As President Bush's program to spur adoption of heath information technology gained momentum in 2005, the debate over what to call the electronic products being promoted became louder and more intense among participants in the field -- while the general public responded with either apathy or confusion.
The "electronic health record" vs. "electronic medical record" issue appeared to reignite this past year. The results were some painfully earnest arguments that were sometimes difficult to penetrate and often resulted in glazed looks on the faces of people listening or reading them.
"The public hasn't made a distinction" between EHRs and EMRs, said Pat Wise, R.N., a retired U.S. Army colonel and the Healthcare Information and Management Systems Society's vice president of EHR initiatives. "They probably think they're synonymous."
She added that most physicians don't know the difference either, explaining that HIMSS recently convened focus groups of 10 to 12 physicians in paper-based practices and "not one of them knew what an electronic health record was."
Promising to offer concise definitions, Wise said that EHRs "are what the nation aspires to and what President Bush calls for," but EMRs are mostly what we have right now.
She explained that an EHR is made up of two components: a personal health record which includes patient-inputted information on symptoms or disease-management data; and an EMR or an EMR summary.
"An electronic medical record is owned by the organization, practice or corporation that you received your healthcare from -- be it St. Elsewhere, County-Municipal, or Doc Smith," Wise said. "You don't want every little bit or byte they have on you. You want summary data, and that summary becomes part of your electronic health record."
Explaining further, Wise said an EMR can contain episodic information from your two-week stay in a local hospital or the visit to an emergency department in another state after you bumped your head on vacation.
"When you're discharged from St. Elsewhere, you know they don't hit the 'delete' button and wipe out everything," she said. "And, while that information is theirs to own, it's also expected that it's theirs to protect."
An EHR is a cradle-to-the-grave summary record that may not contain all the information collected over a lifetime of receiving healthcare, but it can contain pointers to where more information can be found, Wise said.
Two factors are now helping to add confusion to the EHR-EMR debate: the federal government and computer spell-check programs.
Wise said the federal government erred when it granted a $7.5 million contract to the Certification Commission for Healthcare Information Technology to evaluate certification criteria for electronic health records.
"In all actuality, they're certifying vendors' ambulatory-care EMR products, because there is no real EHR yet," Wise said. "So now the marketplace is totally confused."
Spell-check programs are giving the term "EMR" some staying power as well, because many computers will automatically change "EHR" to "HER," forcing people who don't know how to override their spell-check function to use EMR by default. "My job title is 'vice president of EHR initiatives,' imagine how long it took to get spell check to ignore that," Wise said. Dan Michelson, the chief marketing officer for Chicago-based IT vendor Allscripts, said it's such a common problem that the company has produced a set of standard instructions which it sends out to people as a public service.
Here is a copy of those instructions:
"It sounds funny, but it's safe to say we have all made the mistake by now of having 'HER' show up instead of 'EHR' in a Word document, PowerPoint, e-mail, etc. It's not just Allscripts (of course), it's a problem for everyone in the industry. Pretty silly thing, but pretty embarrassing.
So ... here's how to keep it from happening for all Microsoft Office applications:
This will fix the problem for all Office applications ... but hold on!
To fix this in Outlook, you need to take two more steps:
"There. That's it. This will keep 'HER' from showing up."
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