Who EHR is used by
is recorded and maintained by healthcare providers over time and can be shared
across practices and organizations (clinicians, laboratories, pharmacies e.g.)
EHRs are only accessible by authorized personnel. This includes primary health
care providers, specialist, nurses, radiologist, laboratory technicians,
pharmacist, radiographers, administrative staff etc. Additionally, EHR are
accessible by the patient (and their parents if under 18) through a patient
A person who contributes to a medical record is called a documenter (DeVore, 2015). Although, many different members of a healthcare facility can contribute to a patients EHR , how an EHR is used in a given healthcare setting, for instance, what kind of information is being documented and reviewed, often depends on the position of the staff member. For example, administrative staff, such as the front-desk receptionist, will use an EHR to document data about the patient in preparation for their examination (DeVore, 2015). This information is gathered using a patient information form (PIF), found in the EHR system. The information documented can include the (patients) reason for the visit, copayments, request for prescription refills and authorization to obtain or release medical records from other physicians (DeVore, 2015). Additionally, the administrative staff may document appointment information, such as no shows or cancellations (DeVore, 2015). Another common documenter is the medical assistant. The medical assistant is the staff member who accompanies the patient in the examination room and is responsible for measuring the patient’s weight, height, and vital signs (DeVore, 2015). The medical assistant will record this information into the EHR. Additionally, the medial assistant will use the EHR to take notes of any preliminary health information, such as the reason why the patient is visiting, their current medications, allergies etc (DeVore, 2015). Lastly, the main documenter for the patients’ medical chart is the physician. The physician will use the medical chart portion of the EHR during and after the examination to document the examination findings, care plans and any other observations made during the patient counter (DeVore, 2015). All additions to a patient’s medical chart mut be approved by the physician (DeVore, 2015). In addition to the medical record, the physician will also use additional functions of the EHR such as the clinical decision support (CDS) and the computerized physician order entry, which allow physician to order medications electronically. These systems are described later in the text.
Healthcare providers are the key documenters in the EHR, however, as seen earlier with the administrative staff, other people within the healthcare system can access an individual’s EHR. For example, a medical biller may use an induvial EHR to document insurance information (DeVore, 2015). Generally, the function of the EHR system (e.g. medical or administrative) that a given staff member is using to document or review information corresponds to their work responsibilities.
In addition to healthcare providers and staff, the patient themselves also have access to their EHR though a patient portal. The patient portal allows patients to have direct access to their medical record, tools that can support their health and treatment, and allows them to share their information with other providers. In their patient portal, patients will find information regarding (HealthIT, 2017):
- Recent doctor visits
- Discharge summaries
- Lab results
Some patient portals also allow patients to (HealthIT, 2017):
- Securely message their doctor
- Request prescription refills
- Schedule non-urgent appointments
- Check benefits and coverage
- Update contact information
- Make payments
- Download and complete forms
- View educational materials
EMRAM implementation around the world
HIMSS Analytics developed a map for assessing the hospitals which adopted the EMRAM model in order to track the maturity levels achievement (stages 6 and 7) for each hospital. The map is constantly updated and can be consulted here: https://www.himssanalytics.org/europe/stage-6-7-achievement.
Since it was founded in 2005, more and more hospitals started to adopt it. According to HIMSS data, the United Stated and Canada are leading in this domain, with over 6000 hospitals using EMRAM and most of them have very high maturity levels (stage 6 and 7) (Analytics, 2009). Moreover, countries like Ireland, UK, Netherlands, France, Spain, Italy, Switzerland, Belgium, Finland, Sweden, Turkey, KSA, UAE, India, Malaysia, Brazil, Singapore, Australia, China also attained stage six maturity levels according to HIMSS data (Analytics, 2009).
There are several examples of the implementation of EMRAM in hospitals across the world such as: US (Furukawa & Pollack, 2020), US (Kharrazi et. al., 2018), Canada (Sulkers et. al., 2019), Turkey (Kose et. al, 2020).
EHR System structure
The structure and content of EHRs has varied over time. EHRs include both unstructured free text and coded data. The most recent widely accepted structure encompasses three main elements of EHR: time-oriented, problem oriented and source-oriented EHRs (Häyrinen et. al., 2008). In the time-oriented electronic medical record, the data are presented in chronological order. In the problem-oriented medical record, notes are taken for each problem assigned to the patient, and each problem is described according to the subjective information, objective information, assessments and plan (SOAP). In the source-oriented record, the content of the record is arranged according to the method by which the information was obtained (e.g. notes of visits, X-ray reports and blood tests). Within each section, the data are reported in chronological order (Häyrinen et. al., 2008).
Moreover, sustainable business models need to be developed in order to create value for a healthcare provider as well as for the patient, looking at both costs and benefits of e-Health. Therefore, EHR are a good business model for both healthcare providers and patients. Here are some examples of successful EHR business models: https://www.businessinsider.com/ehr-systems-vendors. There is also evidence that EHR can be further improved: https://hbr.org/2020/06/its-time-for-a-new-kind-of-electronic-health-record.