1. EMRs, EHRs, PHRs, questions and answers
Emily Barey, RN, MSN
Director of Nursing Informatics
Epic systems, Verona, wisconsin

2. Welcome Emily Barey RN, MSN
Director of Nursing Informatics, Epic Verona, Wisconsin
Role of the industry vendor

3. What is an EMR? EHR? PHR? Electronic Medical Record
is the digital version of the paper chart, located at the clinic or hospital where you receive care
Electronic Health Record
is a broader data set written by the entire care team; designed to follow the patient across different care settings
Personal Health Record
is like an EHR but entirely entered and managed by the patient
It’s about location, location, location
It is also about who is authoring and who is managing the record.
Whose responsibility is it to update EMRs? Does the patient have to do it, or is it done for them? [Similar: What if the EMR is incomplete, and you want more descriptive data in it? How is this accomplished, by the patient or a professional?
What is EMR as distinct from PHR?

4. What is in an electronic record?
Before EHR
Past History & Problems
Medications you take
Allergies you have
Clinical notes
Vital signs
Scanned documents
Results and Images
After EHR

5. Can I see my record? Patient Portal vs. PHR What is shared?
Shared record with your doctor via a portal
Personal health record that you enter all the data
What is shared?
Determined by organization and capability of software vendor
Proxy access
Consent to see your child’s record or elderly parent, spouse
Content variations in EMRs: Mayo Clinic patients can see visit notes in their “EMR” (actually PHR) from home. Some discussion of how this varies depending on vendor and clinic (consumers did not understand why other people in the room didn’t have the same access to the same content they did…)

6. A clinician point of view
Why use an EHR?
A clinician point of view
A patient point of view
Accessibility
Legibility
Alerts & Reminders
Avoid duplication and decrease cost
Follow patient preferences
Research
More!
A shared record with you
Better care
Convenience
Continuity of care
But sometimes they still ask me the same questions, why?
The software system
The policy of the healthcare organization
Learning a new paradigm to verify and update
How far back does EMR data go?
Concerns about losing the EMR: Before adopting EMR, concerns about having access to older data—one system decided to keep both print copies and electronic copies.
How much do EMRs impact the amount of work a doctor has to do?

7. Who Uses an EHR? Nursing Home Hospital Your Home Doctor’s Office
Do ALL of your medical records get digitized and are available for viewing online, or just those from a certain medical center?
Your Home
Doctor’s Office
Surgery Center

8. Why doesn’t it ALWAYS work? How does my record move electronically?
Interoperability
Why doesn’t it ALWAYS work?
How does my record move electronically?
Computers can talk to each other
Often they need an interpreter
Government standards determine the “language” the EHR computers must send messages to each other in
Basic data set today, growing all the time what can be shared
Some EHR systems can’t send messages yet in the standard language
Role of EHR Certification
Government program called Meaningful Use requires use of an EHR that can send standard messages
Are the experts going to work on some sort of universal basic transfer so that someday records really can be digitally shared with little hassle to either office or patient?
How are EMRs regulated?

9. Lack of Interoperability
What if my doctor or hospital doesn’t use an EHR?
Copy & Fax Machines
US Postal System
You carry your record
It isn’t available
Are the experts going to work on some sort of universal basic transfer so that someday records really can be digitally shared with little hassle to either office or patient?

10. Is my record safe? HIPAA & HITECH
Health Insurance Portability & Accountability Act
Health Information Technology for Economic & Clinical Health Act
Sharing the record to coordinate care
Audit trails of access
How malleable are EMRs? Can the patient change them? Who else can view and change them? Where does authority control come in?
How secure is patient information stored in an EMR? [Similar: Are there privacy issues? How do systems protect against identity theft? How do I know my medical data is safe? General: HIPAA confusion v. medical privacy 1. 2.

11. Questions To ask your Provider
Can you sign up for access to your shared medical record?
Can your provider share your record electronically with other providers if necessary?