1. Health Management Information Systems
Welcome to Health Management Information Systems, Electronic Health Records. This is Lecture a.
The component, Health Management Information Systems, is a “theory” component that provides an introduction to health care applications and the systems that use them, health information technology standards, health-related data structures, and enterprise architecture in health care organizations.
Lecture a will define an electronic medical record (EMR) and electronic health record (EHR) and explain their similarities and differences, identify attributes and functions of an EHR, discuss the issues surrounding EHR adoption and implementation, and describe the impact of EHRs on patient care.
Electronic Health Records
Lecture a
This material Comp6_Unit3a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Electronic Health Records Learning Objectives
State the similarities and differences between an electronic medical record (EMR) and electronic health record (EHR) (Lecture a)
Identify attributes and functions of an EHR (Lecture a)
Describe the perspectives of health care providers and the public regarding acceptance of or issues with an EHR, which can serve as facilitators of or major barriers to its adoption (Lecture a)
Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes (Lecture a)
The Objectives for this unit, Electronic Health Records are to:
State the similarities and differences between an electronic medical record (EMR) and electronic health record (EHR);
Identify attributes and functions of an EHR;
Describe the perspectives of health care providers and the public regarding acceptance of or issues with an EHR, which can serve as facilitators of or major barriers to its adoption; and
Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes;
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Health Management Information Systems Electronic Health Records Lecture a

3. Electronic Health Records Learning Objectives
Discuss how Health Information Exchange (HIE) and Nationwide Health Information Network (NHIN) impact health care delivery and the practice of health care providers (Lecture b)
Outline issues regarding governmental regulation of EHR systems, such as meaningful use of interoperable health information technology and a qualified R (Lecture b)
Summarize how the Institute of Medicine’s Vision for 21st Century Health Care and Wellness may impact health management information systems (Lecture b)
Identify how ongoing developments in biomedical informatics can affect future uses and challenges related to health information systems (Lecture b)
Additional Objectives for this unit, Electronic Health Records are to:
Discuss how Health Information Exchange (HIE) and Nationwide Health Information Network (NHIN) impact health care delivery and the practice of health care providers;
Outline issues regarding governmental regulation of EHR systems, such as meaningful use of interoperable health information technology and a qualified EHR;
Summarize how the Institute of Medicine’s Vision for 21st Century Health Care and Wellness may impact health management information systems;
and Identify how ongoing developments in biomedical informatics can affect future uses and challenges related to health information systems.
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Health Management Information Systems Electronic Health Records Lecture a

4. Purpose of a Patient (Medical) Record
“To recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions”
Serves as the legal business record
As a way of introduction to electronic health records, let’s identify why a patient or medical record exists in the first place. According to Dr. Reiser, the purpose of a patient record is “to recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions” (Reiser, 1991, p. 902).
The medical record is a way of communicating between staff managing patient care. It also allows for an integrated view of patient data.
The patient medical record is also the legal business record for a health care provider, as the American Health Information Management Association (AHIMA) e-HIM Work Group on Maintaining the Legal EHR, pointed out in the article Maintaining a Legally Sound Health Record—Paper and Electronic. In this same article, the Work Group states “As such, it must be maintained in a manner that follows applicable regulations, accreditation standards, professional practice standards, and legal standards” (AHIMA, 2005, para. 1).
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Health Management Information Systems
Electronic Health Records Lecture a

5. Electronic Medical Record (EMR)
Electronic record of health-related information on an individual
Within one health care organization
Historically, patient records have been paper-based. However, more and more health care providers are moving away from paper-based to adoption of an electronic form. There are two terms associated with the electronic form. They are electronic medical record (or EMR) and electronic health record (or EHR).
The report, Defining Key Health Information Technology Terms defines an EMR as “an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization” (NAHIT, 2008, p. 6). This same report stated “health-related information encompasses health, wellness, administrative data, and information derived from public health and scientific research. It includes past and present observations and facts documented in the provision of health care that may be related to preventing illness and promoting wellness or that may be used in the process of informing consent” (NAHIT, 2008, p. 10).
An electronic medical record is a record of medical care created, managed, and maintained by one health care organization. This does not mean a single physical location. There may be instances when information is shared among multiple facilities and still be within one EMR. For example, an electronic record used in a physician practice with several offices is still an EMR when all sites are using the same proprietary data structure and architecture and the information is not moving outside the confines of the organization.
EMRs are the electronic equivalent of an individual’s legal medical record for use by providers and staff within one health care organization.
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Health Management Information Systems
Electronic Health Records Lecture a

6. EMR Purpose
Provide an electronic equivalent of an individual’s legal medical record
Intra-organizational
The purpose of an EMR is to provide an electronic equivalent of an individual’s legal medical record for use by providers and staff within one health care organization.
The EMR is understood to meet specific business needs for care, reimbursement, and disclosure, follow regulation and rules promulgated by Federal, State, or accrediting entities, and contain information as defined by the provider organization.
The electronic medical record encapsulates a record of medical care provided in a single health care organization, i.e., an intra-organizational medical record.
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Health Management Information Systems
Electronic Health Records Lecture a

7. Electronic Health Record (EHR)
Electronic record of health-related information on an individual
Across more than one health care organization
The other term associated with electronic records is electronic health record, or EHR.
The report Defining Key Health Information Technology Terms also provided a definition for electronic health record. An EHR is “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization” (NAHIT, 2008, p. 6).
Being a repository of individual health records that reside in numerous information systems and locations, EHRs are intended to support efficient, high-quality integrated health care, independent of the place and time of health care delivery. Consequently, EHRs are part of a health information technology infrastructure.
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Health Management Information Systems
Electronic Health Records Lecture a

8. EHR Purpose
Provide an electronic equivalent of an individual’s health record for use by providers and staff across more than one health care organization
Support efficient, high-quality integrated health care, independent of the place and time of health care delivery
The purpose of an EHR is to provide an electronic equivalent of an individual’s health record for use by providers and staff across more than one health care organization. An EHR is inter-organizational, that is, two or more unrelated health care organizations contribute to the record which becomes an aggregation of one record focused around a person’s comprehensive health history rather than being one provider’s record. However, to arrive at this level of information aggregation, all contributors must be able to send and receive information using standards that facilitate the interoperable exchange of health-related information.
An EHR is intended to support efficient, high-quality integrated health care, independent of the place and time of health care delivery.
It encapsulate an electronic equivalent of an individual’s health record for use by providers and staff in multiple unrelated facilities.
As the National Alliance for Health Information Technology’s report Defining Key Health Information Technology Terms explained, “The principal difference between an EMR and an EHR is the ability to exchange information interoperably. An EMR aligns with the prevailing state of electronic records today (whether the record is branded an EMR or an EHR). However, the movement of the industry is toward electronic records that are capable of using nationally recognized interoperability standards, which is a key defining component of an EHR” (NAHIT, 2008, p. 5).
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Electronic Health Records Lecture a

9. EMR Versus EHR Table 3.1 EMR and EHR Comparison EMR EHR
A record of medical care created, managed, and maintained by one health care organization (intra-organizational)
A repository of individual health records that reside in numerous information systems and locations (inter-organizational)
Integration of health care data from a participating collection of systems from one health care organization
Aggregation of health-related information into one record focused around a person’s health history, i.e., a comprehensive, longitudinal record
Consulted by authorized clinicians and staff within one health care organization.
Consulted by authorized clinicians and staff across more than one health care organization
Data continuity throughout one health care organization
Data interoperability across different organizations
Adding to NAHIT’s principle difference, other comparisons illustrating similarities and differences between an EMR and EHR are shown in Table 3.1.
The first row in Table 3.1 states an EMR is a record of medical care created, managed, and maintained by one health care organization (intra-organizational) while an EHR is a repository of individual health records that reside in numerous information systems and locations (inter-organizational).
The second row explains an EMR is an integration of health care data from a participating collection of systems from one health care organization in contrast to an EHR which is an aggregation of health-related information into one record focused around a person’s health history, i.e., a comprehensive, longitudinal record.
The third row points out an EMR is consulted by authorized clinicians and staff within one health care organization while an EHR is consulted by authorized clinicians and staff across more than one health care organization.
The fourth and final row reiterates NAHIT’s principle difference, that is, in an EMR, data continuity exists throughout one health care organization but in the case of an EHR, data interoperability across different organizations occurs.
While these distinctions can be made between an EMR and EHR, many regard the two terms as synonymous.
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Health Management Information Systems
Electronic Health Records Lecture a

10. EHRs Versus Paper Records
EHRs can make a patient’s health information available when and where it is needed
EHRs can bring a patient’s total health information together in one place, and always be current
EHRs can support better follow-up information for patients
EHRs can improve patient and provider convenience
According to a Centers for Medicare and Medicaid Services Fact Sheet, Electronic Health Records at a Glance, electronic health records improve care by enabling functions that paper records cannot deliver.
These include:
“EHRs can make a patient’s health information available when and where it is needed – it is not locked away in one office or another.
EHRs can bring a patient’s total health information together in one place, and always be current – clinicians need not worry about not knowing the drugs or treatments prescribed by another provider, so care is better coordinated.
EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office” (CMS, 2010, para. 5)
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11. EHRs Versus Paper Records
Can link information with patient computers to point to additional resources
Don’t just “contain” or transmit information, they also compute with it
Can improve safety
Additionally,
“EHRs can link information with patient computers to point to additional resources – patients can be more informed and involved as EHRs are used to help identify additional web resources.
EHRs don’t just “contain” or transmit information, they also compute with it – for example, a qualified EHR will not merely contain a record of a patient’s medications or allergies, it will also automatically check for problems whenever a new medication is prescribed and alert the clinician to potential conflicts.
EHRs can improve safety through their capacity to bring all of a patient’s information together and automatically identify potential safety issues -- providing “decision support” capability to assist clinicians” (CMS, 2010, para. 5).
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12. EHRs Versus Paper Records
EHRs can
Deliver more information in more directions
While reducing “paperwork” time for providers
Improve privacy and security
Reduce costs
The final group of ways in which EHRs can improve care according to CMS are:
“EHRs can deliver more information in more directions, while reducing “paperwork” time for providers – for example, EHRs can be programmed for easy or automatic delivery of information that needs to be shared with public health agencies or quality measurement, saving clinician time.
EHRs can improve privacy and security – with proper training and effective policies, electronic records can be more secure than paper.
EHRs can reduce costs through reduced paperwork, improved safety, reduced duplication of testing, and most of all improved health through the delivery of more effective health care” (CMS, 2010, para 5).
With regards to improving privacy and security, EHRs can be encrypted and stored on password-protected systems thereby restricting their access to only those authorized. In addition, systems can track who accessed a record, when it occurred and for what purpose. Firewalls and other physical security measures can be put in place to prevent unauthorized users from gaining access to patient records.
Overall EHRs have the potential for improvements in patient safety and quality. However, improvements are not an automatic result of implementing an EHR.
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13. Attributes of an EHR
Provides secure, reliable, real-time access to patient health record information, where and when it is needed to support care
Captures and manages episodic and longitudinal electronic health record information
Thus, an electronic health record is not an electronic version of the paper record. An electronic health record has additional attributes or properties that a paper record does not.
The Healthcare Information and Management Systems Society or HIMSS described eight attributes of an electronic health record in their report HIMSS Electronic Health Record Definitional Model. The first two attributes are that the EHR:
“Provides secure, reliable, real-time access to patient health record information, where and when it is needed to support care
Captures and manages episodic and longitudinal electronic health record information” (Handler, et al., 2003, p. 3).
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14. Attributes continued
Functions as clinicians’ primary information resource during the provision of patient care
Assists with the work of planning and delivering evidence-based care to individual and groups of patients
Supports continuous quality improvement, utilization review, risk management, and performance monitoring
The next three attributes as described in the HIMSS report are the EHR:
“Functions as clinicians’ primary information resource during the provision of patient care
Assists with the work of planning and delivering evidence-based care to individual and groups of patients and
Supports continuous quality improvement, utilization review, risk management, and performance monitoring ” (Handler, et al., 2003, pp. 4-5).
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Electronic Health Records Lecture a

15. Attributes continued
Captures the patient health-related information needed for reimbursement
Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives
Supports clinical trials
The final three attributes listed in the HIMSS report are the EHR
“Captures the patient health-related information needed for reimbursement
Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives
Supports clinical trials” (Handler, et al., 2003, pp. 6-7).
In addition to those identified in the HIMSS report, two additional attributes are the EHR supports timely access to patient information and by more than one person at a time and provides the ability to generate reports that can help measure activity and determine levels of compliance with policies and evidence-based medicine protocols.
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Electronic Health Records Lecture a

16. HL7 EHR Functions Direct care functions Supportive functions
Information infrastructure functions
In addition to the HIMSS report, Health Level Seven International, or HL7, published an EHR System Functional Model. According to HL7’s web site, HL7 is “an ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services” (HL7, 2011, para. 1).
The HL7 EHR System Functional Model establishes EHR systems (EHR-S) standards that will enable the development of EHRs based on one set of functional requirements. The model contains three sections. They are Direct Care functions, Supportive functions, and Information Infrastructure functions.
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17. Direct Care Functions Subset Examples Care management
Table 3.2
HL EHR-S Functional Model Direct Care Functions Subsets with Examples
Subset
Examples
Care management
Identify and maintain a patient record
Manage patient demographics
Manage problem lists
Clinical decision support
Support for standard care plans, guidelines, protocols
Support for medication and immunization administration
Orders, referrals, results and care management
Operations Management and Communication
Clinical workflow tasking
Support clinical communication
Support for provider-pharmacy communication
According to the HL7 EHR-S Model (2007), direct care functions are functions employed in the provision of care to individual patients. Direct care functions are the set of functions that enable delivery of healthcare or offer clinical decision support. Subsets of direct care functions include care management, clinical decision support, and operations management and communication.
Some examples of the Care Management subset are the capability to identify and maintain a patient record, manage patient demographics, and manage problem lists.
For the Clinical Decision Support subset, examples of direct care functionality include support for standard care plans, guidelines, protocols; support for medication and immunization administration; and orders, referrals, results and care management.
Examples for the Operations Management and Communication subset are clinical workflow tasking, support clinical communication, and support for provider-pharmacy communication.
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18. Supportive Functions Clinical Support
Measurement, Analysis, Research and Reports
Administrative and Financial
The HL7 EHR-S Model (2007) describes supportive functions as functions that support the delivery and optimization of care, but generally do not impact the direct care of an individual patient. These functions assist with the administrative and financial requirements associated with the delivery of healthcare, provide support for medical research and public health, and improve the global quality of healthcare.
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19. Information Infrastructure Functions
Security
Health record information and management
Registry and directory services
Standard terminologies and terminology services
Standards-based interoperability
Business rules managementorkflow management
The final section, Information Infrastructure Functions, define the heuristics of a system necessary for reliable, secure and interoperable computing (HL7 EHR-S Model, 2007). These functions are not involved in the provision of healthcare, but are necessary to ensure that the information system provides safeguards for patient safety, privacy and information security, as well as operational efficiencies and minimum standards for interoperability.
The functions for this section include security, health record information and management, registry and directory services, standard terminologies and terminology services, standards-based interoperability, business rules management, and workflow management.
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20. Standards for Certification of EHR Technology
Content exchange standards
NCPDP SCRIPT Standard
HL7 Clinical Document Architecture (CDA), CCD
Vocabulary standards
SNOMED CT
LOINC
Privacy and security standards
NIST encryption algorithm
NIST hashing algorithm
In addition to HL7’s EHR systems (EHR-S) standards, the Office of the National Coordinator for Health Information Technology published The Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology Final Rule (2010) which includes the following standards for the certification of EHR technology:
Content exchange standards for exchanging electronic health information. For example, the National Council for the Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard or the HL7 Clinical Document Architecture (CDA) Release 2, Continuity of Care Document (CCD)
Vocabulary standards for representing electronic health information. Two examples of vocabulary standards are the Systematized Nomenclature of Medicine Clinical Terms and Logical Observation Identifiers Names and Codes.
Standards for health information technology to protect electronic health information created, maintained, and exchanged. For example one standard is any encryption algorithm identified by the National Institute of Standards and Technology (NIST) as an approved security function in Annex A of the Federal Information Processing Standards (FIPS) Publication 140–2. Another example is a hashing algorithm with a security strength equal to or greater than SHA–1 (Secure Hash Algorithm (SHA–1) as specified by the NIST in FIPS PUB 180–3. (p )
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Health Management Information Systems Electronic Health Records Lecture a

21. EHR Acceptance Health care provider
Increasing momentum for widespread adoption and implementation of EHRs
ARRA/HITECH
Authorized Testing and Certification Body by the Office of the National Coordinator
With more and more health care providers moving away from paper-based to adoption of an electronic medical record, with the ultimate goal of implementing an electronic health record, it stands to reason a question one might ask is “why aren’t we there yet?” To answer that question, the perspectives of health care providers and the public regarding acceptance of, or issues with, an EHR will be explored.
First from the standpoint of the provider, EHR acceptance is on the rise throughout the health care community as more and more research supports the benefits far outweigh the costs.
Regarding costs to implement, monetary incentives have been put in place by the Federal Government to stimulate EHR adoption. Momentum for widespread adoption and implementation has picked up since the American Recovery and Reinvestment Act, or ARRA, was signed into law February ARRA provides many different stimulus opportunities, one of which is $19.2 billion for health IT. The Health Information Technology for Economic and Clinical Health, often referred to as HITECH, is a provision of the American Recovery and Reinvestment Act. The funding is expected to assist providers and states in adopting and utilizing health IT in order to achieve widespread adoption of health IT and enable electronic exchange of health information.
Providers have also begun to accept EHRs since the establishment of the Certification Commission For Health Information Technology or CCHIT. With certification, a certain comfort level exists with regards that the EHR purchased and implemented will have longevity and meet specific requirements. In addition to CCHIT, ONC-Authorized Testing and Certification Bodies are Drummond Group, InfoGard Laboratories, SLI Global Solutions, ICSA Labs, and Surescripts. The American National Standards Institute (ANSI) has been approved as the ONC-Approved Accreditor (AA) for the Permanent Certification Program. 
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22. EHR Acceptance Public Harris Interactive Survey from 2005
Mixed Feelings
45% EHR system important
Concern over
Privacy
Increase rather than decrease of medical errors
As cited in IHE Moves EHR Goals Forward, “The public has mixed feelings about EHRs. A national Harris Interactive survey found that 45 percent of adults believe that tools to track and maintain their own personal medical information with an EHR system are very important, but they worry that computerization could increase rather than decrease medical errors and that federal health privacy rules will be reduced in the name of efficiency” (RSNA, 2005, para. 9).
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23. EHR Acceptance: Public
Harris Interactive Survey
All physicians treating me should have access to information contained in my EMR
Percent answering "Strongly/Somewhat Agree"
78% in 2009
78% in 2010
An EMR would be a valuable tool to track the progress of my health
72% in 2009
71% in 2010
A more recent poll conducted by Harris Interactive (2010) online from June 8-10, 2010, among 2,035 U.S. adults, showed little change from 2009 to 2010 with regards to adults attitudes of electronic medical records.
Seventy-eight percent in both 2009 and 2010 answered "Strongly/Somewhat Agree“ that all physicians treating me should have access to information contained in my EMR.
Seventy-two and seventy-one percent in 2009 and 2010 respectively answered "Strongly/Somewhat Agree“ that sn EMR would be a valuable tool to track the progress of my health.
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24. Barriers to Adoption Cost of conversion Perceived lack of ROI
Technical and logistical challenges
Privacy and security concerns
Even with acceptance on the rise, barriers still exist. An editorial Stimulating the Adoption of Health Information Technology describes barriers to adoption as “their substantial cost, the perceived lack of financial return from investing in them, the technical and logistical challenges involved in installing, maintaining, and updating them, and consumers’ and physicians’ concerns about the privacy and security of electronic health information” (Blumenthal, 2009).
Each one of these has its own complexities. For example, logistical challenges would include resources issues, training and re-training, resistance by potential users, and development of new workflow processes. The possibility of poor clinical system performance would impact provider productivity and also become a significant barrier to adoption. Privacy and security concerns include identity theft and widespread exposure of personal health information with the risk of it being seen by unauthorized personnel if it is sent electronically. Breeches through stolen laptops or hacking is also a concern.
Another barrier to adoption is the perceived lack of return on investment to the practitioner.
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Electronic Health Records Lecture a

25. EHR Effect on Patient Care Safety
Reduces the need to repeat tests
Reduces the number of lost reports
Supports provider decision making
Even though perceived or bona fide barriers do exist, potential benefits to adopting and implementing EHRs are surfacing. With respect to having an effect on patient care safety they include:
Reducing the need to repeat tests,
Reducing the number of lost reports, and
Supporting provider decision making
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26. EHR Effect on Efficiency
Improves accessibility of patient information
Integrates data from multiple internal and external sources
Facilitates the co-ordination of health care delivery
EHRs also have an effect on efficiency by
Improving accessibility of patient information, e.g., being able to access reports anytime/anywhere,
Integrating data from multiple internal and external sources, e.g., improving charge capture, and
Facilitating coordination of health care delivery, e.g., no need to retrieve and copy paper charts.
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27. EHR Effect on Patient Outcomes
Has the potential to
Improve the quality of patient care
Help providers practice better medicine
Provide seamless exchange of information among providers
The final effect of EHR adoption and implementation is on patient outcomes. An EHR has the potential to improve the quality of patient care and help providers practice better medicine. Being a repository of individual health records that reside in numerous information systems and locations, EHRs are intended to support efficient, high-quality integrated health care, independent of the place and time of health care delivery. An EHR also has the potential to provide seamless exchange of information among providers.
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Electronic Health Records Lecture a

28. Electronic Health Records Summary – Lecture a
Defined an EMR and EHR
Explained similarities and differences
Identified EHR attributes and functions
Discussed the issues surrounding EHR adoption and implementation
Described the impact of EHRs on patient care
This concludes Lecture a of Electronic Health Records. This lecture defined an electronic medical record (EMR) and an electronic health record (EHR) and explained their similarities and differences, identified EHR attributes and functions, discussed the issues surrounding EHR adoption and implementation, and described the impact of EHRs on patient care.
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Health Management Information Systems Electronic Health Records Lecture a

29. Electronic Health Records References – Lecture a
AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health record—paper and electronic. Journal of AHIMA 76(10), 64A-L. Retrieved from
Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of Medicine 360, Retrieved from
Handler, T., Holtmeier, R., Mtezger, J., Overhage, M., Taylor, S., & Underwood, C. (2003, July 7). HIMSS electronic health record definitional model version 1.0. Retrieved from
Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July 28, 2010). Retrieved from
Harris Interactive. (2010, June 17). Few Americans using 'E-' medical records. Retrieve from
Health Level Seven International. (n.d.). About HL7. Retrieved from
Health Level Seven International. (2007). HL EHR-S functional model. Retrieved from
Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved from
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Electronic Health Records Lecture a

30. Electronic Health Records References – Lecture a
Reiser, S. J. (1991). The clinical record in medicine. Part 1:Learning from cases. Annals of Internal Medicine, 114,
The National Alliance for Health Information Technology. (2008, April 28). Defining key health information technology terms. Retrieved from healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2010, July13). Electronic health records at a glance. Retrieved from
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Charts, Tables, Figures
3.1 Table: EMR and EHR Comparison
3.2 Table: HL EHR-S Functional Model Direct Care Functions Subsets with Examples
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Electronic Health Records Lecture a