Of the many acronyms in healthcare, few are used as frequently and interchangeably as EMR (Electronic Medical Record) and EHR (Electronic Health Record; well, and there are PHR – Personal Health Records – and PM – Practice Management – too). In reality, however, each of these terms refers to a separate type of electronic application. They can be differentiated from one another based on the audience they serve, the unique information they store, and the features they enable.

• PHRs are different from all the rest because they are maintained by patients or authorized individuals rather than practices. As such, they collect patient medical information, but may not track other practitioner-specific medical and diagnostic details.
• EHRs and EMRs are often used interchangeably – both collect a host of medical, clinical, prescription-related, and patient communication information and often support tools to improve practitioner workflow – however, the big difference is that EHRs allow data sharing across multiple, unrelated practices, while EMRs are in one location only.
• Lastly, Practice Management software is related less to patient and clinical information tracking, instead allowing for the smooth management of the practice itself. It facilitates appointment scheduling, patient intake, charting and tracking, inventory management, and more. Recently, more and more practice management platforms are integrating EMR elements (that is, building in patient record keeping, intake, insurance).

 

Side-by-Side Comparisons

Private, secure and confidential electronic application:

		PHR	EMR	EHR	PM
Audience	Accessed and maintained by	Patient or Authorized Individual	A Practice	Multiple Practices	A Practice	Patients & Practices
Information	Medical Information (e.g., demographic, history, allergies)	✓	✓	✓		✓
	Clinical Charts (e.g., exams, diagnoses)		✓	✓		✓
	Prescriptions & Laboratory Tests (e.g., e-prescribing to pharmacies)		✓	✓		✓
	Patient Communications (e.g., patient-provider integration)		✓	✓		✓
	Cross-Practice Communications (e.g., multi-practice integration)			✓		✓
Features	Evidence-based Patient Tracking (e.g., patient health outcomes)		✓	✓		✓
	Appointment Scheduling (e.g., accessible calendars)				✓	✓
	Billing & Insurance (e.g., creating HCFA, bills, submitting claims)				✓	✓
	Inventory Management (e.g., updating supplies)				✓	✓

 

The Scientific Details

 PHR – Personal Health Record

• Personal health records are private, secure and confidential electronic applications accessible to and maintained by individuals (patients or other authorized persons) to track key medical information. ^1,2,3,5
  • They can be used to track demographic details, family medical history, immunizations, diagnoses, medications, and provider information.
  • They can also include information captured directly by patients, such as from home monitoring devices.
• PHRs allow patients to maintain and access their health information directly, and ensure they have credible data and knowledge to support the management of their health. They help patients manage (chronic) diseases, and improve the ways patients communicate and partner with their health care providers to improve quality of care.¹
• PHRs are available through many health plans, providers, and independent vendors; they are authorized by the individual patient to capture details from their health plans, providers, pharmacies, and labs and store them in a central location.³
• For practitioners, they can improve practitioner access to patient data by facilitating the transfer of medical records across providers when PHRs and EHRs are integrated.¹ These records are separate from and in addition to the legal records health care providers must keep.² 

EMR – Electronic Medical Record

• Electronic medical records are private, secure and confidential electronic applications maintained by providers to capture key medical and clinical information collected in diagnosis and treatment of patients at their specific location. ^4,5
  • In addition to storing demographics, medical history, immunizations, diagnoses, radiology images, medications, prescriptions and lab, EMRs also include patient contact information, consent forms, billing and insurance elements.
• Sophisticated EMRs help providers utilize data to improve patient care:
  • Clinical decision support to benefit providers in decisions around patient care (e.g., providing details on drug effects, cross-referencing allergies and prescribed medications), and
  • Computerized physician order entry systems that enable staff to electronically input order codes (e.g., CPT codes), rather than manually, thereby reducing medical errors. ⁴
• They enable easier access to patient information than do paper records. However, EMR data is not easily shared with external providers, and stays with the maintaining provider (does not follow the patient!). For some EMRs, the only way of sharing patient data and charts externally is printing it out.⁴

EHR – Electronic Health Record

• Electronic health records (EMRs) are systematized, private, secure and confidential electronic applications capturing key medical and clinical information that are accessible across multiple practitioners, clinics, and hospitals. ^4-6
  • This can be used to track all demographic, medical and clinical information (same as EMRs; e.g., demographics, medical history, diagnoses, medications, labs, billing, insurance) collected by providers in the diagnosis and treatment of patients across providers.
• EHRs have three key features that serve to improve the quality of care and reduce the costs incurred by practitioners:
  • Clinical decision support (shared with sophisticated EMRs) which help providers make decisions around patient care (e.g., providing information on a drug, cross-referencing allergy and medication information),
  • Computerized physician order entry systems (shared with sophisticated EMRs) that reduce medical errors by having staff enter order codes electronically instead of manually (e.g., CPT codes), and
  • Health information exchange (unique to EHRs), the sharing of patient information between different organizations to create efficiencies in the delivery of health care (e.g., reducing redundant testing across providers) allowing for access to relevant health information, and thus coordinated care, by all clinicians involved in treating the patient. ^5,6

PM – Practice Management

• Practice management software is a private, secure and confidential electronic application tracking day-to-day operational functions associated with the provision of care by a practitioner, clinic, or hospital.⁷
  • Practice management software simplifies the maintenance of a practice by automating administrative tasks, facilitating billing and insurance, reducing financial reporting burdens, supporting all key elements of the practice.
  • Common features of Practice Management software in the health care space include appointment scheduling, capturing patient demographics, and billing data and insurance information.
  • Most practice management software is accessible using desktop software, a client-server software or is Internet-based.
• PMs increasingly include EHR elements (given the natural overlap and increasing legal pressures to capture health information and present it to federal and state public health agencies in electronic format (Health Information Technology for Economic and Clinical Health Act)).

 

References and Additional Resources

1. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association. 2006; 13(2). Available at: http://www.ncbi.nlm.nih.gov/pubmed/16357345. Accessed November 16, 2015.
2. What Is A Personal Health Record? Health IT website. https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record. Updated May 2, 2013. Accessed November 11, 2015
3. Personal Health Records (PHRs). Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/E-Health/PerHealthRecords/index.html. Updated February 27, 2012. Accessed November 11, 2015
4. What Is an Electronic Medical Record (EMR)? Health IT website. https://www.healthit.gov/providers-professionals/electronic-medical-records-emr. Updated August 29, 2014. Accessed November 11, 2015
5. Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. International Journal of Medical Informatics. 2008; 77(5): 291-304.
6. Menachemi N, & Collum TH. Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy. 2011; 4: 47.
7. Practice Management Software (PMS). Techopedia website. https://www.techopedia.com/definition/25018/practice-management-software-pms. Accessed November 11, 2015.