When Shakespeare mused about roses and names, he had no idea that 500 years later health information technology terms would come under such contentious scrutiny. But for all the concern about what is an electronic medical record or an electronic health record, the health IT industry knows whatever name their products go by, they had better be just as sweet as the rose.
Clients are not concerned what their systems are called, only that they work and have effective capabilities that will help their practices, according to industry leaders. The seven-month discussion by the National Alliance for Health Information Technology to define an EMR and EHR, as well as four other IT terms, did not produce definitions that greatly affect the market, said Claudia Tessier, vice president of the Medical Records Institute, which hosts the annual Towards the Electronic Patient Record conference. "Expectations that official definitions will dramatically affect the industry are shortsighted," Tessier said in an e-mail.
Under contract with the Office of the National Coordinator for Health Information Technology, NAHIT convened a range of private and public participants to define EHR, EMR, personal health record, health information exchange and regional health information organization. The group added a sixth term, health information organization, during its work to clarify the difference between the process of exchanging information (HIE) and the overseer governing that exchange (HIO).
Proponents of the work say the goal of defining critical IT terms was to reduce ambiguity. "Differences in how a term is used can cause confusion and misunderstanding about what is being purchased, considered in proposed legislation or included in current applicable policies and regulations," NAHIT wrote in its final report.
The key difference between EMR and EHR is their interoperability. EMRs, under NAHIT's recommendation, are used internally in a medical practice and don't have the capability to share information among other providers. EHRs conform to national standards and are able to exchange information among a wider network. EHRs would have to be nationally certified to prove they are interoperable, a stamp of approval already being granted by the Certification Commission for Healthcare Information Technology, which reviews and tests system capabilities for vendors.
And that's the sticking point for some vendors, whose brand names include the term "EMR" but whose systems already conform to CCHIT's national interoperable standards.
NextGen Healthcare Information Systems' EMR already is approved under CCHIT and to change the name would involve spending money and effort to rebrand a trademark, and reproduce materials of a high-quality product, said Sarah Corley, a physician and chief medical officer for the company that provides EMRs to office-based practices. Should NAHIT's terms become adopted by the industry, NextGen's product now has a disadvantage. "It's painted with an inferior name," she said.
The issue for the industry is not whether a vendor calls itself an EMR or an EHR but whether the products have certified national standards, she said. Just giving a product an official term does not make it meaningful, she said.
It's also unclear whether doctors will even understand the difference, or care all that much. Doctors are interested in electronic records, but they don't understand how systems could benefit their practice, Tessier said. Vendors need to explain associated costs, return on investment and the benefits of electronic systems. Buyers will still need to ask vendors what their own definition of an EMR may be, and what the system will offer them. "It would be naive to assume the usage of official terms means that the systems conform either to the NAHIT definitions or to the practitioner's needs," she said.
NAHIT is moving in the right direction, since the government is pushing interoperability, but they haven't considered the implications to implementing such a broad-reaching change, said Vinson Hudson, president of market researcher Jewson Enterprises. "The end is good, but it's going to cost some money to get there," he said.
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