When asked, “What are EMRs and why do you use one?” most clinicians will likely say electronic medical records (EMRs), as well as electronic health records (EHRs), improve patient care while ensuring health care systems get paid. They might also mention the gaps their EMR system leaves in the patient journey.
Clinicians may tell you they use these health IT tools to store a patient’s health information and medical history, but may also describe how overwhelmed they get using isolated health IT tools that disrupt their workflow and make it difficult to improve their quality of care.
Many EMR-using Care teams still struggle with coordinated care and patient retention. To understand why, we need to examine the functions of and differences between an EMR, an EHR, and a Care Management platform.
What are EMRs?
An EMR is essentially a digital version of a healthcare provider’s paper chart. It contains provider notes — mostly about diagnosis and treatment — but also the patient’s medical history, including immunization dates, allergies, diagnoses, prescriptions, and lab results.
Clinicians who join their first Care team may ask “What are EMRs?” and get many different answers. Electronic medical records are systems that capture medical interventions between patients and Care teams. They’re also used to record large billable events in the form of billing codes which help hold payers accountable for remitting payments. An EMR system ensures every single service is documented so health systems can recoup their costs.
Whether it’s a visit with a specialist, a simple check-in, or an updated diagnosis and prescription, an EMR system keeps track of these interactions. This ensures providers are reimbursed and that all expenses are covered. In addition, these systems keep track of what providers bill against.
HealthIT.gov explains how the “advancing care information” category within the “merit-based incentive payment system” program outlines the following objectives for EMR systems:
- Improve the safety, efficiency, and quality of care
- Reduce healthcare disparities
- Engage patients and patients’ families
- Improve healthcare coordination
- Maintain privacy and security of patient health information
- Expand the reach of population and public health
As vital as EMR systems are for revenue, they aren’t built to forge the kinds of relationships required to achieve these lofty goals. Improving a patient’s reported outcomes requires long-term self-care between clinical appointments — which Care teams help promote. Because of their design, EMRs aren’t great at tracking relationship-focused interactions such as a phone call or email to check on a patient between appointments.
What are EHRs?
Although they’d quickly answer the question “What are EMRs?” clinicians may take a bit more time to describe somewhat more complex electronic health records (EHRs). While very similar to EMRs, EHRs are slightly more broad, allowing access to a complete set of patient information. According to HealthITBuzz, EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”
EHRs are designed to extend beyond the health organization that originally collects and compiles the patient information. They’re designed to share data with all the clinicians involved in a patient’s care. The patient information in an EHR moves with the patient — to the specialist, the laboratory, the hospital, or the nursing home — even if they’re located in another state.
HealthIT.gov reports that more than 95% of U.S. hospitals use EHRs, yet they’re still not necessarily delivering engaging patient-centered care or achieving optimal outcomes. That’s because both EHRs and EMR systems are focused on billing and data — not relationship-building.
What’s the difference between EHR and EMR systems?
The EMR system is used daily in even the smallest practice for storing strictly medical patient information: processing payment and insurance claims, scheduling patients, adding new patients, and centralizing patients’ medical and treatment histories.
Unlike paper records, EMRs allow clinicians to track data, identify preventive screening or checkup due dates, and check biomarkers (like glucose and blood pressure readings). But patient information stored in EMRs doesn’t travel easily out of the practice where they were created. Some providers still print and mail records to specialists and health organizations.
EHRs, on the other hand, perform all of those functions and more, as they document the total health of the patient — not just the standard clinical data a provider collects during an office visit. EHR patient information travels with the patient — whether it’s to a hospital across town or to a specialist across the country. This secure data is fully accessible to patients, but it cannot be used or interpreted by the receiving EHR system.
As HIMSS Analytics puts it: “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” The Centers for Medicare & Medicaid Services (CMS) certifies electronic health record technology (CEHRT) that meets meaningful use standards for incentive-based programs to improve patient outcomes. EMRs do not have any certifications and are not standardized.
EHRs bring clinicians one step closer to patient-centered care by allowing multiple parties to share data. However, neither EHR nor EMR capabilities improve all of the value-based metrics needed for better patient retention, compensation, and increased revenue streams.
When is it necessary to use both EHRs and EMR systems?
Delivering a continuum of care typically requires using both EHRs and EMR systems. The EMR provides a comprehensive care record created by a primary care physician and the EHR makes that care accessible to a spectrum of specialists, health systems, laboratories, pharmacies, or nursing homes.
The patient information that lives in an EMR — diagnosis and treatment data — can be uploaded at even the smallest remote clinic — it’s often critical to any Care team that delivers follow-up care.
For example, the patient information gathered by a primary care provider can alert ER teams to a patient’s life-threatening allergy so they can adjust care for an unconscious patient. EMR records can enable EHR users to avoid dangerous medication combinations and block patients who may be trying to obtain excess controlled substances from various providers. The lab results posted in an EMR can prevent a specialist who’s also using an EHR from running duplicate tests.
More complete and updated patient information — test results, symptoms, and health history — allows for all providers to make more accurate diagnoses and prescribe more personalized, timely treatment. Comparing records from both EMRs and EHRs to track trends may motivate patients to follow their care plans and transform their lifestyles.
What are the limitations of EHR and EMR systems?
The emotional burnout, depersonalization, and decreased sense of accomplishment make many physicians feel strapped by their EHRs due to these limitations:
Long implementation time
Researchers at the National Institutes of Health have estimated that EHR end-users spent 134.2 hours on implementation activities associated with setting up and learning a new system. This loss of productivity may potentially lead to losses in revenue.
One study found that productivity declined approximately 20% in the first month of implementation, 10% in the second month, and 5% in the third month. This resulted in lost revenue of $11,200 per provider in the first year. EHR and EMR systems can cause problems like data bottlenecks, staff training expenditures of time and money, as well as skill mismatches in collaborative teams.
High implementation costs
The U.S. Library of Medicine tracks financial issues surrounding EHR and EMR systems, including adoption and implementation costs, maintenance costs, revenue loss due to temporary productivity lapses, hardware and software purchase and install costs, paper-to-electronic-chart conversion, and end-user training.
The initial costs of software, training, and installation total approximately $22,038, and hardware costs are nearly $13,000 per full-time provider in a solo or small-group primary care practice. A five-physician practice launching an EHR system will spend approximately $162,047 (or $32,409 per physician) in the first 60 days. Ongoing EHR maintenance costs averaged $8,412 per full-time provider per year.
Using EHRs is burdensome for physicians, who, according to Advanced Data Systems, spend on average 45 minutes on their computer per patient — that’s time they can’t dedicate to treating more patients. According to Computer World, clinicians continually complain that
EHRs require far too many mouse clicks and data entry pagination, which diverts attention from patients — impeding the doctor-patient relationship and blurring a robust picture of their health.
EHRs may cause several unintended consequences, such as shifts in Care team power structure, a draining overdependence on technology, and medical errors due to poorly designed EHR system interfaces or inadequate training. All of these issues lead to major disruptions in clinicians’ workflows, which can generate resentment.
Lack of interoperability
According to the National Institutes of Health, there are hundreds of government-certified EHR products used by providers across the country, each with its own clinical terminologies, specifications, and functions — which makes it difficult to create a standard data-sharing interoperability format. Even EHRs built on the same platform may not be interoperable when they’re customized to a provider’s unique workflow and preferences.
For two EHR systems to be truly interoperable, they must be able not only to exchange, but to use that data. That requires standardized coding for the data so that it can be interpreted by the receiving EHR system. Such standards do not exist in the U.S. healthcare system. That’s why the intensive task of inputting and interpreting data must often be repeated whenever a patient transfers to a new clinic or facility. This problem has intensified due to Medicare and Medicaid reimbursement regulations.
Industry initiatives like the CommonWell Health Alliance and Carequality are advocating for vendor-neutral interoperability and seamless data-sharing between facilities — but much work is needed. The Argonaut Project is promoting interoperability standards in the healthcare industry. Innovation is speedily making the transfer of electronic patient information easier and more convenient.
Risk of cyber attacks
Data breaches across the country have exposed patient names, addresses, and medical histories too many times. Enhanced cybersecurity is a challenge for EHRs.
The HIPAA Journal reports that phishing scams have become the most popular method for stealing patient information in the United States. Cybercriminals use the stolen patient data to commit fraud and contact users to get them to share financial information, which they use to buy items illegally or to cover their own medical care. Victims get locked out of cards and become burdened with exorbitant credit card bills and the hassle of fixing their records.
Potential for medication error
The ECRI Institute, which tracks safety issues at healthcare facilities, found that medication error caused by dose timing discrepancies in EHR systems is a common problem for healthcare providers in every specialty. It also causes patient negativity and mistrust.
Configuration and user issues occur when the EHR order-entry system does not prominently display scheduled medication timelines. Prescribers often have trouble modifying times and communicating when a medication can wait and when it needs to be administered immediately. These serious errors can endanger patients and put providers at risk of malpractice suits.
Is there a better way to store and process patient information?
Healthcare providers across the country are reimagining the way they deliver care. There’s one
Care Management platform that has lived up to their imagination: Welkin Health. These unique features are already helping Care teams resolve the issues above:
EMRs and EHRs have produced a very sterile, clinical approach to patient care. They just aren’t designed for optimal patient-provider communication. It shouldn’t be a hassle to check in on patients or expeditiously respond to their questions. Texting and video are so much more direct and personal — and they provide documentation in a patient’s medical record that a conversation took place. Direct communication is much more powerful in promoting patient satisfaction, which leads to better care plan adherence — and ultimately, outcomes.
Even inside the exam room, the paper charts of the past – while certainly not clickable – gave clinicians more color and texture around each patient’s journey. They could flip through their notes to see exactly who did what prior to examining each patient. EMRs promised but did not deliver. So much of the patient story is learned in the exam room itself. But if clinicians are focused on entering patient data into the EMR system, they’re spending less time looking at the patient, being present with them, giving them empathy, and building meaningful relationships.
The Welkin Care Management platform can be used in place of an EHR or EMR as long as your organization isn’t mandated to use a certified product (like Medicare and Medicaid organizations are). Even if your organization is mandated, Welkin can be integrated with your EHR or EMR.
Team-first care delivery
Unlike EHRs which put the primary focus on major medical events, Welkin is an extremely flexible Care Management platform. We understand that every Care team manages patient relationships differently and needs different automated procedures to ease team members’ workloads and increase efficiency.
EMRs typically offer a one-size-fits-all program. Welkin, on the other hand, is customizable, allowing Care teams to share data or interact with patients who have more pressing needs.
As health care providers shift away from the traditional fee-for-service model to value-based care, Care Management tools can fill the gap. They can either supplement your existing systems or provide you with a one-stop platform that manages all patient engagement services.
With leading integrated applications already built in, along with APIs for you to build whatever else you want, you can create a platform that works exactly for you now. You can also integrate these features as you grow:
- Enable your patients to eSign secure documents with DocuSign
- Validate patient medication with Medi-Span, which is built into Welkin
- Leverage Welkin’s integration with DrFirst to execute electronic drug prescriptions
- Enjoy Welkin’s HIPAA-compliant Zoom-based telehealth services
- Use codified reference data to support your billing procedures
- View or build your own dashboards and reports with Sisense
- Sync with your calendar provider to schedule inside Welkin
Welkin takes security seriously. With the help of leading third-party security organizations like Service Organizational Controls (SOC), we’ve implemented a number of technical, administrative, and physical safeguards designed to protect your confidential data. Welkin enables you and your associates subject to HIPAA to use its secure environment to process, maintain, and store patient information.
Welkin also protects your data integrity when you share it between Care team members using flexible role-based, attribute-based, and territory-based security permissions. You can also use our time-stamped audit trail to track who changed user levels, in what location, and at what time. For added security, your team can choose either single sign-on (SSO) or multi-factor authentication (MFA).
Ready to start reimagining your Care team’s workflow?
Schedule your patient-centered Care Management demo today.