Actual Electronic Information Exchange Needs to Become Routine
Dr. William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University, w-hyman@tamu.edu
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A recent e-discussion on EHRs and EMRs reminded me that back in ancient times, e.g. 2011, the terminology Electronic Medical Records (EMR) and Electronic Health Records (EHR) were both being used and were said to have distinct meanings. EMRs were to be an electronic version of the practitioner or hospital medical record. Such medical records were of course well known as paper documents, were mostly provider specific and the providers resisted sharing it with patients even after it became well established that the patient had an absolute right to both see and have a copy of their “chart”.
EHRs, especially under Meaningful Use, envisioned a collection of EMRs (as defined above), i.e. an integrated but practitioner produced big picture of an individual’s health status and their treatment across multiple providers and, importantly, multiple specialties. So far EHRs have not met this goal and have instead largely been EMRs. Collecting and sharing a patient’s medical data has not reached real life as we know it, except perhaps in a few settings where a large but unified system encompasses multiple providers and uses a truly integrated electronic record that all practitioners can look at and populate. The VA;s Vista is noted to be a good example of this, but with the caveat that it can’t share data with the DOD, and at least one project to create a dual system ended in failure. Those of us who see multiple individual doctors and related services have become used to seeing the doctors working on their own electronic record (while perhaps muttering under their breath or even out loud). Yet depending on our level of health care consumption, we are equally familiar with faxed and hand carried data going between specialists.
The term PHR, Personal Health Record, also had its day. PHR is a patient generated record which is used to collect information for their own perusal and to maintain records such as immunizations and lab data that can be shared with a doctor, in part because the doctor can’t access your other provider’s medical record. A PHR might also be used for non-provider derived yet relevant data such as diet and exercise. This is the “wellness” space that many app developers want to be in, especially those savvy enough to realize that they want to be in a consumer environment rather than a regulated environment. While some careful and fastidious people are good at maintaining a PHP, in whatever form, many others are not. Anecdotally, I was told by a urologist that they expect men who are engineers to come in with a spread sheet of their PSA values, especially if they have moved around a bit and/or if they have otherwise gotten values from different providers. I cannot confirm that this is an accurate stereotype.
For those that are cognizant of the differences between EHRs, EMRs, and PHRs, such differences may become moot if actual electronic information exchange becomes routine, even automatic. If (when?) this occurs we might have one electronic record which is our EHR and includes all of our EMRs. And if it were accessible to us as well as our health care professionals (and insurance companies and public health entities) at least some PHR functions would become unnecessary.