Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Tuesday, August 04, 2009

Sorry Words Really Do Matter – We Need to Stop this Definitional Deception and Confusion.

The intellectual dishonesty that I am seeing in the discussions of e-Health in Australia is really getting to be a little annoying. Most especially naughty are the suggestions that the benefits that will flow from PHRs and EHRs are the same and that the terms can almost be used interchangeably. This is just not true!

It seems others are battling the same issues.

The following appeared a day or so ago.

Electronic Records: EMR vs. EHR
The industry is tossing around the terms EMR and EHR as if their meanings were identical; they're not.

By Chris Hobson, MD

Health IT industry news followers have probably noticed industry confusion and inconsistencies regarding terminology about what to call patient information that is collected and shared electronically.

In fact, analysts, vendors, journalists and practitioners all are guilty of using the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably as if they are one and the same. In fact, these are two different terms that address two different sets of business needs with different -- although overlapping -- sets of features and capabilities. The distinction is more than minor semantics, and it's crucial for health IT decision-makers to understand the difference.

Electronic record

To many, an electronic record is considered to be any clinical record that isn't paper-based or hanging on a clipboard. The problem is, this doesn't describe how the data will be used, gathered or shared. Will the electronic record be used only within the confines of a single office or practitioner, or within a single regional health system? Alternatively, will the data be shared across a wide range of different providers, such as specialists' offices, labs, insurance providers and government agencies? For the sake of clarity and accurate understanding, it is important to distinguish between electronic records that can be shared widely and those that are designed to reside within a single organization.

When discussing digitized medical records, depending on the software vendor, geographic region, country or even the personal preferences of the presenter, the two terms -- EMR and EHR -- are being used interchangeably. Unfortunately, that distinction has been lost in the flood of material appearing in the literature.

According to the Healthcare Information and Management Systems Society (HIMSS), an EMR is a component of an electronic health record that is owned by the health care provider. The EMR is a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information within the confines of a single organization. An EMR system may touch clinical data repositories, lab applications and patient information management systems, among others -- but all within the reach of a single organization.

EHRs, on the other hand, comprise as far as is possible, a complete and unified view of all the patient's clinical assessments and care records drawn from across a wide region corresponding to all the providers who are seeing the patient -- the totality of his/her personal data, state of health and delivered care. HIMSS defines EHR as a longitudinal electronic record of patient health information produced by encounters in one or more care settings.

An EHR consists of data provided from organizations throughout the service delivery chain -- laboratories, providers, pharmacists, insurance payment records -- as well as all of the patient's personal data such as date of birth, address, weight, provider visits, and so on. These records can be shared easily across separate health care providers, labs, government agencies and insurance companies, made available whenever and wherever the patient is seen

More here:


Additionally we have had the UK Conservative Party pushing PHRs – rather like the NHHRC – again forgetting about the place and need for EHRs.

Vaulting ambition

16 Jul 2009

If recent press reports are right, the Conservatives are thinking of giving commercial health record platforms a big role in their forthcoming NHS IT strategy. But how have Microsoft HealthVault and Google Health gone down in the US? And why are both still in beta? Neil Versel reports.

British newspapers have been full of speculation that the Conservatives could give patients the option to transfer their medical records to commercial health record platforms; junking parts of the National Programme for IT in the NHS in the process.

As E-Health Insider has reported, if this happens the two most likely beneficiaries will be Google Health and a Microsoft offering called HealthVault. However, like the National Programme, they remain works in progress, hampered by the slow adoption of electronic health records in general, public apathy and occasional growing pains.

Not the only PHRs

HealthVault, introduced in November 2007, and Google Health, unveiled in May 2008, both remain in beta release, with access restricted to US residents - although Microsoft has contracted to introduce HealthVault to Canada next year and to provide accounts for US medical tourists in Thailand.

Both products have grabbed plenty of headlines in the American press, but they still haven’t grabbed many regular users. Microsoft and Google haven’t said so, but anecdotal evidence from several large US hospital systems suggests that personal health record platforms (PHRs) are not in widespread use.

A third offering called Dossia provides some sense of optimism. Dossia is a project of several major corporations, including Wal-Mart Stores, BP America, Intel and Sanofi-Aventis, to provide portable PHRs to their US employees.

Wal-Mart has said that about 50,000 of the approximately 1m people it provides health insurance for in the US are Dossia users, which is a higher rate of PHR adoption than several insurance companies report.

Both Microsoft and Google prefer to call their healthcare products ‘platforms’ rather than PHRs. Microsoft representatives declined to be interviewed for this story and Google did not respond to multiple requests for comment.

But in a May interview with US publication MobiHealthNews, Google Health product manager Dr Roni Zeiger said: “A key part of the value of Google Health is that users can not only use the application, but also connect the application to a variety of other sources, whether importing data from a hospital, pharmacy, lab company or sharing with a family member or even connecting with a service like the Heart Attack Risk Calculator from the American Heart Association. All of those iterations are possible because Google Health is, indeed, a platform.”

In Canada, where telecommunications firm Telus has obtained an exclusive HealthVault license, users will have access to applications for chronic disease management, wellness and disease prevention. According to Telus Health Solutions executive vice president Marc Filion, the HealthVault platform is for health information management, providing a place for such things as reminders of appointments, diet and exercise tips and smoking cessation advice.

“[Patients] want tools to manage their health,” Filion says. The company will brand its platform as “Telus Health Space, powered by Microsoft HealthVault” when it launches the product in 2010.

“These [platforms] exist to aggregate data,” explains Dr Daniel Sands, director of healthcare and medical informatics for the Internet Business Solutions Group at Cisco Systems. He is unsure whether this is best way to build a complete EHR and argues that many questions remain. “Where do you store the data? Who’s going to vouch for the safety of the data? Who’s going to pay for it?” Sands wonders.

Lots more here:


For a really clear exposition of the optimum definitions of the terms in my view it is hard to go past the highly consultative study done for the US Office of the Co-ordinator for Health IT to sort the usage out.

The full report can be found here


The issues they identified were:

Major themes from work group deliberations and public comments

Discussions arising from Alliance-led work group meetings and observations collected from two public forums and two public comment periods helped identify several major themes concerning electronic records and sharing of health-related information:

Interoperability is the common thread running through health IT terms. Interoperability is the essential factor in building the infrastructure to create, transmit, store and manage health-related information.

Nationally recognized standards are required to enable the flow of information. EHRs, PHRs, and HIE require the use of nationally recognized interoperability standards to enable the flow of information reliably, consistently, accurately, and securely.

The principal difference between an EMR and an EHR is the ability to exchange information interoperably. An EMR aligns with the prevailing state of electronic records today (whether the record is branded an EMR or an EHR). However, the movement of the industry is toward electronic records that are capable of using nationally recognized interoperability standards, which is a key defining component of an EHR. With the passage of time, electronic records not capable of exchanging information interoperably will lose their relevance. Thus the term EMR is on course for eventual retirement.

Control of information distinguishes EHR from PHR. The information in a PHR, whether contributed from an EHR or through other sources, is for the individual to manage and decide how it is accessed and used. Electronic portals of information on an individual that are hosted by a provider or payer organization, without transferring the control of the information to the individual, are not PHRs but rather examples of giving individuals access to information in an EHR.

Records contain health-related information. Because of their historical origin, the prevailing terms for electronic records retain an outdated differentiation based on a “medical” or “health” orientation. In fact, both types of records can and do contain a broad range of health-related information, and the differentiation is now along the lines of readiness to make that health-related information interoperable. In this report, health-related information refers to clinical and administrative, health and wellness data and information.

HIE is process. HIO is an oversight organization and RHIO is a type of HIO. In many instances, HIE has been used to describe both the process of health information exchange and the entity overseeing and governing the exchange. Consequently, HIE and RHIO were often used interchangeably. To provide greater clarity, three terms are defined to achieve both separation of meaning and a construct to accommodate a wide range of current and future organizations for information sharing.

Definitions Reached

The Definitions this study reached were as follows.

Electronic Medical Record.

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

Personal Health Record.

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

----- End Definitions

I think we all need to make sure we are very clear what we are talking about both in terms of what we think is needed strategically and what we know will be achieved by implementation.

As I said of the NHHRC’s initial discussion paper as well as the final report we need both – with an emphasis on EHR as this is the technology where there is an evidence base to support adoption and use. This is why the NHHRC recommends implementation and funding of the Deloittes National E-Health Strategy – which has that emphasis – as well as the adoption and use of PHRs.

As I have also said before what is now needed is the plan to get us from where we are now to where we need to be both with EHRs, PHRs and indeed clinical information networking.

Remember EHRs and Secure Clinical Messaging can make the lion’s share of the difference and only when these are in place will there be much information to populate the PHRs. It is also the only way that data for so called Shared EHRs – which are not the same as PHRs – can realistically be created.

This plan is yet to be done and is what must come next.

Lastly with this in mind the absurdity of mandating contribution of EHR information to PHRs, without creating the EHR infrastructure becomes pretty clear. Not a good idea at all I believe.



Michael Legg (President, HISA) said...

I couldn't agree more! This was a discussion initiated with the Coalition for eHealth when use of the term 'individual electronic health record' first appeared in Australian policy papers. There needs to be an agreement and wide understanding of the meaning of these words or I fear we will have an abundance of confusion confounded by ignorance.

Anonymous said...

Most people would agree BUT the problem is that the IT industry thrives on creating confusion. Think back to Y2K. What hope have we got?

Dr David G More MB PhD said...

Sadly, rather than the industry, we have organisations like the NHHRC being careless in the way they use these terms. They, of all people should be more careful.


Anonymous said...

Slightly off-topic, I haven't seen much comment here about the notion of patient-controlled health records - EHR/PMRs. What evidence is there that any significant percentage of consumers want such a capability? And for those who do, what evidence that, once they've obtained their record, it won't suffer the fate of the vast majority of Twitter accounts - never used again?

If I had to guess, I would say that maybe 5% would actively control their record (whatever that might mean). The vast majority would be quite happy to leave their EHR/PMR where their existing record is now; with their GP.

Dr David G More MB PhD said...

That may be true, but providing access to the information does attract significant use. Kaiser Permanente say about 30 percent of their enrolees use their access and record as I recall. It could now be even higher.


Unknown said...

If they're talking about Health Manager, the scope is much greater than just the health record.