The heightened interest in electronic medical records (EMRs) and electronic health records (EHRs) can be attributed, in part, to the recent announcement that federal funds under the American Recovery and Reinvestment Act (ARRA) would be made available to qualified medical practices commencing in 2011. Though radiology continues to question its eligibility for the funding of imaging informatics projects, the benefits (both direct and indirect) of PACS integration with health care records are numerous.
These include enhanced access to medical records, greater availability of imaging studies and reports generated at other imaging facilities, mitigation of medicolegal and risk-management matters through improved access to medical information, and the ability to communicate results and follow-up recommendations more closely. In addition, integrated medical records have the potential to improve billing performance and collection and to enhance cash flow.
Whether radiology has a direct financial stake in the federal funding for wiring US hospitals is unclear, but the indirect benefits of integrating PACS with the EMR and the EHR are indisputable.
EHR and EMR
The EHR is a longitudinal electronic record of the patient’s health information generated by one or more encounters in any care-delivery setting. Included in this record are patient demographics, progress notes, problems, medications, vital signs, medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician’s workflow. It also has the ability to generate a complete record of a clinical patient encounter, as well to support other care-related activities (including evidence-based decision support, quality management, and outcomes reporting) either directly or indirectly via interface.
It is important to recognize that an EHR is generated and maintained within an institution, such as a hospital, integrated-delivery network, clinic, or physician’s office. An EHR is not a longitudinal record of all care provided to the patient, in all venues, over time.
Considerable uncertainty exists regarding the differences between EHRs and EMRs. The confusion is pervasive at all levels of health care delivery. In many instances, the terms are used interchangeably by experts, users, and vendors. According to the National Alliance for Health Information Technology, however, there is a distinct difference between the entities. The EMR is the electronic record of an individual’s health-related information created, gathered, managed, and consulted by licensed clinicians and staff, from a single organization, who are involved in the individual’s health and care.
The EHR differs from the EMR in that it is the aggregate electronic record of an individual’s health-related information created and gathered cumulatively across more than one health care organization. It is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.
Professional Medical Liability
A frequently mentioned reason for the use of EMRs is the perceived impact on professional medical liability or medical malpractice claims. Professional medical liability companies have long emphasized that complete and consistent medical-records documentation aids in defense against claims, and in particular, those that are considered frivolous or without medical merit.
Logically, the ready availability of complete patient health information, in an easy-to-use and readable format, should improve the ability of the physician or nonphysician provider to review and use that health information. By extension, better medical judgments should be possible, and certain types of medical malpractice claims might be avoided.
Data also exist to support this contention. For example, a survey¹ of 1,140 Massachusetts physicians published in the Archives of Internal Medicine indicated a significant difference in the number of malpractice claims brought against those who did not use an EMR system, compared with those who did. According to the study, 6% of those respondents using EMRs reported malpractice claims; in comparison, 11% of physicians who did not use an EMR reported claims.
It is important to note that the study methodology used was logistic regression analysis of reported malpractice claims among respondents, compared with paid-claims data from the Massachusetts Board of Registry