The Electronic Health Record (EHR EHR

electronic health record, health records, digital health records, e-MedRecords) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR EHR electronic health record, health records, digital health records, e-MedRecords automates and streamlines the clinician's workflow. The EHR EHR electronic health record, health records, digital health records, e-MedRecords has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting. In this section you will find many resources that contribute to the ability for healthcare organizations to realize a longitudinal electronic record that spans across the continuum of healthcare. Topics of interest include a focus on quality, efficiency, effectiveness and the safety of patient care through a variety of tools and resources in different formats. By providing this information, HIMSS Members and HIMSS Leadership can be focused on collaboratively working together to achieve the goal of EHRs in use in 80 percent of healthcare organizations and 50 percent of physician practices by 2010. An electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) is a medical record in digital format. In health informatics and most contexts, EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health records) are used synonymously, but many people define an EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) as just the physician interface and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health record) including both a physician and patient interface. Together they are also known as e-MedRecord, e-MedRecords and digital medical records. The terms ave sometimes included other systems which keep track of medical information, such as the practice management system which supports the electronic medical record. As of 2006[update], adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States, in spite of studies showing revenue gains after implementation.[3] Fewer than 10% of American hospitals have implemented health information technology,while a mere 16% of primary care physicians use EHRs. The 2009 economic stimulus package (HITECH) aims at incenting more physician to adopt EMR electronic medical records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EMRs" and, eventually, reducing Medicare payments to those who do not use an EMR electronic medical records, digital health records, e-MedRecords. In order to receive the EMR electronic medical records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EMR electronic medical records, digital health records, e-MedRecords system. The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. If all medical payment transactions in the U.S. were handled electronically, America could save $11 billion annually. The healthcare industry spends only 2% of gross revenues on information technology, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%. The following issues are behind the slow rate of adoption: EHR EHR electronic health record Interoperability In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.[11] Interoperability can also refer to legal interoperability, i.e. the regulatory issues of cross-border EMR electronic medical records, digital health records, e-MedRecords implementations. In the United States, the development of standards for EMR electronic medical records, digital health records, e-MedRecords interoperability is at the forefront of the national health care agenda.[4] EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing patient information (lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR EHR electronic health record, health records, digital health records, e-MedRecords systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs. The Certification Commission for Healthcare Information Technology (CCHIT) has developed an open-source program called Laika to test EHR EHR electronic health record, health records, digital health records, e-MedRecords software for compliance with CCHIT interoperability standards. The Center for Information Technology Leadership described four different categories (“levels”) of data structuring at which health care data exchange can take place. [12] While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization. The four levels are: Privacy A major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access.[14] Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws.[15] In the European Union (EU), several Directives of the European Parliament and of the Council protect the processing and free movement of personal data, including for purposes of health care.[16] The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. The growth of EHR EHR electronic health record, health records, digital health records, e-MedRecords creates new issues, since electronic data may be physically much more difficult to secure, as lapses in data security are increasingly being reported.[17] Information security practices have been established for computer networks, but technologies like wireless computer networks offer new challenges as well. A related concern is the potential privacy risk posed by interoperability. One of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he estimates to be 12 million, will inevitable lead to breaches of privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients," they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida, to check if the fellow has a cocaine habit."[18] Older record incorporation To attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR electronic medical records, digital health records, e-MedRecords, older paper medical records ideally should be incorporated into the patient's record. The digital scanning process involved in conversion of these physical records to EMR electronic medical records, digital health records, e-MedRecords is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data.[19] Social and organizational barriers According to the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology, EMR electronic medical records, digital health records, e-MedRecords implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself. Such organizational and social issues include restructuring workflows, dealing with physicians' resistance to change (or, alternatively, software engineers' evolving research in deep modeling of the physician's knowledge and workflow domains), as well as IT personnels' resistance to design and implementation flexibility needed in the complex healthcare environment, and creating a collaborative environment that fosters communication between physicians and information technology project managers. Exemplifying this need are several highly publicized HIT implementation failures, such as one at Cedars Sinai Medical Center in Los Angeles, in which physicians revolted and forced the administration to scrap a $34 million CPOE system [20] as well as others compiled at a collection of cases of health IT difficulties by medical informatics specialists.[21] There are, however, several successful examples of EMR electronic medical records, digital health records, e-MedRecords implementations in large hospitals, usually hospital systems that have had years of experience developing custom EMRs, for example the Veterans Administration hospital system, Kaiser Permanente's HealthConnect and the VistA EMR electronic medical records, digital health records, e-MedRecords. Technology limitations Limitations in software, hardware and networking technologies has made EMR electronic medical records, digital health records, e-MedRecords difficult to affordably implement in small, budget conscious, multiple location healthcare organizations. Until recently most EMR electronic medical records, digital health records, e-MedRecords systems were developed using older programming languages such as Visual Basic; however with many systems now being developed using Microsoft .NET Framework and Java technology EMRs can be securely implemented across multiple locations with greater performance and interoperability.[22] Prior to the recent introduction of IEEE 802.11g/n wireless technology, access to large files such as MRI and X-Ray images was slow. With these new wireless technologies data can be securely transferred at speeds of up to 108 Mbit/s, across extended distances and in older buildings built with brick or concrete walls. In the ASP model, where the EMR electronic medical records, digital health records, e-MedRecords data is stored at an off-site data center, the bandwidth limitation of the last mile Internet access still remains as the bottleneck and as a technological limitation for large scanned file transfers. Tablet PC technology has significantly improved over the recent years, Li-Ion/polymer batteries for battery life of up to 8 hours, biometric security, low-voltage processors and lighter weight solutions. For the new generation of Tablet PC, there are now EMRs that are fully handwriting capable[23] Preservation Under data protection legislation and the law generally responsibility for patient records (irrespective of the form they are kept in) is always on the creator and custodian of the record, usually a health care practice or facility. The physical medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound, etc. The patient, however, according to HIPAA, owns the information contained within the record and has a right to view the originals, and to obtain copies under law.[24] Additionally, those responsible for the management of the EMR electronic medical records, digital health records, e-MedRecords are responsible to see the hardware, software and media used to manage the information remain usable and not degraded. This requires backup of the data and protection being provided to copies. It will also require the planned periodic migration of information to address concerns of media degradation from use.[25] Legal status Medical records, such as physician orders, exam and test reports are legal documents, which must be kept in unaltered form and authenticated by the creator. * Digital signatures Most national and international standards accept electronic signatures.[26] According to the American Bar Association, "A signature authenticates a writing by identifying the signer with the signed document. When the signer makes a mark in a distinctive manner, the writing becomes attributable to the signer."[27] With proper security software, electronic authentication is more difficult to falsify than the handwritten doctor's signature. However, as the recent rise in identity theft demonstrates, no security method can totally prevent fraud, so auditing information security will continue to be prudent when using EMR electronic medical records, digital health records, e-MedRecords. * Digital records such as EHR EHR electronic health record, health records, digital health records, e-MedRecords create difficulties ensuring that the content, context and structure are preserved when the records do not have a physical existence. As of 2006[update], national and state archives authorities are still developing open, non-proprietary technical standards for electronic records management (ERM).[28] standards Though there are few standards for modern day EMR electronic medical records, digital health records, e-MedRecords systems as a whole, there are many standards relating to specific aspects of EHRs and EMRs. These include: * ASTM International Continuity of Care Record - a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords systems, allowing easy interoperability between otherwise disparate enities.[29] * ANSI X12 (EDI) - A set of transaction protocols used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information, because several of the transactions became required by the Health Insurance Portability and Accountability Act (HIPAA) for transmitting data to Medicare. * CEN - CONTSYS (EN 13940), a system of concepts to support continuity of care. * CEN - EHRcom (EN 13606), the European standard for the communication of information from EHR EHR electronic health record, health records, digital health records, e-MedRecords systems. * CEN - HISA (EN 12967), a services standard for inter-system communication in a clinical information environment. * DICOM - a heavily used standard for representing and communicating radiology images and reporting * HL7 - HL7 messages are used for interchange between hospital and physician record systems and between EMR electronic medical records, digital health records, e-MedRecords systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material. * ISO - ISO TC 215 has defined the EHR EHR electronic health record, health records, digital health records, e-MedRecords, and also produced a technical specification ISO 18308 describing the requirements for EHR EHR electronic health record, health records, digital health records, e-MedRecords Architectures. * openEHR - next generation public specifications and implementations for EHR EHR electronic health record, health records, digital health records, e-MedRecords systems and communication, based on a complete separation of software and clinical models. Various factors involving the timing, the right players, market history, utility, and governance play a key role in the overall enrichment of the standard and certification development. The standardization and certification even though seem to bring uniformity in the EMR electronic medical records, digital health records, e-MedRecords development, do not guarantee their acceptability and sustainability in the long run. [30] In 2005 the US Federal Government awarded a contract to CCHIT - Certification Commission for Healthcare Information Technology to develop certification criteria for EMR electronic medical records, digital health records, e-MedRecords. Starting in early 2007 vendors began to utilize these certification criteria for their EMR electronic medical records, digital health records, e-MedRecords systems. Customization Pricing for EMR electronic medical records, digital health records, e-MedRecords systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is due to the majority of EMR electronic medical records, digital health records, e-MedRecords systems being based on templates that are initially general in scope. In many cases, these templates can then be customized in co-operation with the vendor/developer to better fit data entry based on a medical specialty, environment or other specified needs. There are also EMR electronic medical records, digital health records, e-MedRecords systems available that do not use templates for data entry and therefore can be easily personalized by each individual user. Alternative data entry methods include concept processing, voice recognition, and transcription. As of 2005, one of the largest projects for a national EMR electronic medical records, digital health records, e-MedRecords is by the National Health Service (NHS) in the United Kingdom. The goal of the NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010. The Canadian province of Alberta's Alberta Netcare project is a large-scale operational Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) system.[citation needed] US medical groups' adoption of EHR EHR electronic health record, health records, digital health records, e-MedRecords (2005) Adoption of electronic medical records by US doctors is increasing slowly. The latest data from the National Ambulatory Medical Care Survey (NAMCS) indicate that one-quarter of office-based physicians report using fully or partially electronic medical record systems (EMR electronic medical records, digital health records, e-MedRecords) in 2005, a 31% increase from the 18.2 percent reported in the 2001 survey.[31] However, the survey also states that just 9.3% of these physicians actually have a "complete EMR electronic medical records, digital health records, e-MedRecords system", with all four basic functions deemed minimally necessary for a full EMR electronic medical records, digital health records, e-MedRecords: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.[32] Barriers to adopting an EMR electronic medical records, digital health records, e-MedRecords system include training, costs and complexity, as well as the lack of a national standard for interoperability among competing software options.[33] Advocates of electronic health records hope that product certification will provide US physicians and hospitals with the assurance they need to justify significant investments in new systems. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards and certify vendors who meet them. On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products.[34] and then on July 31 2006, additionally announced that two further EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products had achieved certification.[35] In the United States, the Department of Veterans Affairs (VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders, including medications, special procedures, X-rays, patient care nursing orders, diets, and laboratory tests. The New York City Health and Hospitals Corporation, the largest urban healthcare agency in the United States serving 1.3 million patients, is another example of a significant healthcare organization that has successfully implemented an electronic health records system in the United States. An electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) refers to an individual patient's medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. Among the many forms of data often included in EMRs are patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives. EHR EHR electronic health record, health records, digital health records, e-MedRecords systems can reduce medical errors.[1] In one ambulatory healthcare study, however, there was no difference in 14 measures, improvement in 2 outcome measures, and worse outcome on 1 measure.[2] EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR electronic medical records, digital health records, e-MedRecords systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.[3] Multiple terms have been used to define electronic patient care records, with overlapping definitions.[4] Both electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) and electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) have gained widespread use, with some health informatics users assigning the term EHR EHR electronic health record, health records, digital health records, e-MedRecords to a global concept and EMR electronic medical records, digital health records, e-MedRecords to a discrete localised record. For most users, however, the terms EHR EHR electronic health record, health records, digital health records, e-MedRecords and EMR electronic medical records, digital health records, e-MedRecords are used interchangeably. An EHR EHR electronic health record, health records, digital health records, e-MedRecords system is also often abbreviated as EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords. Information in the section on EMRs electronic medical record may be more relevant to physician offices seeking a less expensive or comprehensive solution. Health Information Technology is an even broader term that describes any computer-based electronic aid to healthcare delivery. An electronic health record is a patient’s health record that has been compiled into a digital format. n his joint address to Congress in 2009, Obama stated that: "Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down cost, ensure privacy, and save lives" [5] The 2009 economic stimulus package (HITECH Act) passed by Obama aims at incenting more physician to adopt EHR EHR electronic health record, health records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EHRs" and, eventually, reducing Medicare payments to those who do not use an EHR EHR electronic health record, health records, digital health records, e-MedRecords. In order to receive the EHR EHR electronic health record, health records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EHR EHR electronic health record, health records, digital health records, e-MedRecords system.[6] EHR EHR electronic health record Categories of information in a patient record A patient record consists of 4 main categories of information. Some information requires digitization. Other forms of information are by nature digital but require an infrastructure designed for secure access through the EHR EHR electronic health record, health records, digital health records, e-MedRecords. EHR EHR electronic health record Textual information Textual information in a patient record include notes and individual reports. EHR EHR electronic health record Data for Calculations Data for calculations or graphing from laboratory reports are included in a patient record. This information is used for searching or decision support. EHR EHR electronic health record Multimedia Multimedia information in a patient record such as diagnostic images are typically located in various departments in a healthcare facility. The large volume and disparate locations of this data make the electronic health record the only viable way for access. EHR EHR electronic health record Paperwork Patient records include signed forms, hand drawn figures, photographs of wounds, and other various forms of paper-based documentation. EHR EHR electronic health record Advantages of electronic medical records There are several benefits to wide scale usage of electronic health records. EHR EHR electronic health record Reduce healthcare costs One of the major sources of rapid growth in healthcare costs comes from medical imaging. Medicare Part B spending on imaging rose from $6.80 billion in 2000 to $14.11 billion in 2006.[7] Access to a patient's images in an EHR EHR electronic health record, health records, digital health records, e-MedRecords is an effective way to avoid duplicating expensive imaging procedures. Other cost savings include the reduction of medical errors that can otherwise lead to further expensive care. EHR EHR electronic health record Improve quality of care An EHR EHR electronic health record, health records, digital health records, e-MedRecords system can help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine enable proliferation of ongoing improvements in healthcare efficacy. EHR EHR electronic health record Promote evidence-based medicine EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. These benefits may be realized in a realistic sense only if the EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are interoperable and wide spread (e.g. national) so that various systems can easily share information. Also, to avoid failures that can cause injury to the patient and violations to privacy, the best practices in software engineering and medial informatics must be deployed.[8] EHRs also have the advantages of electronic medical records (EMR electronic medical records, digital health records, e-MedRecords). In general, medical records may be on "physical" media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure. Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage. When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance. In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR electronic medical records, digital health records, e-MedRecords is offset by the cost of only a few unnecessary tests or admissions.[9][10] Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.[11] Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. In contrast, EMR health care records can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"[12]) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] The Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR EHR electronic health record, health records, digital health records, e-MedRecords automates and streamlines the clinician's workflow. The EHR EHR electronic health record, health records, digital health records, e-MedRecords has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting. In this section you will find many health care records resources that contribute to the ability for healthcare organizations to realize a longitudinal electronic record that spans across the continuum of healthcare. Topics of interest include a focus on quality, efficiency, effectiveness and the safety of patient care through a variety of tools and resources in different formats. By providing this information, HIMSS Members and HIMSS Leadership can be focused on collaboratively working together to achieve the goal of EHRs in use in 80 percent of healthcare organizations and 50 percent of physician practices by 2010. An electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) is a medical record in digital format. In health informatics and most contexts, EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health records) are used synonymously, but many people define an EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) as just the physician interface and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health record) including both a physician and patient interface. Together they are also known as e-MedRecord, e-MedRecords and digital medical records. The terms ave sometimes included other systems which keep track of medical information, such as the practice management system which supports the electronic medical record. As of 2006[update], adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States, in spite of studies showing revenue gains after implementation.[3] Fewer than 10% of American hospitals have implemented health information technology,while a mere 16% of primary care physicians use EHRs. The 2009 economic stimulus package (HITECH) aims health care records at incenting more physician to adopt EMR electronic medical records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EMRs" and, eventually, reducing Medicare payments to those who do not use an EMR electronic medical records, digital health records, e-MedRecords. In order to receive the EMR electronic medical records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EMR electronic medical records, digital health records, e-MedRecords system. The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. If all medical payment transactions in the U.S. were handled electronically, America could save $11 billion annually. The healthcare industry spends only 2% of gross revenues on information technology, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%. The following issues are behind the slow rate of adoption: EHR EHR electronic health record Interoperability In healthcare, interoperability is the ability of health care records different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.[11] Interoperability can also refer to legal interoperability, i.e. the regulatory issues of cross-border EMR electronic medical records, digital health records, e-MedRecords implementations. In the United States, the development of standards for EMR electronic medical records, digital health records, e-MedRecords interoperability is at the forefront of the national health care agenda.[4] EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing patient information (lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR EHR electronic health record, health records, digital health records, e-MedRecords systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs. The Certification Commission for Healthcare Information Technology (CCHIT) has developed an open-source program called Laika to test EHR EHR electronic health record, health records, digital health records, e-MedRecords software for compliance with CCHIT interoperability standards. The Center for Information Technology Leadership described four different health care records categories (“levels”) of data structuring at which health care data exchange can take place. [12] While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization. The four levels are: Privacy A major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access.[14] Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws.[15] In the European Union (EU), several Directives of the European Parliament and of the Council protect the processing and free movement of personal data, including for purposes of health care.[16] The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. The growth of EHR EHR electronic health record, health records, digital health records, e-MedRecords creates new issues, since electronic data may be physically much more difficult to secure, as lapses in data security are increasingly being reported.[17] Information security practices have been established for computer networks, but technologies like wireless computer networks offer new challenges as well. A related concern is the potential privacy risk posed by interoperability. One of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he estimates to be 12 million, will inevitable lead to breaches of privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients," they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida, to check if the fellow has a cocaine habit."[18] Older record incorporation To attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR electronic medical records, digital health records, e-MedRecords, older paper medical records ideally should be incorporated into the patient's record. The digital scanning process involved in conversion of these physical records to EMR electronic medical records, digital health records, e-MedRecords is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data.[19] Social and organizational barriers According to the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology, EMR electronic medical records, digital health records, e-MedRecords implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself. Such organizational and social issues include restructuring workflows, dealing with physicians' resistance to change (or, alternatively, software engineers' evolving research in deep modeling of the physician's knowledge and workflow domains), as well as IT personnels' resistance to design and implementation flexibility needed in the complex healthcare environment, and creating a collaborative environment that fosters communication between physicians and information technology project managers. Exemplifying this need are several highly publicized HIT implementation failures, such as one at Cedars Sinai Medical Center in Los Angeles, in which physicians revolted and forced the administration to scrap a $34 million CPOE system [20] as well as others compiled at a collection of cases of health IT difficulties by medical informatics specialists.[21] There are, however, several successful examples of EMR electronic medical records, digital health records, e-MedRecords implementations in large hospitals, usually hospital systems that have had years of experience developing custom EMRs, for example the Veterans Administration hospital system, Kaiser Permanente's HealthConnect and the VistA EMR electronic medical records, digital health records, e-MedRecords. Technology limitations Limitations in software, hardware and networking technologies has made EMR electronic medical records, digital health records, e-MedRecords difficult to affordably implement in small, budget conscious, multiple location healthcare organizations. Until recently most EMR electronic medical records, digital health records, e-MedRecords systems were developed using older programming languages such as Visual Basic; however with many systems now being developed using Microsoft .NET Framework and Java technology EMRs can be securely implemented across multiple locations with greater performance and interoperability.[22] Prior to the recent introduction of IEEE 802.11g/n wireless technology, access to large files such as MRI and X-Ray images was slow. With these new wireless technologies data can be securely transferred at speeds of up to 108 Mbit/s, across extended distances and in older buildings built with brick or concrete walls. In the ASP model, where the EMR electronic medical records, digital health records, e-MedRecords data is stored at an off-site data center, the bandwidth limitation of the last mile Internet access still remains as the bottleneck and as a technological limitation for large scanned file transfers. Tablet PC technology has significantly improved over the recent years, Li-Ion/polymer batteries for battery life of up to 8 hours, biometric security, low-voltage processors and lighter weight solutions. For the new generation of Tablet PC, there are now EMRs that are fully handwriting capable[23] Preservation Under data protection legislation and the law generally responsibility for patient records, health care records (irrespective of the form they are kept in) is always on the creator and custodian of the record, usually a health care practice or facility. The physical medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound, etc. The patient, however, according to HIPAA, owns the information contained within the record and has a right to view the originals, and to obtain copies under law.[24] Additionally, those responsible for the management of the EMR electronic medical records, digital health records, e-MedRecords are responsible to see the hardware, software and media used to manage the information remain usable and not degraded. This requires backup of the data and protection being provided to copies. It will also require the planned periodic migration of information to address concerns of media degradation from use.[25] Legal status Medical records, such as physician orders, exam health care records and test reports are legal documents, which must be kept in unaltered form and authenticated by the creator. * Digital signatures Most national and international standards accept electronic signatures.[26] According to the American Bar Association, "A signature authenticates a writing by identifying the signer with the signed document. When the signer makes a mark in a distinctive manner, the writing becomes attributable to the signer."[27] With proper security software, electronic authentication is more difficult to falsify than the handwritten doctor's signature. However, as the recent rise in identity theft demonstrates, no security method can totally prevent fraud, so auditing information security will continue to be prudent when using EMR electronic medical records, digital health records, e-MedRecords. * Digital records such as EHR EHR electronic health record, health records, digital health records, e-MedRecords create difficulties ensuring that the content, context and structure are preserved when the records do not have a physical existence. As of 2006[update], national and state archives authorities are still developing open, non-proprietary technical standards for electronic records management (ERM).[28] standards Though there are few standards for modern day EMR electronic medical records, digital health records, e-MedRecords systems as a whole, there are many standards relating to specific aspects of EHRs and EMRs. These include: * ASTM International Continuity of Care Record - a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords systems, allowing easy interoperability between otherwise disparate enities.[29] * ANSI X12 (EDI) - A set of transaction protocols used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information, because several of the transactions became required by the Health Insurance Portability and Accountability Act (HIPAA) for transmitting data to Medicare. * CEN - CONTSYS (EN 13940), a system of concepts to support continuity of care. * CEN - EHRcom (EN 13606), the European standard for the communication of information from EHR EHR electronic health record, health records, digital health records, e-MedRecords systems. * CEN - HISA (EN 12967), a services standard for inter-system communication in a clinical information environment. * DICOM - a heavily used standard for representing and communicating radiology images and reporting * HL7 - HL7 messages are used for interchange between hospital and physician record systems and between EMR electronic medical records, digital health records, e-MedRecords systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material. * ISO - ISO TC 215 has defined the EHR EHR electronic health record, health records, digital health records, e-MedRecords, and also produced a technical specification ISO 18308 describing the requirements for EHR EHR electronic health record, health records, digital health records, e-MedRecords Architectures. * openEHR - next generation public specifications and implementations for EHR EHR electronic health record, health records, digital health records, e-MedRecords systems and communication, based on a complete separation of software and clinical models. Various factors involving the timing, the right players, market history, utility, and governance play a key role in the overall enrichment of the standard and certification development. The standardization and certification even though seem to bring uniformity in the EMR electronic medical records, digital health records, e-MedRecords development, do not guarantee their acceptability and sustainability in the long run. [30] In 2005 the US Federal Government awarded a contract to CCHIT - Certification Commission for Healthcare Information Technology to develop certification criteria for EMR electronic medical records, digital health records, e-MedRecords. Starting in early 2007 vendors began to utilize these certification criteria for their EMR electronic medical records, digital health records, e-MedRecords systems. Customization Pricing for EMR electronic medical records, digital health records, e-MedRecords systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is due to the majority of EMR electronic medical records, digital health records, e-MedRecords systems being based on templates that are initially general in scope. In many cases, these templates can then be customized in co-operation with the vendor/developer to better fit data entry based on a medical specialty, environment or other specified needs. There are also EMR electronic medical records, digital health records, e-MedRecords systems available that do not use templates for data entry and therefore can be easily personalized by each individual user. Alternative data entry methods include concept processing, voice recognition, and transcription. As of 2005, one of the largest projects for a national EMR electronic medical records, digital health records, e-MedRecords is by the National Health Service (NHS) in the United Kingdom. The goal of the NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010. The Canadian province of Alberta's Alberta Netcare project is a large-scale operational Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) system.[citation needed] US medical groups' adoption of EHR EHR electronic health record, health records, digital health records, e-MedRecords (2005) Adoption of electronic medical records by US doctors is increasing slowly. The latest data from the National Ambulatory Medical Care Survey (NAMCS) indicate that one-quarter of office-based physicians report using fully or partially electronic medical record systems (EMR electronic medical records, digital health records, e-MedRecords) in 2005, a 31% increase from the 18.2 percent reported in the 2001 survey.[31] However, the survey also states that just 9.3% of these physicians actually have a "complete EMR electronic medical records, digital health records, e-MedRecords system", with all four basic functions deemed minimally necessary for a full EMR electronic medical records, digital health records, e-MedRecords: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.[32] Barriers to adopting an EMR electronic medical records, digital health records, e-MedRecords system include training, costs and complexity, as well as the lack of a national standard for interoperability among competing software options.[33] Advocates of electronic health records hope that product certification will provide US physicians and hospitals with the assurance they need to justify significant investments in new systems. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards and certify vendors who meet them. On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products.[34] and then on July 31 2006, additionally announced that two further EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products had achieved certification.[35] In the United States, the Department of Veterans Affairs (VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders, including medications, special procedures, X-rays, patient care nursing orders, diets, and laboratory tests. The New York City Health and Hospitals Corporation, the largest urban healthcare agency in the United States serving 1.3 million patients, is another example of a significant healthcare organization that has successfully implemented an electronic health records system in the United States. An electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) refers to an individual patient's medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. Among the many forms of data often included in EMRs are patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives. EHR EHR electronic health record, health records, digital health records, e-MedRecords systems can reduce medical errors.[1] In one ambulatory healthcare study, however, there was no difference in 14 measures, improvement in 2 outcome measures, and worse outcome on 1 measure.[2] EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR electronic medical records, digital health records, e-MedRecords systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.[3] Multiple terms have been used to define electronic patient care records, with overlapping definitions.[4] Both electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) and electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) have gained widespread use, with some health informatics users assigning the term EHR EHR electronic health record, health records, digital health records, e-MedRecords to a global concept and EMR electronic medical records, digital health records, e-MedRecords to a discrete localised record. For most users, however, the terms EHR EHR electronic health record, health records, digital health records, e-MedRecords and EMR electronic medical records, digital health records, e-MedRecords are used interchangeably. An EHR EHR electronic health record, health records, digital health records, e-MedRecords system is also often abbreviated as EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords. Information in the section on EMRs electronic medical record may be more relevant to physician offices seeking a less expensive or comprehensive solution. Health Information Technology is an even broader term that describes any computer-based electronic aid to healthcare delivery. An electronic health record is a patient’s health record that has been compiled into a digital format. n his joint address to Congress in 2009, Obama stated that: "Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down cost, ensure privacy, and save lives" [5] The 2009 economic stimulus package (HITECH Act) passed by Obama aims at incenting more physician to adopt EHR EHR electronic health record, health records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EHRs" and, eventually, reducing Medicare payments to those who do not use an EHR EHR electronic health record, health records, digital health records, e-MedRecords. In order to receive the EHR EHR electronic health record, health records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EHR EHR electronic health record, health records, digital health records, e-MedRecords system.[6] EHR EHR electronic health record Categories of information in a patient record A patient record consists of 4 main categories of information. Some information requires digitization. Other forms of information are by nature digital but require an infrastructure designed for secure access through the EHR EHR electronic health record, health records, digital health records, e-MedRecords. EHR EHR electronic health record Textual information Textual information in a patient record include notes and individual reports. EHR EHR electronic health record Data for Calculations Data for calculations or graphing from laboratory reports are included in a patient record. This information is used for searching or decision support. EHR EHR electronic health record Multimedia Multimedia information in a patient record such as diagnostic images are typically located in various departments in a healthcare facility. The large volume and disparate locations of this data make the electronic health record the only viable way for access. EHR EHR electronic health record Paperwork Patient records include signed forms, hand drawn figures, photographs of wounds, electronic health records, and other various forms of paper-based documentation. EHR EHR electronic health record Advantages of electronic medical records There are several benefits to wide scale usage of electronic health records. EHR EHR electronic health record Reduce healthcare costs One of the major sources of rapid growth in healthcare costs comes from medical imaging. Medicare Part B spending on imaging rose from $6.80 billion in 2000 to $14.11 billion in 2006.[7] Access to a patient's images in an EHR EHR electronic health record, health records, digital health records, e-MedRecords is an effective way to avoid duplicating expensive imaging procedures. Other cost savings include the reduction of medical errors that can otherwise lead to further expensive care. EHR EHR electronic health record Improve quality of care electronic health records, electronic health records An EHR EHR electronic health record, health records, digital health records, e-MedRecords system can help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine enable proliferation of ongoing improvements in healthcare efficacy. EHR EHR electronic health record Promote evidence-based medicine EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. These benefits may be realized in a realistic sense only if the EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are interoperable and wide spread (e.g. national) so that various systems can easily share information. Also, to avoid failures that can cause injury to the patient and violations to privacy, the best practices in software engineering and medial informatics must be deployed.[8] EHRs also have the advantages of electronic medical records (EMR electronic medical records, digital health records, e-MedRecords). In general, medical records may be on "physical" media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure. Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage. When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance. In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR electronic medical records, digital health records, e-MedRecords is offset by the cost of only a few unnecessary tests or admissions.[9][10] Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.[11] Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. health care records, health care records, electronic health records In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, health care records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, electronic health records, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, health care records, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, electronic health records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, electronic health records, health care records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, electronic health records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, health care records, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] electronic health records e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. The Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR EHR electronic health record, health records, digital health records, e-MedRecords automates and streamlines the clinician's workflow. The EHR EHR electronic health record, health records, digital health records, e-MedRecords has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting. In this section you will find many resources that contribute to the ability for healthcare organizations to realize a longitudinal electronic record that spans across the continuum of healthcare. Topics of interest include a focus on quality, efficiency, effectiveness and the safety of patient care through a variety of tools and resources in different formats. By providing this information, HIMSS Members and HIMSS Leadership can be focused on collaboratively working together to achieve the goal of EHRs in use in 80 percent of healthcare organizations and 50 percent of physician practices by 2010. An electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) is a medical record in digital format. In health informatics and most contexts, EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health records) are used synonymously, but many people define an EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) as just the physician interface and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health record) including both a physician and patient interface. Together they are also known as e-MedRecord, e-MedRecords and digital medical records. The terms ave sometimes included other systems which keep track of medical information, such as the practice management system which supports the electronic medical record. As of 2006[update], adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States, in spite of studies showing revenue gains after implementation.[3] Fewer than 10% of American hospitals have implemented health information technology,while a mere 16% of primary care physicians use EHRs. The 2009 economic stimulus package (HITECH) aims at incenting more physician to adopt EMR electronic medical records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EMRs" and, eventually, reducing Medicare payments to those who do not use an EMR electronic medical records, digital health records, e-MedRecords. In order to receive the EMR electronic medical records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EMR electronic medical records, digital health records, e-MedRecords system. The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. If all medical payment transactions in the U.S. were handled electronically, America could save $11 billion annually. The healthcare industry spends only 2% of gross revenues on information technology, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%. The following issues are behind the slow rate of adoption: EHR EHR electronic health record Interoperability In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.[11] Interoperability can also refer to legal interoperability, i.e. the regulatory issues of cross-border EMR electronic medical records, digital health records, e-MedRecords implementations. In the United States, the development of standards for EMR electronic medical records, digital health records, e-MedRecords interoperability is at the forefront of the national health care agenda.[4] EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing patient information (lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR EHR electronic health record, health records, digital health records, e-MedRecords systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs. The Certification Commission for Healthcare Information Technology (CCHIT) has developed an open-source program called Laika to test EHR EHR electronic health record, health records, digital health records, e-MedRecords software for compliance with CCHIT interoperability standards. The Center for Information Technology Leadership described four different categories (“levels”) of data structuring at which health care data exchange can take place. [12] While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization. The four levels are: Privacy A major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access.[14] Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws.[15] In the European Union (EU), several Directives of the European Parliament and of the Council protect the processing and free movement of personal data, including for purposes of health care.[16] The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. The growth of EHR EHR electronic health record, health records, digital health records, e-MedRecords creates new issues, since electronic data may be physically much more difficult to secure, as lapses in data security are increasingly being reported.[17] Information security practices have been established for computer networks, but technologies like wireless computer networks offer new challenges as well. A related concern is the potential privacy risk posed by interoperability. One of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he estimates to be 12 million, will inevitable lead to breaches of privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients," they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida, to check if the fellow has a cocaine habit."[18] Older record incorporation To attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR electronic medical records, digital health records, e-MedRecords, older paper medical records ideally should be incorporated into the patient's record. The digital scanning process involved in conversion of these physical records to EMR electronic medical records, digital health records, e-MedRecords is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data.[19] Social and organizational barriers According to the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology, EMR electronic medical records, digital health records, e-MedRecords implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself. Such organizational and social issues include restructuring workflows, dealing with physicians' resistance to change (or, alternatively, software engineers' evolving research in deep modeling of the physician's knowledge and workflow domains), as well as IT personnels' resistance to design and implementation flexibility needed in the complex healthcare environment, and creating a collaborative environment that fosters communication between physicians and information technology project managers. Exemplifying this need are several highly publicized HIT implementation failures, such as one at Cedars Sinai Medical Center in Los Angeles, in which physicians revolted and forced the administration to scrap a $34 million CPOE system [20] as well as others compiled at a collection of cases of health IT difficulties by medical informatics specialists.[21] There are, however, several successful examples of EMR electronic medical records, digital health records, e-MedRecords implementations in large hospitals, usually hospital systems that have had years of experience developing custom EMRs, for example the Veterans Administration hospital system, Kaiser Permanente's HealthConnect and the VistA EMR electronic medical records, digital health records, e-MedRecords. Technology limitations Limitations in software, hardware and networking technologies has made EMR electronic medical records, digital health records, e-MedRecords difficult to affordably implement in small, budget conscious, multiple location healthcare organizations. Until recently most EMR electronic medical records, digital health records, e-MedRecords systems were developed using older programming languages such as Visual Basic; however with many systems now being developed using Microsoft .NET Framework and Java technology EMRs can be securely implemented across multiple locations with greater performance and interoperability.[22] Prior to the recent introduction of IEEE 802.11g/n wireless technology, access to large files such as MRI and X-Ray images was slow. With these new wireless technologies data can be securely transferred at speeds of up to 108 Mbit/s, across extended distances and in older buildings built with brick or concrete walls. In the ASP model, where the EMR electronic medical records, digital health records, e-MedRecords data is stored at an off-site data center, the bandwidth limitation of the last mile Internet access still remains as the bottleneck and as a technological limitation for large scanned file transfers. Tablet PC technology has significantly improved over the recent years, Li-Ion/polymer batteries for battery life of up to 8 hours, biometric security, low-voltage processors and lighter weight solutions. For the new generation of Tablet PC, there are now EMRs that are fully handwriting capable[23] Preservation Under data protection legislation and the law generally responsibility for patient records (irrespective of the form they are kept in) is always on the creator and custodian of the record, usually a health care practice or facility. The physical medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound, etc. The patient, however, according to HIPAA, owns the information contained within the record and has a right to view the originals, and to obtain copies under law.[24] Additionally, those responsible for the management of the EMR electronic medical records, digital health records, e-MedRecords are responsible to see the hardware, software and media used to manage the information remain usable and not degraded. This requires backup of the data and protection being provided to copies. It will also require the planned periodic migration of information to address concerns of media degradation from use.[25] Legal status Medical records, such as physician orders, exam and test reports are legal documents, which must be kept in unaltered form and authenticated by the creator. * Digital signatures Most national and international standards accept electronic signatures.[26] According to the American Bar Association, "A signature authenticates a writing by identifying the signer with the signed document. When the signer makes a mark in a distinctive manner, the writing becomes attributable to the signer."[27] With proper security software, electronic authentication is more difficult to falsify than the handwritten doctor's signature. However, as the recent rise in identity theft demonstrates, no security method can totally prevent fraud, so auditing information security will continue to be prudent when using EMR electronic medical records, digital health records, e-MedRecords. * Digital records such as EHR EHR electronic health record, health records, digital health records, e-MedRecords create difficulties ensuring that the content, context and structure are preserved when the records do not have a physical existence. As of 2006[update], national and state archives authorities are still developing open, non-proprietary technical standards for electronic records management (ERM).[28] standards Though there are few standards for modern day EMR electronic medical records, digital health records, e-MedRecords systems as a whole, there are many standards relating to specific aspects of EHRs and EMRs. These include: * ASTM International Continuity of Care Record - a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords systems, allowing easy interoperability between otherwise disparate enities.[29] * ANSI X12 (EDI) - A set of transaction protocols used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information, because several of the transactions became required by the Health Insurance Portability and Accountability Act (HIPAA) for transmitting data to Medicare. * CEN - CONTSYS (EN 13940), a system of concepts to support continuity of care. * CEN - EHRcom (EN 13606), the European standard for the communication of information from EHR EHR electronic health record, health records, digital health records, e-MedRecords systems. * CEN - HISA (EN 12967), a services standard for inter-system communication in a clinical information environment. * DICOM - a heavily used standard for representing and communicating radiology images and reporting * HL7 - HL7 messages are used for interchange between hospital and physician record systems and between EMR electronic medical records, digital health records, e-MedRecords systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material. * ISO - ISO TC 215 has defined the EHR EHR electronic health record, health records, digital health records, e-MedRecords, and also produced a technical specification ISO 18308 describing the requirements for EHR EHR electronic health record, health records, digital health records, e-MedRecords Architectures. * openEHR - next generation public specifications and implementations for EHR EHR electronic health record, health records, digital health records, e-MedRecords systems and communication, based on a complete separation of software and clinical models. Various factors involving the timing, the right players, market history, utility, and governance play a key role in the overall enrichment of the standard and certification development. The standardization and certification even though seem to bring uniformity in the EMR electronic medical records, digital health records, e-MedRecords development, do not guarantee their acceptability and sustainability in the long run. [30] In 2005 the US Federal Government awarded a contract to CCHIT - Certification Commission for Healthcare Information Technology to develop certification criteria for EMR electronic medical records, digital health records, e-MedRecords. Starting in early 2007 vendors began to utilize these certification criteria for their EMR electronic medical records, digital health records, e-MedRecords systems. Customization Pricing for EMR electronic medical records, digital health records, e-MedRecords systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is due to the majority of EMR electronic medical records, digital health records, e-MedRecords systems being based on templates that are initially general in scope. In many cases, these templates can then be customized in co-operation with the vendor/developer to better fit data entry based on a medical specialty, environment or other specified needs. There are also EMR electronic medical records, digital health records, e-MedRecords systems available that do not use templates for data entry and therefore can be easily personalized by each individual user. Alternative data entry methods include concept processing, voice recognition, and transcription. As of 2005, one of the largest projects for a national EMR electronic medical records, digital health records, e-MedRecords is by the National Health Service (NHS) in the United Kingdom. The goal of the NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010. The Canadian province of Alberta's Alberta Netcare project is a large-scale operational Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) system.[citation needed] US medical groups' adoption of EHR EHR electronic health record, health records, digital health records, e-MedRecords (2005) Adoption of electronic medical records by US doctors is increasing slowly. The latest data from the National Ambulatory Medical Care Survey (NAMCS) indicate that one-quarter of office-based physicians report using fully or partially electronic medical record systems (EMR electronic medical records, digital health records, e-MedRecords) in 2005, a 31% increase from the 18.2 percent reported in the 2001 survey.[31] However, the survey also states that just 9.3% of these physicians actually have a "complete EMR electronic medical records, digital health records, e-MedRecords system", with all four basic functions deemed minimally necessary for a full EMR electronic medical records, digital health records, e-MedRecords: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.[32] Barriers to adopting an EMR electronic medical records, digital health records, e-MedRecords system include training, costs and complexity, as well as the lack of a national standard for interoperability among competing software options.[33] Advocates of electronic health records hope that product certification will provide US physicians and hospitals with the assurance they need to justify significant investments in new systems. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards and certify vendors who meet them. On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products.[34] and then on July 31 2006, additionally announced that two further EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products had achieved certification.[35] In the United States, the Department of Veterans Affairs (VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders, including medications, special procedures, X-rays, patient care nursing orders, diets, and laboratory tests. The New York City Health and Hospitals Corporation, the largest urban healthcare agency in the United States serving 1.3 million patients, is another example of a significant healthcare organization that has successfully implemented an electronic health records system in the United States. An electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) refers to an individual patient's medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. Among the many forms of data often included in EMRs are patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives. EHR EHR electronic health record, health records, digital health records, e-MedRecords systems can reduce medical errors.[1] In one ambulatory healthcare study, however, there was no difference in 14 measures, improvement in 2 outcome measures, and worse outcome on 1 measure.[2] EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR electronic medical records, digital health records, e-MedRecords systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.[3] Multiple terms have been used to define electronic patient care records, with overlapping definitions.[4] Both electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) and electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) have gained widespread use, with some health informatics users assigning the term EHR EHR electronic health record, health records, digital health records, e-MedRecords to a global concept and EMR electronic medical records, digital health records, e-MedRecords to a discrete localised record. For most users, however, the terms EHR EHR electronic health record, health records, digital health records, e-MedRecords and EMR electronic medical records, digital health records, e-MedRecords are used interchangeably. An EHR EHR electronic health record, health records, digital health records, e-MedRecords system is also often abbreviated as EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords. Information in the section on EMRs electronic medical record may be more relevant to physician offices seeking a less expensive or comprehensive solution. Health Information Technology is an even broader term that describes any computer-based electronic aid to healthcare delivery. An electronic health record is a patient’s health record that has been compiled into a digital format. n his joint address to Congress in 2009, Obama stated that: "Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down cost, ensure privacy, and save lives" [5] The 2009 economic stimulus package (HITECH Act) passed by Obama aims at incenting more physician to adopt EHR EHR electronic health record, health records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EHRs" and, eventually, reducing Medicare payments to those who do not use an EHR EHR electronic health record, health records, digital health records, e-MedRecords. In order to receive the EHR EHR electronic health record, health records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EHR EHR electronic health record, health records, digital health records, e-MedRecords system.[6] EHR EHR electronic health record Categories of information in a patient record A patient record consists of 4 main categories of information. Some information requires digitization. Other forms of information are by nature digital but require an infrastructure designed for secure access through the EHR EHR electronic health record, health records, digital health records, e-MedRecords. EHR EHR electronic health record Textual information Textual information in a patient record include notes and individual reports. EHR EHR electronic health record Data for Calculations Data for calculations or graphing from laboratory reports are included in a patient record. This information is used for searching or decision support. EHR EHR electronic health record Multimedia Multimedia information in a patient record such as diagnostic images are typically located in various departments in a healthcare facility. The large volume and disparate locations of this data make the electronic health record the only viable way for access. EHR EHR electronic health record Paperwork Patient records include signed forms, hand drawn figures, photographs of wounds, and other various forms of paper-based documentation. EHR EHR electronic health record Advantages of electronic medical records There are several benefits to wide scale usage of electronic health records. EHR EHR electronic health record Reduce healthcare costs One of the major sources of rapid growth in healthcare costs comes from medical imaging. Medicare Part B spending on imaging rose from $6.80 billion in 2000 to $14.11 billion in 2006.[7] Access to a patient's images in an EHR EHR electronic health record, health records, digital health records, e-MedRecords is an effective way to avoid duplicating expensive imaging procedures. Other cost savings include the reduction of medical errors that can otherwise lead to further expensive care. EHR EHR electronic health record Improve quality of care An EHR EHR electronic health record, health records, digital health records, e-MedRecords system can help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine enable proliferation of ongoing improvements in healthcare efficacy. EHR EHR electronic health record Promote evidence-based medicine EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. These benefits may be realized in a realistic sense only if the EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are interoperable and wide spread (e.g. national) so that various systems can easily share information. Also, to avoid failures that can cause injury to the patient and violations to privacy, the best practices in software engineering and medial informatics must be deployed.[8] EHRs also have the advantages of electronic medical records (EMR electronic medical records, digital health records, e-MedRecords). In general, medical records may be on "physical" media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure. Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage. When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance. In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR electronic medical records, digital health records, e-MedRecords is offset by the cost of only a few unnecessary tests or admissions.[9][10] Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.[11] Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. In contrast, EMR health care records can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"[12]) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] The Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR EHR electronic health record, health records, digital health records, e-MedRecords automates and streamlines the clinician's workflow. The EHR EHR electronic health record, health records, digital health records, e-MedRecords has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting. In this section you will find many health care records resources that contribute to the ability for healthcare organizations to realize a longitudinal electronic record that spans across the continuum of healthcare. Topics of interest include a focus on quality, efficiency, effectiveness and the safety of patient care through a variety of tools and resources in different formats. By providing this information, HIMSS Members and HIMSS Leadership can be focused on collaboratively working together to achieve the goal of EHRs in use in 80 percent of healthcare organizations and 50 percent of physician practices by 2010. An electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) is a medical record in digital format. In health informatics and most contexts, EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health records) are used synonymously, but many people define an EMR electronic medical records, digital health records, e-MedRecords (electronic medical record) as just the physician interface and EHR EHR electronic health record, health records, digital health records, e-MedRecords (electronic health record) including both a physician and patient interface. Together they are also known as e-MedRecord, e-MedRecords and digital medical records. The terms ave sometimes included other systems which keep track of medical information, such as the practice management system which supports the electronic medical record. As of 2006[update], adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States, in spite of studies showing revenue gains after implementation.[3] Fewer than 10% of American hospitals have implemented health information technology,while a mere 16% of primary care physicians use EHRs. The 2009 economic stimulus package (HITECH) aims health care records at incenting more physician to adopt EMR electronic medical records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EMRs" and, eventually, reducing Medicare payments to those who do not use an EMR electronic medical records, digital health records, e-MedRecords. In order to receive the EMR electronic medical records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EMR electronic medical records, digital health records, e-MedRecords system. The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. If all medical payment transactions in the U.S. were handled electronically, America could save $11 billion annually. The healthcare industry spends only 2% of gross revenues on information technology, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%. The following issues are behind the slow rate of adoption: EHR EHR electronic health record Interoperability In healthcare, interoperability is the ability of health care records different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.[11] Interoperability can also refer to legal interoperability, i.e. the regulatory issues of cross-border EMR electronic medical records, digital health records, e-MedRecords implementations. In the United States, the development of standards for EMR electronic medical records, digital health records, e-MedRecords interoperability is at the forefront of the national health care agenda.[4] EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing patient information (lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR EHR electronic health record, health records, digital health records, e-MedRecords systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs. The Certification Commission for Healthcare Information Technology (CCHIT) has developed an open-source program called Laika to test EHR EHR electronic health record, health records, digital health records, e-MedRecords software for compliance with CCHIT interoperability standards. The Center for Information Technology Leadership described four different health care records categories (“levels”) of data structuring at which health care data exchange can take place. [12] While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization. The four levels are: Privacy A major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access.[14] Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws.[15] In the European Union (EU), several Directives of the European Parliament and of the Council protect the processing and free movement of personal data, including for purposes of health care.[16] The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. The growth of EHR EHR electronic health record, health records, digital health records, e-MedRecords creates new issues, since electronic data may be physically much more difficult to secure, as lapses in data security are increasingly being reported.[17] Information security practices have been established for computer networks, but technologies like wireless computer networks offer new challenges as well. A related concern is the potential privacy risk posed by interoperability. One of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he estimates to be 12 million, will inevitable lead to breaches of privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients," they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida, to check if the fellow has a cocaine habit."[18] Older record incorporation To attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR electronic medical records, digital health records, e-MedRecords, older paper medical records ideally should be incorporated into the patient's record. The digital scanning process involved in conversion of these physical records to EMR electronic medical records, digital health records, e-MedRecords is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data.[19] Social and organizational barriers According to the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology, EMR electronic medical records, digital health records, e-MedRecords implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself. Such organizational and social issues include restructuring workflows, dealing with physicians' resistance to change (or, alternatively, software engineers' evolving research in deep modeling of the physician's knowledge and workflow domains), as well as IT personnels' resistance to design and implementation flexibility needed in the complex healthcare environment, and creating a collaborative environment that fosters communication between physicians and information technology project managers. Exemplifying this need are several highly publicized HIT implementation failures, such as one at Cedars Sinai Medical Center in Los Angeles, in which physicians revolted and forced the administration to scrap a $34 million CPOE system [20] as well as others compiled at a collection of cases of health IT difficulties by medical informatics specialists.[21] There are, however, several successful examples of EMR electronic medical records, digital health records, e-MedRecords implementations in large hospitals, usually hospital systems that have had years of experience developing custom EMRs, for example the Veterans Administration hospital system, Kaiser Permanente's HealthConnect and the VistA EMR electronic medical records, digital health records, e-MedRecords. Technology limitations Limitations in software, hardware and networking technologies has made EMR electronic medical records, digital health records, e-MedRecords difficult to affordably implement in small, budget conscious, multiple location healthcare organizations. Until recently most EMR electronic medical records, digital health records, e-MedRecords systems were developed using older programming languages such as Visual Basic; however with many systems now being developed using Microsoft .NET Framework and Java technology EMRs can be securely implemented across multiple locations with greater performance and interoperability.[22] Prior to the recent introduction of IEEE 802.11g/n wireless technology, access to large files such as MRI and X-Ray images was slow. With these new wireless technologies data can be securely transferred at speeds of up to 108 Mbit/s, across extended distances and in older buildings built with brick or concrete walls. In the ASP model, where the EMR electronic medical records, digital health records, e-MedRecords data is stored at an off-site data center, the bandwidth limitation of the last mile Internet access still remains as the bottleneck and as a technological limitation for large scanned file transfers. Tablet PC technology has significantly improved over the recent years, Li-Ion/polymer batteries for battery life of up to 8 hours, biometric security, low-voltage processors and lighter weight solutions. For the new generation of Tablet PC, there are now EMRs that are fully handwriting capable[23] Preservation Under data protection legislation and the law generally responsibility for patient records, health care records (irrespective of the form they are kept in) is always on the creator and custodian of the record, usually a health care practice or facility. The physical medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound, etc. The patient, however, according to HIPAA, owns the information contained within the record and has a right to view the originals, and to obtain copies under law.[24] Additionally, those responsible for the management of the EMR electronic medical records, digital health records, e-MedRecords are responsible to see the hardware, software and media used to manage the information remain usable and not degraded. This requires backup of the data and protection being provided to copies. It will also require the planned periodic migration of information to address concerns of media degradation from use.[25] Legal status Medical records, such as physician orders, exam health care records and test reports are legal documents, which must be kept in unaltered form and authenticated by the creator. * Digital signatures Most national and international standards accept electronic signatures.[26] According to the American Bar Association, "A signature authenticates a writing by identifying the signer with the signed document. When the signer makes a mark in a distinctive manner, the writing becomes attributable to the signer."[27] With proper security software, electronic authentication is more difficult to falsify than the handwritten doctor's signature. However, as the recent rise in identity theft demonstrates, no security method can totally prevent fraud, so auditing information security will continue to be prudent when using EMR electronic medical records, digital health records, e-MedRecords. * Digital records such as EHR EHR electronic health record, health records, digital health records, e-MedRecords create difficulties ensuring that the content, context and structure are preserved when the records do not have a physical existence. As of 2006[update], national and state archives authorities are still developing open, non-proprietary technical standards for electronic records management (ERM).[28] standards Though there are few standards for modern day EMR electronic medical records, digital health records, e-MedRecords systems as a whole, there are many standards relating to specific aspects of EHRs and EMRs. These include: * ASTM International Continuity of Care Record - a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords systems, allowing easy interoperability between otherwise disparate enities.[29] * ANSI X12 (EDI) - A set of transaction protocols used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information, because several of the transactions became required by the Health Insurance Portability and Accountability Act (HIPAA) for transmitting data to Medicare. * CEN - CONTSYS (EN 13940), a system of concepts to support continuity of care. * CEN - EHRcom (EN 13606), the European standard for the communication of information from EHR EHR electronic health record, health records, digital health records, e-MedRecords systems. * CEN - HISA (EN 12967), a services standard for inter-system communication in a clinical information environment. * DICOM - a heavily used standard for representing and communicating radiology images and reporting * HL7 - HL7 messages are used for interchange between hospital and physician record systems and between EMR electronic medical records, digital health records, e-MedRecords systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material. * ISO - ISO TC 215 has defined the EHR EHR electronic health record, health records, digital health records, e-MedRecords, and also produced a technical specification ISO 18308 describing the requirements for EHR EHR electronic health record, health records, digital health records, e-MedRecords Architectures. * openEHR - next generation public specifications and implementations for EHR EHR electronic health record, health records, digital health records, e-MedRecords systems and communication, based on a complete separation of software and clinical models. Various factors involving the timing, the right players, market history, utility, and governance play a key role in the overall enrichment of the standard and certification development. The standardization and certification even though seem to bring uniformity in the EMR electronic medical records, digital health records, e-MedRecords development, do not guarantee their acceptability and sustainability in the long run. [30] In 2005 the US Federal Government awarded a contract to CCHIT - Certification Commission for Healthcare Information Technology to develop certification criteria for EMR electronic medical records, digital health records, e-MedRecords. Starting in early 2007 vendors began to utilize these certification criteria for their EMR electronic medical records, digital health records, e-MedRecords systems. Customization Pricing for EMR electronic medical records, digital health records, e-MedRecords systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is due to the majority of EMR electronic medical records, digital health records, e-MedRecords systems being based on templates that are initially general in scope. In many cases, these templates can then be customized in co-operation with the vendor/developer to better fit data entry based on a medical specialty, environment or other specified needs. There are also EMR electronic medical records, digital health records, e-MedRecords systems available that do not use templates for data entry and therefore can be easily personalized by each individual user. Alternative data entry methods include concept processing, voice recognition, and transcription. As of 2005, one of the largest projects for a national EMR electronic medical records, digital health records, e-MedRecords is by the National Health Service (NHS) in the United Kingdom. The goal of the NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010. The Canadian province of Alberta's Alberta Netcare project is a large-scale operational Electronic Health Record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) system.[citation needed] US medical groups' adoption of EHR EHR electronic health record, health records, digital health records, e-MedRecords (2005) Adoption of electronic medical records by US doctors is increasing slowly. The latest data from the National Ambulatory Medical Care Survey (NAMCS) indicate that one-quarter of office-based physicians report using fully or partially electronic medical record systems (EMR electronic medical records, digital health records, e-MedRecords) in 2005, a 31% increase from the 18.2 percent reported in the 2001 survey.[31] However, the survey also states that just 9.3% of these physicians actually have a "complete EMR electronic medical records, digital health records, e-MedRecords system", with all four basic functions deemed minimally necessary for a full EMR electronic medical records, digital health records, e-MedRecords: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.[32] Barriers to adopting an EMR electronic medical records, digital health records, e-MedRecords system include training, costs and complexity, as well as the lack of a national standard for interoperability among competing software options.[33] Advocates of electronic health records hope that product certification will provide US physicians and hospitals with the assurance they need to justify significant investments in new systems. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards and certify vendors who meet them. On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products.[34] and then on July 31 2006, additionally announced that two further EMR electronic medical records, digital health records, e-MedRecords and EHR EHR electronic health record, health records, digital health records, e-MedRecords products had achieved certification.[35] In the United States, the Department of Veterans Affairs (VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture (VistA). A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders, including medications, special procedures, X-rays, patient care nursing orders, diets, and laboratory tests. The New York City Health and Hospitals Corporation, the largest urban healthcare agency in the United States serving 1.3 million patients, is another example of a significant healthcare organization that has successfully implemented an electronic health records system in the United States. An electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) refers to an individual patient's medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. Among the many forms of data often included in EMRs are patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives. EHR EHR electronic health record, health records, digital health records, e-MedRecords systems can reduce medical errors.[1] In one ambulatory healthcare study, however, there was no difference in 14 measures, improvement in 2 outcome measures, and worse outcome on 1 measure.[2] EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR electronic medical records, digital health records, e-MedRecords systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.[3] Multiple terms have been used to define electronic patient care records, with overlapping definitions.[4] Both electronic health record (EHR EHR electronic health record, health records, digital health records, e-MedRecords) and electronic medical record (EMR electronic medical records, digital health records, e-MedRecords) have gained widespread use, with some health informatics users assigning the term EHR EHR electronic health record, health records, digital health records, e-MedRecords to a global concept and EMR electronic medical records, digital health records, e-MedRecords to a discrete localised record. For most users, however, the terms EHR EHR electronic health record, health records, digital health records, e-MedRecords and EMR electronic medical records, digital health records, e-MedRecords are used interchangeably. An EHR EHR electronic health record, health records, digital health records, e-MedRecords system is also often abbreviated as EHR EHR electronic health record, health records, digital health records, e-MedRecords or EMR electronic medical records, digital health records, e-MedRecords. Information in the section on EMRs electronic medical record may be more relevant to physician offices seeking a less expensive or comprehensive solution. Health Information Technology is an even broader term that describes any computer-based electronic aid to healthcare delivery. An electronic health record is a patient’s health record that has been compiled into a digital format. n his joint address to Congress in 2009, Obama stated that: "Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down cost, ensure privacy, and save lives" [5] The 2009 economic stimulus package (HITECH Act) passed by Obama aims at incenting more physician to adopt EHR EHR electronic health record, health records, digital health records, e-MedRecords. The act promises incentive payments to those who adopt and use "certified EHRs" and, eventually, reducing Medicare payments to those who do not use an EHR EHR electronic health record, health records, digital health records, e-MedRecords. In order to receive the EHR EHR electronic health record, health records, digital health records, e-MedRecords stimulus money, the HITECH act (ARRA) requires doctors to also show "meaningful use" of an EHR EHR electronic health record, health records, digital health records, e-MedRecords system.[6] EHR EHR electronic health record Categories of information in a patient record A patient record consists of 4 main categories of information. Some information requires digitization. Other forms of information are by nature digital but require an infrastructure designed for secure access through the EHR EHR electronic health record, health records, digital health records, e-MedRecords. EHR EHR electronic health record Textual information Textual information in a patient record include notes and individual reports. EHR EHR electronic health record Data for Calculations Data for calculations or graphing from laboratory reports are included in a patient record. This information is used for searching or decision support. EHR EHR electronic health record Multimedia Multimedia information in a patient record such as diagnostic images are typically located in various departments in a healthcare facility. The large volume and disparate locations of this data make the electronic health record the only viable way for access. EHR EHR electronic health record Paperwork Patient records include signed forms, hand drawn figures, photographs of wounds, electronic health records, and other various forms of paper-based documentation. EHR EHR electronic health record Advantages of electronic medical records There are several benefits to wide scale usage of electronic health records. EHR EHR electronic health record Reduce healthcare costs One of the major sources of rapid growth in healthcare costs comes from medical imaging. Medicare Part B spending on imaging rose from $6.80 billion in 2000 to $14.11 billion in 2006.[7] Access to a patient's images in an EHR EHR electronic health record, health records, digital health records, e-MedRecords is an effective way to avoid duplicating expensive imaging procedures. Other cost savings include the reduction of medical errors that can otherwise lead to further expensive care. EHR EHR electronic health record Improve quality of care electronic health records, electronic health records An EHR EHR electronic health record, health records, digital health records, e-MedRecords system can help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine enable proliferation of ongoing improvements in healthcare efficacy. EHR EHR electronic health record Promote evidence-based medicine EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. These benefits may be realized in a realistic sense only if the EHR EHR electronic health record, health records, digital health records, e-MedRecords systems are interoperable and wide spread (e.g. national) so that various systems can easily share information. Also, to avoid failures that can cause injury to the patient and violations to privacy, the best practices in software engineering and medial informatics must be deployed.[8] EHRs also have the advantages of electronic medical records (EMR electronic medical records, digital health records, e-MedRecords). In general, medical records may be on "physical" media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure. Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage. When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance. In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic medical records are estimated to improve efficiency by 6% per year, and the monthly cost of an EMR electronic medical records, digital health records, e-MedRecords is offset by the cost of only a few unnecessary tests or admissions.[9][10] Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.[11] Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. health care records, health care records, electronic health records In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, health care records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, electronic health records, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, health care records, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, electronic health records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, electronic health records, health care records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, electronic health records, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange health care records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] e-medrecords, EMR, EHR,e-medrecords, EMR, health care records, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology. In contrast, EMRs can be continuously updated. The ability to exchange records between different EMR electronic medical records, digital health records, e-MedRecords systems ("interoperability"e-medrecords, EMR, EHR,) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13] electronic health records e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, EMR, EHR,e-medrecords, "EMR", "EHR", health information technology, health information technology, health information technology.