The Electronic Health Record (EHR) aggregates health-related information generated across more than one healthcare organization. In contrast, the Electronic Medical Record represents information generated within a single healthcare organization. In simplest terms, the EMR is a digital equivalent of the paper chart. Despite the efforts of The National Alliance for Health Information Technology (NAHIT) and Healthcare Information and Management Systems Society (HIMSS) to explain the differences, the terms EHR and EMR have been used synonymously.

A Personal Health Record (PHR) has similar purposes as an EHR to aggregate one's health information. However, a PHR is under the control of an individual. Electronic healthcare privacy is increasingly important as ostensibly private health information has been used by [insurance companies] and employers to deny coverage or employment.http://sites.google.com/site/hcinfosys/literature/privacy

The page provides a list of EHR functions, EHR maturity scale, and describes the numerous problems and high failure rates of EHR technology.

Usability in Health IT: Strategic, Research, and Implementation Workshop by National Institute of Standards and Technology (NIST) July 13, 2010

HIMSS uses a seven stage EMR adoption model to determine the readiness towards EHR integration http://www.himssanalytics.org/docs/wp_emr_ehr.pdf

Stage 0: Some clinical automation may be present, but all three of the major ancillary department systems for laboratory, pharmacy, and radiology are not implemented.

Stage 1: All three of the major ancillary clinical systems are installed (i.e., pharmacy, laboratory, radiology).

Stage 2: Major ancillary clinical systems feed data to a clinical data repository (CDR) that provides physician access for retrieving and reviewing results.

Stage 3: Clinical documentation (e.g. vital signs, flow sheets) is required; nursing notes, care plan charting, and/or the electronic medication administration record (eMAR)

Stage 4: Computerized Practitioner/Physician Order Entry (CPOE) for use by any clinician is added to the nursing and CDR environment along with the second level of clinical decision support capabilities related to evidence based medicine protocols.

Stage 5: The closed loop medication administration environment is fully implemented in at least one patient care service area.

Stage 6: Full physician documentation/charting (structured templates) is implemented for at least one patient care service area.

Stage 7: The hospital has a paperless EMR environment. Clinical information can be readily shared via electronic transactions or exchange of electronic records with all entities within a regional health network.

A full-featured EHR has the following functions according to the HL7 standards http://wiki.hl7.org/index.php?title=Product_EHR_FM:

1. Identify and maintain a patient record
2. Manage patient demographics
3. Manage problem lists
4. Manage medication lists
5. Manage patient history
6. Manage clinical documents and notes
7. Capture external clinical documents
8. Present care plans, guidelines, and protocols
9. Manage guidelines, protocols and patient-specific care plans
10. Generate and record patient-specific instructions
11. Place patient care orders
12. Order diagnostic tests
13. Manage order sets
14. Manage results
15. Manage consents and authorizations
16. Support for standard assessments
17. Support for standard care plans, guidelines, protocols
18. Support for drug interaction checking
19. Patient specific dosing and warnings
20. Support for accurate specimen collection
21. Present alerts for preventive services and wellness
22. Notifications and reminders for preventive services and wellness
23. Support for monitoring response to notifications regarding an individual patient's health, including appropriate follow-up notifications
24. Clinical task assignment and routing
25. Clinical task linking
26. Clinical task tracking
27. Clinical task timeliness tracking
28. Inter-provider communication
29. Pharmacy communication
30. Provider and patient or family communication
31. Patient, family and care giver education
32. Entity Authentication
33. Entity Authorization
34. Secure Data Exchange
35. Enforcement of Confidentiality
36. Data Retention, Availability and Destruction
37. Workflow Management
38. Provider demographics
39. Patient demographics
40. Patient's residence for the provision and administration of services
41. De-identified data request management
42. Scheduling
43. Report generation
44. Health record output
45. Specialized views
46. Rules-driven clinical coding assistance
47. Rules-driven financial and administrative coding assistance
48. Service authorizations
49. Support of service requests and claims
50. Claims and encounter reports for reimbursement
51. Manage Practitioner/Patient relationships

There is an attempt to build certification requirements in the United States through the Department of Commerce/NIST.http://electronichealthrecordsus.net/reading-the-tea-leaves-in-a-disclosure-document-when-will-onc-and-nist-be-prepared-to-accredit-health-it-certifying-bodies/ Booz Allen Hamilton has been awarded a $400,000 contract to develop a framework for electronic health record certification.

Numerous studieshttp://sites.google.com/site/hcinfosys/literature/failure report that electronic records in healthcare are fraught with failure. An academic study in a Milbank Quarterly January 2010 article by Greenhalgh, Potts, Wong, Bark and Swinglehurst at University College London titled "Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method" points this out but note that homegrown systems tended to be better received.http://eprints.ucl.ac.uk/18821/ Upwards of 80% of EMR adoptions fail especially large scale ones.http://sites.google.com/site/hcinfosys/literature/failure In Phoenix Arizona, 20% of medical practices have de-installed their EHRs due to implementation and financial reasons.http://www.mcmsonline.com/pdf/media/Pulling_EMR_Plug.pdf

A new Health Affairs article suggests $7 billion could be saved by simplifying billing - on order of projected savings of EHR it seems.http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0075v1

Translation of physician dictation via natural language processing into an EHR is the focus of several new products and US government research. Nuance announced some advances, acquisition, and a partnership to further the technology. The US Government is also funding the efforts for Consortium for Healthcare Informatics Research (CHIR) "to change free text as found in the doctor’s notes in electronic medical records and then translate these notes into structured data." Mr Record is an EHR that claims "data Elements imported from Physician Dictations to meet meaningful use criteria". The meaningful use criteria must be satisfied to receive a EHR benefits usage from the US Government.

Unidentifiable patient data is sold to drug firms and researchers seeking patients for clinical trials.http://www.ihealthbeat.org/articles/2010/5/18/some-hospitals-share-electronic-health-data-to-earn-or-save-money.aspx