Related Links

Web Seminars

This story is the first in an in-depth, three-part series Health Data Management will publish this year about EMRs, EHRs and PHRs. We’ll also be running three other series of feature-length articles on revenue cycle, point-of-care technologies and CIO Issues. These series represent our effort to provide insightful, concise and timely information to our readers on the technologies and business issues that shape their strategic initiatives. -Greg Gillespie, Publisher

What in the world is the difference between an “electronic medical record,” “electronic health record” and “personal health record?” What’s the difference between a “regional health information organization” and a “health information exchange?”

Two work groups funded by the Department of Health and Human Services are working to seek industry consensus on the definitions and use of these terms. The Networks Work Group is tackling RHIOs and HIEs, while the Records Work Group covers EMRs, EHRs and PHRs. The groups in January held a public forum to solicit industry input. A second forum is scheduled during the Healthcare Information and Management Systems Society Annual Conference & Exhibition in February.

Final reports, due in late March, can’t come too soon.

Just take a look at the Web site of dbMotion Inc., a vendor of data integration services and exchange platforms for health care organizations. In describing its services, the Pittsburgh-based company uses the term EMR. And EHR. And RHIO. And HIE. It also uses HIN for “health information network” and IDNs for “integrated delivery networks.” It even mentions “integrated healthcare delivery systems.”

“We ourselves are guilty of abusing the terms freely,” acknowledges Joel Diamond, M.D., chief medical officer and a practicing family physician. But from a corporate viewpoint, “we have to use everything because all these terms mean different things to different people,” he adds.

Indeed they do. Robert Kolodner, M.D., national coordinator for health information technology at HHS, wonders if progress in adopting electronic records and creating a national health information network is hampered by the lack of clarity in what the heck we’re talking about. “By being more consistent in the terminology, it will help us move forward more quickly,” he says.

Kolodner previously has tackled some of the terminology issues that face the HHS-authorized work groups (see sidebar, page 54).

But to link the misuse and possible misunderstanding of these and other terms to any slowness in I.T. adoption “is a stretch in my opinion,” contends Becky Quammen, CEO of The Quammen Group, a Winter Park, Fla.-based consulting firm. “Folks basically know what they are doing and why they are doing it.”

The question of what to call electronic records systems is not delaying physician purchasing decisions, contends Mark Renfro, executive director of North East Florida Regional Health Organization, an emerging HIE serving the greater Jacksonville area. “The fundamental problem is they do not want to pay for it themselves,” he adds. “Doctors say, ‘I can invest in technology and my take-home pay to my wife is less.’”

Some others, however, contend that inconsistent ways to describe information systems that physicians are being told they really need is contributing to delayed purchase decisions.

“Doctors are confused of the differences and wary of technological advances,” says Wendy Angst, general manager of the CapMed PHR software division of Bio-Imaging Technologies Inc., Newtown, Pa. “They don’t want to buy and find out in six months that they should have waited. So we need to better explain up front what these products do. People need to know what the thing is.”

Clarity in Law

What Kolodner knows for certain is that the lack of clear use and definitions for these terms isn’t helping politicians and government officials as they consider laws and regulations that affect health I.T. “We don’t have the clarity we need for them to help us move forward,” he says.

For instance, there’s no legal definition of any of these terms, but federal and state I.T. grant programs often use specific terms. So, if a grant program specifically targets RHIOs, can HIEs apply? If a grant program targets physician adoption of EHRs, can a physician adopting an EMR apply?

“These terms increasingly will be used in federal and state laws and regulations,” says Bill Bernstein, chair of the health care division in the New York law firm Manatt, Phelps & Phillips. He’s also co-chair of the Networks Work Group studying the terms RHIO and HIE.

Consistent terminology, he adds, will lead to less confusion in the marketplace. “If people can be clear on the definitions, it will help make sure when they are having conversations that they are having the same conversation.”

Confusion in rulemaking already has happened. When federal officials first proposed relaxing the Stark Act and anti-kickback laws to permit health I.T. donation or subsidy programs, initial regulations appeared to limit the relaxation to programs to encourage adoption of electronic prescribing. Language in the final regulations had to be changed to encompass other I.T. applications.

“What’s in a word can really determine from a policy standpoint what you’re going to give incentives for,” notes Michael Kappel, senior vice president for government and industry relations at the Provider Technologies division of McKesson Corp., San Francisco.

That’s why the current effort to define terms is necessary, Kappel believes. If mandates for use of electronic records are on the horizon, it will be “hugely important to be precise on what is required.”

In the Beginning

Before EMR, there was CPR—the computer-based patient record. Kolodner, the national I.T. coordinator, thinks he knows how CPR became EMR.

“Some saw CPR as an electronic substantiation of the paper record,” he says. “But others also saw CPR as an extension beyond the record with features such as reminders. Others said, ‘No, that’s an EMR. An EMR also would capture other information, such as vital signs from patient monitors in homes and pacemaker tracings.’”