Electronic Medical Records

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Ahmet Kocyigit, Admin, Laura Ritchie, WikiSysop and Kim Jackson

Introduction[edit | edit source]

An electronic health record (EHR) (also electronic patient record (EPR) or computerised patient record) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations.[1] It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.

Purpose[edit | edit source]

Its purpose can be understood as a complete record of patient encounters that allows the automation and streamlining of the workflow in health care settings and increases safety through evidence-based decision support, quality management, and outcomes reporting.[2]

Data Types[edit | edit source]

There have been different definitions to describe the use of electronic systems to collect patient data. While these terms have been used interchangeably, each of them has its specific use case [3];

  1. The Personal Health Record (PHR): An individual and personal account for medical history in a digital format.
  2. The Electronic Medical Record (EMR): A provider-based system that includes all documentation for a patient covering all services provided within an enterprise.
  3. The Electronic Patient Record (EPR): A patient-centered system containing only patient documentation

These systems are structured around their technical capabilities, which will determine factors of stored data such as type and quantity, such as;

  • Medical imaging devices can store the raw data of the screening within each patients file
  • Video recordings of surgical interventions or medical tests can be archived within capable systems
  • Internal memos and notes can be stored in their relative fields as text
  • Correspondence with third parties can also be stored (Pharmacies, patients, government agencies, etc.)
  • Legal documents such as consent forms can be backed up and accessed digitally to ensure safe medical practice

Electronic devices can be networked to allow spontaneous access and/or uploading of all these data types. An internet connection via a secured network will also enable synchronization between buildings and organizations.[4]

Role in Healthcare[edit | edit source]

EHR systems are used in a variety of ways within healthcare infrastructure. A wide range of uses exists such as awareness programs for communicable diseases, automated alerts via the use of existing data, and statistical inferences for use in oversight of public health. Progression of technology allows for new tools to be implemented and improvements made for increasing quality and efficiency. While the progress of research has been lacking relative to the fast pace of technological discoveries, with time these components show great potential to form a more robust and advanced frame for all types of health services. [5]

Role in Research[edit | edit source]

Electronic data systems can be used in clinical research environments to support clinical research processes. institutions that are dedicated to research can benefit from specific form design, documentation, clinical decision support, and research protocol order sets. This approach can enable easier adherence to legislations while making easier creation of accumulative and reusable data. This in turn can provide valuable large datasets for refining further research efforts. [6]

Security[edit | edit source]

The 2021 HIMSS Healthcare Cybersecurity Survey gives valuable information with the help of healthcare cybersecurity professionals that has responsibility for day-to-day cybersecurity operations. The findings of this annual survey will provide health professionals with insight and awareness for using electronic data systems.

For 2021 important bullet points of the survey is as follows;

  • Phishing is the most prominent malicious attack vector for these systems, health professionals being a primary target because of their access.
  • These malicious attacks generally aim to gather information of financial value. Financially valuable data should have higher standards of security and access.
  • Disruption of these systems, which some institutions heavily depend on, can occur during these attacks. There should be contingencies in place for such a scenario to continue health care services. [7]

EHR in Physiotherapy[edit | edit source]

Physiotherapy services can benefit from the electronic data approach. There have been attempts to implement such systems which paved the way for the specific design needed in therapy. Tele-rehabilitation also accelerated this process due to its remote and digital nature. These systems can hold examination, diagnosis, treatment plan and patient history data built around the ICF (The International Classification of Functioning, Disability and Health). While the advantages are clear, there remains the process of certifying these systems for general use and security along with the implementation in current clinics. [8] Pilot studies conducted to understand the current attitude of clinicians to these systems have reported a critical need for digital literacy, motivation, and an understanding of the advantages of electronic record systems among physiotherapists. [9]

The Future of EHR[edit | edit source]

Data collected through providers and researchers is gaining momentum both in volüme and variation. Funding limitations, legal obstacles, and ethical considerations are the main problems that require attention before electronic data gathering can evolve into a much more significant subject. The technology to process and analyze vast quantities of data (big data) is existent and can be fruitful in many aspects such as the genetic correlation of current data to discover new vectors for treatment. [10]

The benefits of chasing this endeavor are almost equal to the caution it requires, especially with AI-assisted (Artificial Intelligence) analysis running the risk of recreating the bias of its creators and affecting the ecosystem of healthcare in ways that may not be predicted. Physiotherapists can be involved to a greater extent with research in the area.

References[edit | edit source]

  1. Gunter TD, Terry NP. The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models, Costs, and Questions. J Med Internet Res. 2005 Mar 14;7(1):e3.
  2. Resource Center - All Resources | HIMSS [Internet]. 2019 [cited 2022 Nov 20]. Available from: https://www.himss.org/resources-all
  3. Lim EYS, Fulham M, Feng DD. 2 - Electronic Medical Records. In: Feng DD, editor. Biomedical Information Technology [Internet]. Burlington: Academic Press; 2008 [cited 2022 Nov 20]. p. 29–49. (Biomedical Engineering).
  4. Rodrigues JJPC, Sendra Compte S, de la Torra Diez I. 1 - Electronic Medical Records and Their Standards. In: Rodrigues JJPC, Sendra Compte S, de la Torra Diez I, editors. e-Health Systems [Internet]. Elsevier; 2016 [cited 2022 Nov 20]. p. 3–19.
  5. Hilty D, Naslund JA, Ahuja S, Torous J, Kishimoto T, Crawford A. 2 - Information technology and electronic health record to improve behavioral health services. In: Stein DJ, Fineberg NA, Chamberlain SR, editors. Mental Health in a Digital World [Internet]. Academic Press; 2022 [cited 2022 Nov 20]. p. 11–39. (Global Mental Health in Practice).
  6. McKeeby JW, Coffey PS. Chapter 40 - The Importance and Use of Electronic Health Records in Clinical Research. In: Gallin JI, Ognibene FP, Johnson LL, editors. Principles and Practice of Clinical Research (Fourth Edition) [Internet]. Boston: Academic Press; 2018 [cited 2022 Nov 20]. p. 687–702.
  7. 2021 HIMSS Healthcare Cybersecurity Survey Report | HIMSS [Internet]. 2022 [cited 2022 Nov 20]. Available from: https://www.himss.org/resources/himss-healthcare-cybersecurity-survey
  8. Buyl R, Nyssen M. Structured electronic physiotherapy records. Int J Med Inform. 2009 Jul;78(7):473–81.
  9. Filipec M, Brumini G. Attitude of physiotherapists toward electronic health record in Croatia. Archives of Physiotherapy. 2019 Oct 22;9(1):10.
  10. Jensen PB, Jensen LJ, Brunak S. Mining electronic health records: towards better research applications and clinical care. Nat Rev Genet. 2012 Jun;13(6):395–405.