Mike On Healthcare

I agree that there is a lot of confusion and digarseement with the definition of terms associated with digital health records. The confusion comes from having too many meanings packed into terms like EMR, EHR, and PHR. Perhaps we are trying to accomplish too much with these terms, as some people want them to define a type of information, others are trying to define a type of system, and yet others are referring to the intended application or purpose of the information.As you point out, in Canada the term EMR is most commonly associated with the systems used by physicians in their office or in an out-patient clinic. EHR is often associated with the data in Health Authority systems, or in emerging Provincial systems. For example, in BC the Provincial Lab Information System (PLIS) is referred to as part of the EHR. But lab data in the Fraser Health Meditech system is also called EHR.Recognizing the confusion, the Auditor General of BC in a Feb 2010 report provided definitions for electronic health record , electronic medical record and regional electronic health record. The report distinguished each of these systems not by the type of data, but by the users of the system. They state that EMR is used by physician’s in their office, a regional EHR is used by regional health authorities, and EHR is used by authorized care providers across the province.This doesn’t clear up the confusion for me. I’m still hung up on the letters in EMR, EHR, and PHR. If you ignore E and R , as we are talking about Electronic Records in all cases, then M is for Medical, H is for Health, and P is for Personal. The word Medical is perhaps being used to mean Healthcare , whereas Health is more of a measurement of status not of treatment. The Canadian Bar Association reports that Your medical records actually belong to the doctor or hospital that made them, not to you. That’s also the case with dental records and nursing home records. But the information in the medical records belongs to you, and normally, you have a right to see that information. Furthermore, the law requires doctors to make sure the information in your medical records is accurate and to keep it private. From my point of view, the law needs to have a clear definition of your medical record [care provided to you] so that patients, care providers, and other parties can be properly and fairly treated. This is all about Healthcare as opposed to about Health.The HIMSS Analytics definition states that an EMR is a system used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO. This is consistent with the definition by the Canadian Bar Association. It’s about Healthcare and not about Health.Of course EMR defined around a Healthcare definition will certainly include Health information. When Health information is extracted from a set of EMR systems and made available for sharing that forms part of a Health record. Conceptually we can talk about having a complete health record , but I don’t think it’s possible or even desirable to have this under the custodianship of care providers. For example, a personal health record might include all sorts of consumer-reported data relevant for monitoring and managing the health of a specific person. Such data may be personal/private, and is not collected by or stored in CDO systems, but it is certainly part of the complete health record for a person.The HIMSS Analytics definition of Electronic Health Record as A subset of each care delivery organization’s EMR is more narrow than your definition of EHR. Most of the people that I talk to about EHR use this more narrow definition. There is limited understanding of the person-centric vision you describe. Where will this go in the future? I think your person-centric vision is where it’s headed for Health Records. I think that Healthcare will continue to be provider-centric, as the purpose of those records has more to do with the provider than the patient.Will the terms EMR and EHR become moot when fully interoperable electronic health records become more commonplace? Who knows. Whatever happens, I’ll bet that vendors will continue to market systems that appeal to their target customer using a mix of inconsistently defined EMR, EHR, and PHR for many years to come.