital letters of acronyms fool people into thinking the expanded term should be capitalized and many sources capitalize the first mention of a term so that the origin of the acronym is made clearer. After the first mention, they usually refer to it by acronym only, so people rarely see it uncapitalized (although the writers may not know it is supposed to be uncapitalized themselves, either). -- Kjkolb 02:36, 30 September 2006 (UTC)

Seems to have been done. Andrewa 09:24, 6 October 2006 (UTC)

Contribution to Interoperability subsection

A paragraph was added to the Interoperability section, which I have "commented out", pending further review:

The AAFP believes the ASTM CCR standard is a clinically sophisticated and technically robust solution to the need for both portability and interoperability of patient health information stored in physicians’ EHRs. We believe the ASTM CCR will provide a near term benefit by making those products and services which are compliant with it more desirable to new purchasers of EHRs, thus making it possible for the New Model of family practice to go from concept to reality at an accelerated pace. The AAFP recommends to its members that they select EHR products, services, and vendors of HIT that are ASTM CCR compliant or in the process of adopting the ASTM CCR. Vendor recognition and acceptance of the value to be gained by complying with the ASTM CCR is borne out by the fact that over twenty-five vendors of HIT software have been involved in its ongoing development and have participated in two demonstrations of ASTM CCR interoperability in 2004 and 2005.

My comments are:

The text above is not formatted for an encyclopedia ("We believe"...who is "we"?) and is unreferenced. It reads as if it was lifted from a sales site. It does not describe what ASTM standards are, why they are deserving of mention here, and how it will improve EHR interoperability. The contributor of this text should reformat these statements and provide references, rather than purchasing recommendations.

Ryanjo 03:20, 28 December 2006 (UTC)

Personal bias and "niche" creation of EMR and EHR

I strongly disagree with those who would espouse their own definition of the differences between EMR and EHRs.

There is no standardization in terminology regarding these acronyms, no matter how strongly one or more people assert it to be true.

Furthermore, the distinctions are often subtle, fluid, and subject to marketing whims of companies that are trying to establish a niche for their product.

If some people espouse a separation of terms for localized storage versus distributed storage of health data, Wikipedia is not the place to attempt to do so.

There is already a lot of disagreement between centralized storage at a local site versus localized storage at a central site.

These differentaitions are relevant to the Internet and Information Technology as a whole, not specifically to Electronic Health (Medical) Records.

It is a disservice to the world at large to attempt to co-opt terms for marketing reasons.

I vote to merge EMR with EHR on Wikipedia.

I agree. The merge request has been taken away for some reason though. Donama 01:52, 28 September 2007 (UTC)
I am going to add a merge tag back. Donama (talk) 22:55, 31 March 2008 (UTC)

Contribution to Social and organizational barriers section

Two paragraphs was added to the Social and organizational barriers section, which I have "commented out", pending further review:

While many believe that the implementation of electronic health records is a solution for the ever-increasing cost of health care, others believe that they will instead create more problems rather than providing a solution. Privacy advocates, consumer groups, and civil libertarians are concerned with privacy violations which may occur once information is made available electronically. Others are concerned with additional expenses which will be incurred while implementing EHR. Physicians have identified that much of the evidence available regarding the cost-savings associated with EHR is published by vendors and by others who have a stake in the success of EHR implementation. Without evidence, published by unbiased sources, of EHR's financial savings for individual physicians, many are resistant to invest in a system which they are not confident will provide them with a return on their investment.

One primary reason that organizations are so resistant to EHR implementation is that such implementation would result in significant changes in their daily operations. Changes will occur in how patient and patient care information is collected, stored and communicated. Those changes will require education, skills training, continuous improvement, and the proper management to help assist in the transition from paper to electronic health records.

The author should provide references for the statements in these two paragraphs, and replace the weasel words. The rest of the article is heavily referenced, and this material should be supported similarly by citations. Ryanjo 00:40, 12 June 2007 (UTC)

I vote no to merge Personal Health Record (PHR) with EHR/EMR

The difference between the scope of a personal health record and an electronic health record/electronic medical record is the difference between a flash drive and a centralized server.

The order of magnitude, scope of purpose, portability, user base (individual versus entire nation or hospital) and numerous other distinctions are substantial. Furthermore a personal health record may not be specific to any particular EMR/EHR.

It is a different animal not only in terminology but also in physical dimension and implementation. I vote to keep Personal Health Record as a separate article. Physadvoc 20:32, 12 July 2007 (UTC)

Thanks for the information. Instead of merging Portable digital personal health record to here, I've redirected it to Personal health record. --Alynna 17:39, 13 July 2007 (UTC)

Note: An EHR can be an personal health record, if it is a person-centric EHR (what contemporary EHRs are these days). Donama 01:50, 28 September 2007 (UTC)

PHRs available commercially?

I removed the line that states that PHRs are available for purchase online. The reference cited made no mention of that claim and therefore was a dishonest citation.

The negative implication by the statement was that commercial online companies could acquire all your health data and then sell it back to you.

This is an argumentative speculation by detractors of the concept of a personal health record, not a reality.

Physadvoc 19:27, 15 July 2007 (UTC)

It sounds more like you removed a potentially true statement because you don't want people to think about the possibility! Perhaps it would be more honest and complete to write something like "the commercial sale of PHR information is a potential threat/danger of such information being available as electronic files"? -69.87.200.188 20:57, 26 July 2007 (UTC)

Disagree 69.87.200.188. This is meant to be an encyclopaedia so we shouldn't state untruths and in most cases don't need to remind people about possibilities. Let's include only factual, referenced informatics as per Wikipedia guidelines. Donama 01:49, 28 September 2007 (UTC)

30% reduction in article size

In some cases I removed the same sentence that was repeated 10 times!

I know that there are lots of people trying to make a buck on electronic health record systems, but gosh! if you make the article unreadable by everyone jockeying for their little phrasing of the same sentence over and over again, no one reads the article!

Try to keep fact minutiae, if you must include it, in the footnotes. By the way, some footnotes were repeated 4 times as well. Physadvoc 01:45, 16 July 2007 (UTC)

I can no longer find some of the toughest criticisms of problems with EHR:
  1. Several studies in peer-reviewed journals found that outcomes were worse with EHR, including increased mortality, than in comparison groups.
  1. There is now a loophole in the HIPAA rules which allow hospitals to merge psychotherapy records with general medical records, which removes the special protection given to psychotherapy records. Patricia Galvan, a lawyer, sued a hospital when they disclosed her psychotherapy records, despite specific assurances, to an insurance company which then used their misinterpretation of her therapist's notes to deny her disability.
Why were these deleted? Nbauman 18:32, 9 August 2007 (UTC)

If you don't cite the reference, don't make a blanket statement. I read the Archives of Internal Medicine article, and it said no such thing as was initially claimed. It is now quoted correctly. If you would like to claim something, read the referenced article before "quoting" it.

Also, a single lawyer's lawsuit is not the focus of this Wikipedia article. Lawyers will sue about anything.

I didn't cite a single lawyer's lawsuit, I cited a Wall Street Journal article which interviewed privacy experts on all sides. In lawsuits, hospitals and other defendants often have to disclose information about their policies that they've never before disclosed publicly. Galvan's lawsuit disclosed the fact that despite their assurances to patients that psychotherapy records are confidential, hospitals do disclose psychotherapy records in ways that are not required by law and are harmful to patients. These disclosures are the result of entering records into EHRs. This is an example of how EHRs can sacrifice patient privacy and confidentiality, and harm patients. This danger is important enough to include in a Wikipedia article about EHR. How would you like it if your most private information was entered into a public record if you challenged a disability determination?
I cited the Archives article when I first included it in the article, as I recall. I saw a reference to these problems in last week's NEJM, and I'll get back to this after I read it.
Generally speaking, EHRs have a lot of potential, and work well in places like the VA system, but when people try them out elsewhere, they often don't work and sometimes do more harm than good. Anyone who writes about EHRs should acknowledge their successes and their failures. Nbauman 13:50, 14 August 2007 (UTC)
I just re-read the Archives article, and it says in the Conclusion: "As implemented, EHRs were not associated with better quality ambulatory care."[1] That's the authors' conclusion, and that's what the Wikipedia article should say about that study. Nbauman 13:57, 14 August 2007 (UTC)

EHRs are not EMRs

Basically, an EMR is a hospital database of patient encounter information, usually within a healthcare institution such as a clinic or hospital. This record should not be available to other institutions. —Preceding unsigned comment added by 68.156.185.162 (talk) 08:07 +9:30GMT, 7 April 2008

The EHR is more of a combination of health & medical record information for individuals and can include PHR, EMR, Dental, Chiropractic and public health information. The EHR is the health application that could form the back-bone for a RHIO to which all health institutions would need to connect to, through established interoperability standards. Anthony O. Oloni, MD, MPHi, CPHI Medical Director & Physician Informatics Consultant, PHICON (Public Health Informatics Consultants), Division of Preventive Medicine Associates, Atlanta Clinical Informatics & Information Specialist, Georgia Poison Control Center, Hughes Spalding Children's Hospital Grady Health System, 80 Jesse Hill, Jr. Dr., SE, Box 2822, Acworth GA 30102, Phone: Cell (678) 886 7992; Office (678) 354 6144; Fax (678) 302-6330, Email: Anthony.Oloni@PHICON.org | Company Web: www.PHICON.org —Preceding unsigned comment added by 68.156.185.162 (talk) 08:07 +9:30GMT, 7 April 2008

There must be certain requirements met in order for a system to be considered an Electronic Health Record. NAHIT recently released HIT definitions concerning this very topic, and clearly outlined the differences. An Electronic Medical Record is defined as 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. An Electronic Health Record however, 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. —Preceding unsigned comment added by 206.145.28.20 (talk) 16:31, 30 July 2008 (UTC)
In order for a system to be considered an EHR, it must possess interoperability standards defined at a national level based upon the ability of the record to be utilized across more than one organization. This becomes even clearer as the government slowly works towards rewarding an interoperable system through higher reimbursement for organizations that have an EHR in place. —Preceding unsigned comment added by 206.145.28.20 (talk) 16:31, 30 July 2008 (UTC)

What does the literature say?

Perhaps we should look to the literature to guide this discussion. I'll add the appropriate citations but I wanted to quickly state the electronic health record (EHR) is the standard label at this point in time. Electronic medical record (EMR) can in some instances be the medical/physician specific area of the EHR -but when the EHR is integrated there is a challenge identifying the EMR from the EHR. The personal or even individual health record is yet another subcategory of the EHR. These comments may in fact prove wrong as change is so rapid in this area.

Real problem is there are too many consultants and academics wanting to name things as if we're discovering new stars or new elements. The only problem is we are really frauds as renaming things is not a discovery, it's theft. Let's look at sensible ways to link pages together so the end user is able to find what they are looking for with little to no effort? P.A.P. (talk) 03:06, 2 October 2008 (UTC)

Do we need a section on "Comparison of EHR software solutions"?

I suggest that this section either be deleted or expanded to encompass all available software. Also, it has no bona fide references verifying the data presented. It really adds nothing worthy of Wikipedia unless it is expanded or referenced. In view of the fact that potential references will likely point to commercial sites, it would be appropriate simply to delete it, and focus on improving the general information in the rest of the article, instead of providing a sales guide. Other editors please comment. Ryanjo (talk) 02:31, 24 November 2008 (UTC)


Hello my friend. I think the software area cluters the page. As an educator, I don't see the value of this area on this page. I might suggest creating a seperate page called EHR Software where this endeavor can continue. Perhaps physicians and others may find this information helpful when trying to make purchasing decisions? Regardless, I think the material is not appropriate for the page. PatientSafetyGuru (talk) 19:43, 11 March 2009 (UTC)

Piecemeal versus comprehensive treatment

So much of the material under EHR and EMR covers the same ground, yet does not adequately distinguish between the two. The Obama administration is supporting widespread adoption of "certified EHR", so that is probably how electronic health care records will be referred to, regardless of the differences. It seems to me this topic needs to be addressed in its entirety, with the different record types explained in terms of who will create them, who will use them, and how they will be used. So I think EHR, EMR, PHR, and all the others need to be merged into a single article, but I have no idea how to title it! Wgieric (talk) 20:28, 27 February 2009 (UTC)


Hello. I think we should do much like I am attempting to do with the Patient safety page. Perhaps we can create a master page with a short and concise paragraph about each topic and then link the page? For example, in the Patient safety page, I moved the content about safety and technology to the Health information technology (HIT) page that I created but I left a paragraph on the Patient safety page to direct interested viewers to that area. So, I'd be up to doing the same thing with the EHR and EMR -place a paragraph or two on the HIT page with the appropriate link to the individual pages. Then, we can endeavor to edit and clean the pages of redundant materials. Keep in mind that the overall category is health information technology -according to the literature and the expert organizations. Your thoughts? PatientSafetyGuru (talk) 19:50, 11 March 2009 (UTC)

Virtualization

Several of the EMR software solutions are listed as multi-platform. However, at least Amazing Charts (which I use) only runs natively on Windows XP & Vista. Some users have run it using a Virtual Machine on Macs -- the reliability on Linux is more doubtful. Therefore, I have added the qualifier using virtualization to the listing. Other editors should modify the listings similarly if the EMR is not native but can run by emulator. Ryanjo (talk) 18:40, 7 March 2009 (UTC)

I agree

I agree that EHR and EMR be combined as a medical office assistant student and medical office receptionist I use an EHR and have studied simulations of both EHR and EMR's and they are basically the same thing with a different name. It's a waste to have to articles that should be merged. Angie R. MOA student,RMA


Hello Angie. Although you may feel the two topics are similar in your world, I need to caution you about making assumptions about the rest of healthcare. Yes, I agree from the medical office perspective, this discussion may seem mundane. But in hospitals and nursing homes, these records are EHR that incorporate a specific EMR dedicated for physicians and mid-level providers. My comments are not simply my opinion, but based on the literature. Publications like the International Journal of Healthcare Information Systems and Informatics and the Journal of the American Medical Informatics Association have numerous papers that address the point. PatientSafetyGuru (talk) 19:39, 11 March 2009 (UTC)

Hello Angie and guru. I am a trauma, vascular, and general surgeon that has worked in health informatics for over 20 years. The differences in terms are arbitrary and are mostly insisted upon by coffee-addled advocates, programmers, marketing departments, and bureaucrats who care more about arbitrary terminology than getting a nationwide interoperable electronic records system in place that all providers in the trenches can use and afford. Perspectoff (talk) 16:19, 10 April 2009 (UTC)

Hello. I welcome and appreciate your perspective. As an active academic and appropriately credentialed practitioner in the HIT (Health Information Technology) community, I feel qualified to remain comfortable with my previous comments. In terms of your thoughts, I agree in part and disagree in part. Yes you are correct, the terms have become arbitrary. I disagree for the cause for this situation. From my perspective, the reason for this dilemma results from so-called experts providing their questionable opinions -those clearly lacking support from current research and literature. Unfortunately, it is all too easy for people to speak with authority yet these opinions are empty vessels lacking knowledge. In my view, there is are significant differences between general opinions, expert opinions, and literature/research supported positions. Might I suggest we discuss this issue by using current intellectual knowledge and research to provide supported positions? PatientSafetyGuru (talk) 15:23, 22 April 2009 (UTC)

I just wanted to note that I'm well aware of the COI Policy. It is not my primary intent to promote epSOS by using it as a reference in the Interoperability section - I feel it's a good reference: showing that issues such as this one are also part of any cross-border EMR implementation further drives home the point about the 80:20-rule, and it underlines the importance of the legal sphere in the whole eHealth sector. eHealth isn't a purely technical / technological topic, after all!

My reasons for quoting the project I work with, specifically:

  • it explicitly tackles legal interoperability issues
  • there's publicly available reference material (website texts)
  • it's directly related to the topic (even though patient summaries, EMRs and EHRs obviously aren't exactly the same)
  • the article feels very US-centric at the moment

I hope this puts any worries regarding this reference at ease :-) Epsos (talk) 13:33, 4 May 2009 (UTC)

Article should be structured to assist all users, not to decide a debate

As is clear from the above entries, users of Wikipedia have various understandings of the meaning and relationship between EMR, EHR, and other terms.

That is all we need to know to intelligently structure the article. The myriad users of Wikipedia who do not participate in these talk pages will represent all of the various opinions expressed here or will know nothing of the topic and should be able to access this information by any term that will get them here.

Therefore the suggestion in topic 20, Piecemeal versus comprehensive treatment is hard to argue with:

Perhaps we can create a master page with a short and concise paragraph about each topic and then link the page? For example, in the Patient safety page, I moved the content about safety and technology to the Health information technology (HIT) page that I created but I left a paragraph on the Patient safety page to direct interested viewers to that area. So, I'd be up to doing the same thing with the EHR and EMR -place a paragraph or two on the HIT page with the appropriate link to the individual pages. Then, we can endeavor to edit and clean the pages of redundant materials. Keep in mind that the overall category is health information technology -according to the literature and the expert organizations. Your thoughts? PatientSafetyGuru (talk) 19:50, 11 March 2009 (UTC)

The present intense activity in this area due to the HITECH provisions of the stimulus bill will make this article of great usefulness and importance. EHR and EMR are used as terms of art in the policy-making world, among those who will receive funding, and by technical experts. Users should be able to find this information. Clinicians and others who use the terms more broadly should be able to find that usage here also. Lets get to work implementing PatientSafetyGuru's suggestion and take down the merge tag instead of arguing over what are obviously multiple patterns of usage.

Dan Timmel (talk) 14:15, 5 June 2009 (UTC)

Article trim

I'm trying to trim the article down a bit. There's a lot of WP:Original research in here. I know from my own experience that some of the things I'm cutting out are valid concerns, but I can't cite personal experience. I suggest that if anyone feels strongly about sections I'm cutting out, they be discussed here first, where we can all work on sourcing/phrasing before they go back in the article. --SarekOfVulcan (talk) 14:16, 19 October 2009 (UTC)

Including product endorsements in the article

Several recent edits have been placed in this article, basically consisting of product placements. While these products may be noteworthy, they are being given undue emphasis. The recognized method for mentioning commercial products in an Wikipedia article covering a general topic, such as EHR, is to include a statement covering the general principle or scope of the product type, with a footnote containing the product name and a link (if necessary and useful, not just to a sales site).

For example, this provides little information and a lot of sales hype:

However, a new template-based supplementary EHR system, called “Julius” could bring satisfaction among physicians. It does not require any repetition of data recording, nor more effort from clinicians. The Julius system is composed of three subsystems: (1) the Concept Data Service (CDS) which is the starting point where clinicians can define the variables they want to record; (2) the Template Data Service (TDS) which is the subsystem where individuals are allowed to easily compose the new templates or edit old ones; and (3) the Patient Data Service (PDS) that manages and stores patient data. The Julius system is beneficial and compatible for EHR. In addition, it has received positive feedback from clinicians so far, since it provides the opportunity for health care professionals to adjust the system according to their specific needs. [22]

Could be rewritten as a more informative, less pandering:

Newer EHR systems are being introduced to simplify data recording. <reference here>

I plan to wait a few days for those contributers work on these edits to make them more impartial and suitable for Wikipedia, before doing the edits myself. Comments anyone? Ryanjo 00:57, 20 June 2007 (UTC)

I "commented out" the product endorsement, and preserved the reference> Ryanjo 11:42, 14 July 2007 (UTC)
The Links at the bottom recommend that additional links be put on the "Comments" page, so I'm adding it here, since I couldn't find a "links" section within this page. I also feel that OpenELIS is a "product" even though it's not for sale per se. That said, any discussion of EHR necessarily involves a "product" even if someone wishes to abstract the concept (thought the article doesn't), so I'm not sure what difference that makes. I discovered an open-source initiative like OpenEHR (which is on the page) that's currently in use in Missouri and Haiti and may be selected for use for EHR in some African nations in the near future. —Preceding unsigned comment added by 99.234.81.140 (talk) 14:23, 25 February 2010 (UTC)
http://openelis.uhl.uiowa.edu —Preceding unsigned comment added by 99.234.81.140 (talk) 14:23, 25 February 2010 (UTC)
openEHR is a framework not a product and the intellectual property is held by a non-profit organisation of the same name, so isn't a "product endorsement" or even commercial. Though commercial product implementations of openEHR do exist by their own names these are not mentioned or endorsed on Wikipedia to the best of my knowledge. Donama (talk) 23:55, 25 February 2010 (UTC)

End-of-life directives

The article seems to make no mention of living wills, health care proxies, etc. Electronic health record systems must make active provisions for making such end-of-life directive information available -- and DNR orders etc prominent! -69.87.200.188 20:54, 26 July 2007 (UTC)

Good point! I added it in as a type of information contained in medical records... 


   End of Life directives can be known by different names, such as Advance Directive for Healthcare,

Power of Attorney for Healthcare, Living Will. I worked for 28 years in field of Health Information Technology. When the records became computerized at the hospital I worked at, the Advance directives were also. However while often part of a patient's care or part of a legal case, they aren't technically part of either a EHR or a EMR ,which to me are essentially the same thing, excepting that the EHR may be outpatient visits only, at an Outpatient clinic or Physicians Office.Meb0987 (talk) 01:23, 27 February 2010 (UTC) Meb0987

New section

As a general rule, I always take the position that if two terms exist to describe a seemingly identical subject, there must be a distinction, even if subtle. In the case of EHR vs. EMR, the distinction is hardly subtle.

As Pgillogley accurately describes below, an EHR is a term that generally describes the concept of a patient's longitudinal health history across all categories - radiology, pathology, meds, lab results, etc.

Conversely, an EMR describes the information technology package - software - a healthcare provider uses to access, contribute to, or otherwise manage their patients' health information on a daily basis.

The best analogy I can think of is this Wiki: the cumulative content on this subject is the equivalent of an EHR, whereas the collaborative Wikipedia input platform constitutes the EMR - the electronic vehicle for contributing the content.

Another important distinction is that between the EMR and a HIS - Healthcare Information System. A HIS will typically feature an EMR module, but also goes into every aspect of hospital management, including Finance, Human Resources, Ancillary Services, etc.

Based on this, we should recognize that enough evidence exists to maintain a clear distinction between the concept of an EHR and that of an EMR. They go hand in hand, but are definitely not the same.

fsaintclair, March 4, 2010. —Preceding unsigned comment added by Fsaintclair (talk • contribs) 20:31, 4 March 2010 (UTC)


Will the EHR or the EMR actually improve a patient's care or Health??

I have over 28 years total experience in the field of health information technology (Medical Records). I have a fairly large medical background. My answer to this 2 part question is 1. Possibly and 2.--No. The largest flaw with the United States' attempt to totally computerize their medical records is A--they are putting the "Cart before the Horse" meaning in having the dictations and test results in the computer system of the hospital realistically indicates that only a physcian, nurses, or PA, would actually be able to use these reports properly without possibly doing more harm than good to the Patient.

The majority of the personnel in today's Medical Records departments in the USA don't have either background or even possibly the Aptitude to fax or otherwise use these computerized reports. I have seen the disasterous results of this endeavor.

The computerized medical record is actually the person's stay or visit to the Hospital either Inpatient or Outpatient. Placing these reports in a user friendly format will be a great aid to doctors and hospital personnel.

Maryeb12345 (talk) 19:07, 11 October 2009 (UTC)Mary E.Bender

Dear Maryeb12345, thank you for contacting me. I have restored the above section [2] that was deleted on 15:05, 19 October 2009, by User:SarekOfVulcan with the following explanation "discussing subject, not article". I assume you wrote this comment in good faith, to stimulate a discussion about the article. Although general discussion on the topic are very useful and often help to think about writing issues, please try to relate this to specific aspects of the article. Many thanks for your thoughts and input. Yours, Mootros (talk) 10:13, 22 October 2009 (UTC)

Can anybody point to research undertaken that investigated whether Electronic health records improve patient's care or health? Thanks Mootros (talk) 10:51, 22 October 2009 (UTC)

Key references here would include...
Greenhalgh T, Stramer K, Bratan T, Byrne E, Russell J, Potts HWW (2010). Adoption and non-adoption of a shared electronic summary care record in England: A mixed-method case study. BMJ, 340, c3111 (press coverage includes Rose D (2010). 'Flawed' database could put lives at risk, doctors warn. The Times, 17 Jun 2010, p. 11; http://www.telegraph.co.uk/health/healthnews/7833021/Millions-have-online-medical-records-without-knowing-it.html ; http://news.bbc.co.uk/1/hi/health/10333432.stm ; http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4126314&c=2 )
Greenhalgh T, Potts HWW, Wong G, Bark P, Swinglehurst D (2009). Tensions and paradoxes in electronic patient record research: A systematic literature review using the meta-narrative method. Milbank Quarterly, 87(4), 729-88 (press coverage includes http://www.computerweekly.com/Articles/2009/12/16/239735/paper-better-than-computers-for-patient-records-say-ucl.htm )
... but I have a COI here, having been involved in this work. I've added both of these to the article. Bondegezou (talk) 21:22, 21 June 2010 (UTC)
Thanks for adding these links here. Very useful! Mootros (talk) 04:19, 22 June 2010 (UTC)
"Best Care Anywhere" by Phillip Longman would be another reference to think about. He attributes significant improvements in the quality of healthcare at the VA to improvements or particular features of the VA's EHR system. (WBTtheFROG (talk) 23:34, 27 March 2011 (UTC))
EHRs done well probably help; if poorly thought out and not well built, they probably cause harm. WBTtheFROG (talk) 23:34, 27 March 2011 (UTC)
Just wondering why Wikipedia should even mention the opinions of people in this regard? Whether or not EHRs improve patient care/health is an aside to the main topic - EHRs, which should just remain an objective description of what EHRs are. Donama (talk) 04:56, 22 June 2010 (UTC)
Further to this discussion, I don't see how the Maryeb12345's comment at the top of this section is at all, even slightly, relevant to this article. The USA case, with dictated information being so common, is a really poor situation in which to imagine the improvement person-centered EHRs might be able to bring to healthcare outcomes. Donama (talk) 04:59, 22 June 2010 (UTC)
I respectfully disagree with Donama on this particular point. The effect EHRs have, whether they improve care or not, is central to what EHRs are. We could do with more in the article on technical aspects of EHRs, but to describe the technology without consideration of its effects seems to me to miss the point. Also, in the article's discussion of the EHR's pros and cons, we're not generally dealing with "the opinions of people in this regard". We're dealing with research studies. Bondegezou (talk) 14:19, 22 June 2010 (UTC)
Okay I take your point, so long as it is a broad enough discussion to cover more than just the USA case. Sorry I sounded somewhat aggressive. Donama (talk) 01:37, 23 June 2010 (UTC)
The article does have a strong US perspective. Splitting that off to a separate article (like there's an article for the Summary Care Record, the UK national scheme) could be one approach. (No aggression presumed!) Bondegezou (talk) 08:11, 23 June 2010 (UTC)

EHR - definition and history

I agree that there is a significant distinction between EHR and EMR. Part of the problem in getting quality articles for these two subjects is that the definitions are still emerging, especially the EHR because it's implementation is still largely theoretical.

The other difficulty is that both are highly controversial, involving huge financial and political interests. Therefore, it is hard to obtain editorial input that most reviewers view as "neutral". Even defining them in one way or another intrinsically implies endorsement of design concepts which can drive regulatory requirements, favoring one technology interest over another in a very competitive and lucrative market.

But since this controversy is itself a huge part of the story, I'd suggest that the only way to arrive at "neutrality" is to invite as much balanced advantage vs. disadvantage input on various aspects of the EMR and EHR evolution and adoption as possible.

Most government regulators, insurance companies and large institutions (AMA, AAFP, etc.) routinely endorse EMR's and EHR's, citing advantages and downplaying costs, barriers to implementation, or current shortages in interoperability, portability or ease of use. There are precious few research papers at this point to solidly confirm statistically significant advantages at the point of care. Advantages are already realized at the institutional level because portability and accumulation of data benefit both efficient claims processing and research requirements in ways that are unimaginable with paper records. This is why it is so easy to find endorsements without citation of research.

EMR vendors obviously believe in their products and stand to gain by any promotion of EMR adoption. This is logical and doesn't suggest any improper motive, though it does explain their one sided point of view.

Actual users of EMR and EHR technology give strong positive or negative input based mainly on their own (valid yet still) anectodal experience. Even so-called research of user communities poll the users opinions of whether or not they think they've saved money or improved efficiencies. None of these that I have seen quote financially verifiable figures in accordance with accepted research findings. They are opinion polls which provide some value, no doubt, but not numbers.

As a point of disclosure, I am a consultant to this industry and believe EMR and EHR adoption is an irresistable force which will yield many benefits in the long run. But I also work daily at the point of the spear, where all the theoretical benefits of this emerging technology run smack into the real world problems of implementing this technology with all it's current shortcomings amongst a user base that is both frustrated and resistant to change. Many people are interested in this subject and would benefit greatly by a substantial and well written article in a neutral venue such as this.Pjcmba (talk) 22:15, 15 October 2010 (UTC)

All correct Pjcmba, but in the 5 years I've watched the EMR and EHR articles I'm yet to see any major improvement of them towards being neutral and reliable. You're right -- it's about the lack of definition of what they even are. A big one I see is the lack of definition between standardised/interoperable (and therefore computable/queryable) EHRs and just basic digitisation of narrative data. It's bigger than the gap between basic digitisation and paper records, but for the layperson that is hard to see. One other thing, please please please don't say EHR's. Say EHRs. There's absolutely no reason for the apostrophe! Cheers Donama (talk) 03:35, 16 October 2010 (UTC)

Privacy concerns

The section about privacy names numbers on how many people have access to a medical record. It does not state where? US average? Los Angeles? It certainly is not true for all medical records, regardless of the country. —Preceding unsigned comment added by 82.182.96.92 (talk) 16:32, 28 March 2011 (UTC)

Dear Editor, I would like you to consider adding the following link to the EHR article: http://www.amazon.com/Electronic-Health-Record-Analysis-Medications/dp/1439878528/ref=tmm_hrd_title_0 The book introduces the clinicians to the methodology of systems analysis and the IT professionals to the nuances of the medications domain. It is a bridge between these two highly educated groups of professionals that raely speak the same language. Many thanks A. Scarlat MD — Preceding unsigned comment added by Drscarlat (talk • contribs) 01:06, 3 March 2013 (UTC)

Dear Editor, I am requesting to add a link to your references [3] to your References for Electronic health record article. Chartlogic is an EHR/EMR company that addresses the needs of physicians and their practices. Thank you kindly for your consideration. Shari (Emrsolution (talk) 18:55, 19 October 2011 (UTC))

We cite references when we use them as reliable sources in an article. Company websites aren't generally used for this purpose. Maybe you want it to be in the external links section, but I doubt it would pass the test. Thanks. Jesanj (talk) 19:17, 19 October 2011 (UTC)

New additions from new research and reports, mostly since 2008

I will be adding recent, verifiable references from sources of the highest reputation that I use in my teaching on EHRs (e.g., the US National Academies of Science, the U.S. National Institute of Standards, the Journal of the American Medical Association, the U.K.'s NHS, etc.) along with a short summary of their findings on EHR issues, and page numbers where applicable. If these entries are found to violate any Wikipedia rules, please advise. Thank you. S. Silverstein MD, Drexel University, Institute for Healthcare Informatics, Philadelphia. InformaticsMD (talk) 06:06, 29 January 2012 (UTC)

Thank you for your contributions Mikael Häggström (talk) 10:08, 3 August 2013 (UTC)

Dated references

There are a number of references that are more than 5 years old. Since the mid-2000s, the EHR industry has made significant strides in technology. Referencing information older than 2-3 years makes the article's information suspect. — Preceding unsigned comment added by 75.151.253.162 (talk) 17:41, 6 May 2014 (UTC)

I think this entry requires wholesale deletions of everything that does not have a citation to a WP:RS (and preferably to a WP:MEDRS), and everything that was written before the current generation of EMRs were adopted, predicting what they should be like. Does anybody object? --Nbauman (talk) 11:07, 9 September 2014 (UTC)
We do need to use reliable sources, and to bring the article up-to-date. However, let us not be careful not to lose any material that is part of the history of the development of EHRs, particularly as this has been quite different in different countries. Bondegezou (talk) 11:14, 9 September 2014 (UTC)

United States subsection dominating National contexts

United States subsection is longer than all other subsections of National contexts combined. Almost a year ago (July 2013), Beland suggested moving portions of it to the Health Information Technology for Economic and Clinical Health Act (HITECH) article. I didn't find any related discussion in the archive for this talk page, and in the meantime, the subsection has continued to grow.

I agree that parts/most of the subsection should be moved to another article, but I question whether Beland's suggestion is the best approach. Most the subsection's content is beyond the scope of the HITECH Act article.

One possibility could be to incorporate this content into an article about the federal Meaningful Use EHR incentive program, particularly as Meaningful Use currently redirects to this article.

I'm sure other folks have thoughts on this.—Shelley V. Adams ‹blame
credit› 00:36, 6 June 2014 (UTC)

If I understand correctly, the Affordable Care Act also made some changes. Maybe we should just move the subsection to Electronic health records in the United States and sort things out from there? -- Beland (talk) 01:27, 6 June 2014 (UTC)
Given that the main issues now are legal and cultural, not technical, would it make sense to separate out the national sections into separate articles?Rathfelder (talk) 14:22, 18 December 2014 (UTC)
Agreed. It's a big article: some spin-offs for particular countries makes sense. Bondegezou (talk) 21:04, 19 December 2014 (UTC)

ACP statement

doi:10.7326/M14-2128 - clinical documentation on EMRs. Position paper. JFW | T@lk 15:08, 13 January 2015 (UTC)

This paper distinguishes health records and electronic health records. There is a Wikipedia article called Medical record and then this one called "electronic health record". I am trying to come to terms with what articles exist on this topic and created Category:Electronic health records to sort the articles and try to connect related topics. Blue Rasberry (talk) 19:58, 31 January 2015 (UTC)

re: my previous edit

There is also already a section on Australia: Electronic_health_record#Australia --12.180.133.18 (talk) 22:00, 8 August 2015 (UTC)

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Implementation section

This article reads as if written by an industry PR specialist. Far too much of it discusses unsubstantiated claims made before the adoption of EHR, as if these were absolute facts. A much higher degree of editing is needed, together with citations to articles that actually contain proof or support for statements made. The content is supposed to be neutral but it is currently far off of that:

"EHR do help improve care coordination. Since anyone with that EHR can view the patients chart it cuts down on guessing histories, seeing multiple specialists, smoothing transitions between care settings, and better care in emergency situations." [sic]

The above section, for instance, simply repeats the claims made in an HIMSS article, then uses the article itself as a citation for its veracity. This is entirely circular. As a medical article (according to Wiki), every statement needs a citation. Part of the problem with the adoption of EMR's is that unproven claims by vendors have been accepted as true without sufficient analysis, leading to the installation of expensive but poorly-performing platforms, with predictable results. Wiki should not perpetuate this error by permitting uncited statements. As I have an interest in this area, I am going to start editing the content in a more scientific manner than it is currently found. — Preceding unsigned comment added by Mgrossmdjd (talk • contribs) 19:46, 24 June 2015‎

Mgrossmdjd Thanks for your interest in this space. I care about this topic too but editing this article is difficult for me and many others. Even outlining the topic is not easy. Whatever you can do would be appreciated. If you could identify the sources of information which ought to be read and cited to develop this then that might be a good start.
Note that Healthcare Information and Management Systems Society is a United States organization and this article is supposed to have international coverage. Already the article is too focused on United States practice rather than the general concept, and I would like to decouple the US notions of EHRs from this article as much as possible. I am glad that you are commenting here. Blue Rasberry (talk) 20:09, 24 June 2015 (UTC)

Agree with User:Mgrossmdjd. If I had to improve this article, I'd blank the whole thing and start all over again, first using the peer-reviewed journals like NEJM and JAMA as sources, rather than press releases and trade press articles. I'd like to get rid of articles that are too old, like "predictions" from 2005 (and 1997). This article seems to have a lot of WP:OR, and references to government documents as primary sources. The "stakeholders" adapted to electronic billing records very well, but clinical records are much more difficult, and many doctors don't like them, especially in their current implementation. I think this article should reflect that controversy. (Not the "tension.") I think it's a massive job to explain EMRs in the US alone, and if you try to make the entry international, you're increasing the difficulty by an order of magnitude. Most of the literature I've seen on EMRs is about the US (and I can't recall anything in the BMJ or Lancet). There are important international contributions to EMRs, like the way the Scandanavian and Taiwanese systems use their EMRs for epidemiological studies, and I'd like to know about the nuts and bolts of their computer systems, but I also want to have an overview that someone can read in one sitting. Of course, if EMR salesmen and fanboys turn this article into their marketing literature, it will be impossible to have a good entry. And it's hard to understand how we could write an article about EHRs in the US without mentioning Epic.

BTW, if you want a good place to start, I'd recommend the following (free) article, and then the book she's reviewing, Robert Wachter's The Digital Doctor:

http://www.nejm.org/doi/full/10.1056/NEJMp1509961
Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine
L. Rosenbaum
N Engl J Med 2015;373:1585-1588
October 22, 2015
--Nbauman (talk) 17:06, 22 October 2015 (UTC)

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EMR/EHR nomenclature

The evolving use of EHR and EMR needs to be addressed. It is my opinion that the terms EHR and EMR are being differentiated in the literature and that the section would be more up to date if EHR was used only for longitudinal records while EMR restricted to more encounter-centric records, such as in American hospitals and clinics. (I am familiar with the NHS issues of implementation, but couldn't comment on international issues.) This would require editing the entire article for the use of these terms, but is necessary for clarity. I'd appreciate input here.

The introduction needs to be re-written. It's not really a brief overview. The "Ambulance" section from Australia is interesting but totally out of place. There isn't really any history of the initial development of EMR's, which is how I came to the article in the first place, for research into it.Mgrossmdjd (talk) 03:40, 25 June 2015 (UTC)

Speaking just to the EMR/EHR thing from the U.S., I think scholars try to retroactively apply a distinction that doesn't exist. The closest consensus I've seen (entirely anecdotal) is that EMR is an older term and gradually industry leaders adjusted the name in parallel with modern thinking on health care - it's about health not just medicine. Alaynestone (talk) 01:16, 16 August 2015 (UTC)

Per https://www.healthit.gov/providers-professionals/faqs/what-are-differences-between-electronic-medical-records-electronic, the US government makes a distinction between EMR as a digital version of a paper chart in a clinic and EHR as coming from all clinicians involved in a patient's care. I think this page should use this language.50.206.34.10 (talk) 14:52, 29 July 2016 (UTC)

I am not sure. Whatever information is added to this page should be true to the original source from which it is taken. If a report does not make this distinction, then Wikipedia should not force that distinction on the information from the report. Right now I do not think this article distinguishes the sort of information which used to be kept online on paper from information which is digital. It would be fascinating to have a Wikipedia article that covered something like History of the digitization of health records and which explained what new kinds of information started being collected over the change from paper to digital. Of course Wikipedia has to start with sources. The source above is interesting but I am not even sure that the US government itself follows this rule. Outside of the US I am not sure what style guides are available. I think the US is behind other countries in managing these records, even if there is a big market for this in the US. Blue Rasberry (talk) 15:44, 29 July 2016 (UTC)
There is a formal EMR/EHR distinction as defined above, but its use is very inconsistent. The article should reflect that, using EMR/EHR as appropriate, but saying something like, "A distinction is sometimes made..." when explaining the difference. There's also "EPR" of course! Bondegezou (talk) 08:17, 30 July 2016 (UTC)

Needs a History section

There is very little in the article describing the rise of electronic health records. Some kind of timeline would be helpful.Pleasantville (talk) 20:08, 21 November 2016 (UTC)

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Patient Access

The current entry on Patient Access appears to be self-advertising. It reads "It has been possible for patients to access their own GP records online for some time, and Dr Amir Hannan pioneered this using EMIS software. He says "there are some doctors and nurses who have genuine concerns about patients suddenly being let loose to access their records without any controls in place or without clinicians having to do anything and a feeling of irresponsibility that that raises."[179]"

Three reasons for my argument:

As a result, I am going to remove this paragraph and replaced it with a reference to the systematic review. Perhaps someone else can follow up with more details. Kmasters0 (talk) 07:06, 5 February 2017 (UTC)

Hannan, who I've met professionally a couple of times, is broadly considered an important figure in the field and his work is pioneering in application. However, systematic reviews are generally better citations than blogs, so happy with that. Bondegezou (talk) 12:57, 5 February 2017 (UTC)

Outdated picture

The picture in the lede (File:Electronic_medical_record.jpg) needs to be updated with a newer sample image if we can find one. Looks like that image is from 2009ish, and EMRs have changed a lot since then. Per WP:SCREENSHOT, screenshots should "portray the software in its most common form", which is definitely not an almost decade-old screenshot. cymru.lass (talk • contribs) 15:11, 14 May 2017 (UTC)

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