Learning the alphabet of healthcare IT: healthcare IT is like a great big bowl of alphabet soup, with three- and four-letter acronyms swimming together in spoonfuls

Healthcare Financial Management, March, 2006 by Randy L. Thomas

While most people would agree on the word that each individual letter in an acronym stands for, there is significant confusion and conflict over what exactly the technologies represented by these acronyms are supposed to do. For that reason, industry standard definitions of these technologies are needed.

The good news is that significant work has been done to define some key concepts. Unfortunately, this news isn't necessarily being heard. Every day, news items are published, vendor announcements made, and presentations given that all use healthcare IT terms differently. Three of the most misused, misunderstood acronyms are EHR, EMR, and PHR.

Electronic Health Records

A good definition for electronic health records comes from the Healthcare Information and Management Systems Society, which defines EHRs as "a secure, real-time, point-of-care, patient-centric information resource for clinicians." According to HIMSS, EHRs aid clinicians by providing access to patient health record information when they need it, as well as evidence-based decision support. EHRs automate and streamline clinician workflow, ensuring that clinical information is effectively communicated and decreasing the potential for delays or gaps in care. They also support the collection of data for uses other than clinical care, such as billing, quality management, outcomes reporting, and public health disease surveillance and reporting.

In short, EHRs drive more efficient, effective healthcare delivery. EHR applications come under a variety of labels, such as the computerized patient record, and are provided by numerous vendors.

Another authoritative source for the definition of EHRs is Health Level 7, a healthcare standards development organization. The organization was asked in 2003 by the Institute of Medicine to construct a definition for EHRs. HLT's definition lists approximately 110 discrete functions that should be present in an EHR. This definition is careful to articulate that not all of the required functions need to come from the same application or vendor. HL7's definition of an EHR was the first to establish that such a system could be accomplished by integrating the required functions from different applications and vendors within a single organization, such as a hospital, physician office, or home health agency.

The Certification Commission for Health Information Technology, which was awarded a contract by the U.S. Department of Health and Human Services to define and deploy criteria and a process for certifying EHRs, has used the HL7 definition as the basis for its certification criteria (see www.cchit.org). The CCHIT is currently piloting the criteria and process for certifying ambulatory EHRs. The criteria and processes for other venues of care will follow.

Electronic Medical Records

The acronym for electronic medical records is frequently used interchangeably with the acronym EHR. However, an EMR is not the same as an EHR. An EMR is the electronic version of a legal health record. It is a subset of EHR functionality and data.

The American Health Information Management Association has defined the legal health record as "the documentation of the healthcare services provided to an individual in any aspect of healthcare delivery by a healthcare provider organization. The term includes records of care in any health-related setting used by healthcare professionals while providing patient care services, for reviewing patient data, or documenting observations, actions, or instructions" (see www.ahima.org). In summary, the EMR consists of electronic versions of the types of data and documents found in a paper-based legal health record, such as structured data (i.e., data generated by the EHR or ancillary systems), diagnostic images, wave forms, scanned images of paper documents, and other types of documentation.

Personal Health Records

A personal health record is a digital health record that is owned, updated, and controlled by the consumer. It contains a summary of health information from throughout an individual's entire lifetime.

Examples of information contained in a PHR include a record of immunizations, family health history, personal health history (i.e., significant illnesses and surgical procedures), significant diagnostic procedures and dates (such as mammograms), a list of health problems, a current medication list, allergies, contact information for physicians seen on a routine basis, and a physician visit history. A PHR also may contain information from other healthcare providers and payers, such as diagnostic test results, as well as self-reported health monitoring information, such as weight, blood glucose levels, and blood pressure. In the future, as home health monitoring devices become more sophisticated, this information may be directly logged into the PHR from the device via wireless technology.

Typically, PHRs are web portal-based. This makes them accessible from anywhere at any time by the patient and other authorized persons. Security and privacy protocols ensure that only authorized users have access.