The Consumer’s Guide to Electronic Health Records

electronic health records featureEMR, EHR, and PHR?

Now that the healthcare industry has finally moved into the electronic (digital) age for medical recordkeeping, a whole new vocabulary defining different types of health records has emerged. To manage your health records, you need to know the basic differences between three types of electronic health records; namely,

  1. Electronic Health Records (EHRs)
  2. Electronic Medical Records (EMRs)
  3. Personal Health Records (PHRs)

Your health records, contained within Electronic Health Records (EHRs) and Electronic Medical Records (EMRs), are created and controlled by the healthcare businesses (hospitals and healthcare providers) who maintain them. Patients have access to Electronic Health Records (EHRs) but not to Electronic Medical Records (EMRs). Software systems for these types of health records are designed and sold with the healthcare professional in mind. The Personal Health Record (PHR), on the other hand, is controlled by the patient. Technically, the PHR can also be in a non-electronic format (paper files), but for this blog post, I will concentrate only on electronic PHRs.  Software systems are available (many free) to organize and manage Personal Health Records (PHRs) online or on individual home electronic media (like personal computers and various portable devices).

types of electronic health recordsElectronic Health Records (EHRs)

The primary goal of Electronic Health Records (EHRs) rests on sharing and easy communication of patient health records for the coordination of care (this is called interoperability). When I first saw the words “patient-centered” Electron Health Record (EHR) I thought that it was simply a different name for the Personal Health Record (PHR). I learned later that to owners of healthcare businesses, the term “patient-centered” simply means that the information within the EHR is organized by individual patients so that they (and other healthcare providers) have access to one patient’s specific health records and no one else’s.

Electronic Health Records (EHRs) must contain content defined by the “Medicare and Medicaid EHR Incentive Programs” (HITECH Act of 2009). If your healthcare provider or hospital participated in this program, then you should have access to its EHR.  Healthcare providers and hospitals often refer to the EHRs they maintain as “patient portals”.  The software systems that house them must be certified by the federal government. Your health records, above and beyond that demanded by the federal government for Electronic Health Record (EHR), do not usually get placed into your EHR.  If you want access to these “hidden” files, you must request for copies directly from your healthcare provider.

There are over 750 certified software vendors (as of March 2015) selling proprietary software packages. The software programs that organize these records into electronic (digital) format are designed using “Medicare and Medicaid EHR Incentive Programs” criteria.  Patients gain access by asking their healthcare provider for an email invitation to sign into the healthcare provider’s EHR website.  For coordination of care, the patient grants permission to all healthcare providers who need to view the content of your EHR. This coordination of care is aimed at reducing over-treatment and over-testing.

Although all Electronic Health Records (EHRs) do not look exactly alike (given they are housed in many proprietary software systems), they all do follow a basic structure that includes:

  • Message center–to electronically ask the doctor questions, request prescription refills
  • Appointment center—to see upcoming and past appts, request or cancel appt
  • Medical records—including patient demographics, list of medications, list of allergies, immunizations and preventive care, medical histories, vital signs, current health issues, diagnoses, progress notes, health summaries, lab and test results , radiology images, hospital admissions
  • Billing and Insurance information

While I do not favor inclusion of personal billing and insurance information in my Electronic Health Record (EHR), it does provide an alternate way of paying one’s healthcare bills. From a security standpoint, it is this billing and insurance information that hackers are eager to get for financial exploitation. We must rely on many individual healthcare providers (who maintain the EHRs) to pay for adequate website security measures.

 Electronic Medical Records (EMRs)

While the Electronic Health Record (EHR) is designed for sharing with patients and other healthcare professionals for coordination of care, the Electronic Medical Records (EMRs) are not designed for sharing with people outside the healthcare business.  Because payers (government and insurance companies) often demand documentation for reimbursement purposes, the health records on the EMR is routinely accessed and shared  with payers.  Electronic Medical Records (EMRs) have been around longer than Electronic Health Records (which only came into existence with the HITECH Act of 2009).

Electronic Medical Records (EMRs) are designed to improve the efficiency of a healthcare business and not to benefit the patient. Healthcare businesses that use EMRs usually populate them with ALL your health records including “raw” digital (electronic) outputs from medical equipment (images, xrays, CT scans, test results, etc.). The EMR also contains any other information demanded by the federal government and insurance companies for reimbursement purposes including patient progress records used to receive bonus payments linked to improved health outcomes.

Unlike Electronic Health Records (EHRs), the content of Electronic Medical Records (EMRs) is not regulated by the government. Software for Electronic Medical Records (EMRs) does not have to be certified. Medical businesses with EMRs before 2009 were probably better equipped (and trained) for Electronic Health Record (EHR) adoption than those who only kept health records in “paper” format. Hospitals and HMOs have had sophisticated EMR systems for internal use for many years.

Personal Health Records (PHRs)

Personal Health Records (PHRs)  are different from both the EHRs and EMRs described above because they are not controlled nor maintained by healthcare businesses. The information in the Personal Health Record (PHR) is collected, organized, and maintained by individual patients either as organized paper files, as electronic files on your personal electronic devices, or as electronic files using any number of web-based services.  The web-based services are available for free or for a small subscription fee and are offered through health insurance plans, health care providers, employers,and independent vendors (standalone).  It is always important to keep in mind that privacy of records is not always assured when records are accessible by anyone other than you and you alone (e.g., third party web-based services).

The information that ends up in the Personal Health Record (PHR) comes from individual Electronic Health Records (EHRs), scanned documents of paper health records, and from any consumer-generated pertinent information you choose to include (like weight measurements, blood pressure readings, OTC drugs taken, and electronic device outputs).

The descriptions of EHRs, EMRs, and PHRs above have been tabulated below for quick reference:

 Electronic Medical RecordElectronic Health RecordPersonal Health Record
DefinitionElectronic recordkeeping that is used exclusively within a given healthcare businessElectronic health records whose content adheres to HITECH Act of 2009 requirementsPatient's private collection of all medically pertinent information (includes info from all EHRs, scanned documents, and patient-generated data)
Where found and who controls?Housed and controlled within individual medical businesses for personal use by ownersAccessed on the Internet; housed with (and controlled by) individual healthcare businessesAccessed on the Internet or on personal electronic devices; controlled by the individual patient
intentTo organize and improve efficiency and practices within a given healthcare business and for sharing with payers for reimbursement purposes.For sharing with patients and other healthcare businesses for coordination of careTo be the COMPLETE PERSON health record for “patient engagement” and health management
HiTECH Act of 2009NO HiTECH Act connectionCreated (and funded) through the Medicare and Medicaid EHR Incentive Programs from the HITECH ActNO HiTECH Act connection

Summarizing Health Records from the Consumer’s Viewpoint

Understanding the differences between individual health record types is really about understanding the “business of health records”; namely, who has control of what records and who is allowed to see what records.

The healthcare businesses that generate the health records have primary control of your health records. For reimbursement purposes, they release your health records to insurance company and government payers as needed for reimbursement using FAXed copies of paper health records or electronic copies from Electronic Medical Records (EMRs). The content within the Electronic Health Record (EHR) represents your health records that “trickle down” to you as required by the “Medicare and Medicaid EHR Incentive Programs” (HITECH Act of 2009). This situation is illustrated in the figure below.

business of electronic health records

From your individual Electronic Health Records (EHRs) (see the figure above), you are free to download content into your Personal Health Record (PHR), which is totally under your control and outside the business of health records. If you don’t make a Personal Health Record (PHR) for yourself (and for any family members who cannot), then they will not exist. It should be noted that even though your healthcare provider has an EHR, you will still have to obtain paper copies of your “hidden” (within EMRs and filing cabinets) health records for a complete Personal Health Record (PHR).

The Bottom Line

Health records are fast going electronic (digital) and different terms are surfacing to differentiate what health records are found where, who controls them, and who is allowed to access them. While physical records (paper and images) still exist from the past, most health records generated today are found in Electronic Medical Records (EMRs) controlled within individual private healthcare businesses across the country. Some of these records (Electronic Medical Records (EMRs) are shared with insurance companies and government for reimbursement and others (Electronic Health Records (EHRs) with individual patients and other healthcare providers for coordination of care .

Unlike the EMR and the EHR, the Personal Health Record (PHR) is created and controlled by the patient. Its content includes information from individual Electronic Health Records (EHRs), scanned documents of paper health records, and from any consumer-generated pertinent information you choose to include (like weight measurements, blood pressure readings, OTC drugs taken, and electronic device outputs). The Personal Health Record (PHR) is the only health record that represents your COMPLETE PERSON health “resume” for healthcare management.

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