The Evolution of EMR, EHR, and Practice Management

Electronic medical records (EMRs) and electronic health records (EHRs) have been getting quite a lot of attention over the past several years. As technological advancements become more widespread, it only makes sense for the healthcare industry to begin embracing solutions that have the potential to make patient—and provider—lives better. Now, before we dive into the evolution of these software systems—how they came to rule the roost in modern care facilities around the world—let’s first address a common question. EMR vs. EHR: What’s the difference? Historically speaking, the difference between an EMR and EHR has to do with the difference between the words “medical” and “health.” Electronic medical records were simply electronic versions of the medical charts that healthcare providers used to document on paper, whereas electronic health records purportedly took a broader lens to encompass not only the patient’s medical records, but also information related to his or her health and wellbeing.

Today, though, the difference between EMRs and EHRs can be vast or non-existent—depending on the system and, sometimes, who you ask.

The Difference Between EMR and EHR

According to this U.S. News and World Report article, which makes no distinction between EMR and EHR, “At their best, EMRs (also abbreviated EHR, for electronic health records) pull together all of a patient’s information, from the results of the last routine checkup with her primary care doctor to CT scans from her emergency hospital admission because of a fall she took while vacationing 500 miles from home, in one place that is secure but remotely accessible not only to physicians but to the patient herself.” In other words, regardless of whether a particular system bears the moniker of EMR or EHR, the comprehensive information contained within it is meant to be accessible to all providers in a patient’s care team (à la interoperability) as well as to the patient.

One-Size-Fits-All Software Fits No One

In a recent webinar, WebPT CEO Nancy Ham said that EMRs and EHRs share many similarities, including the fact that they both house digital records of important patient information (among other things) and are capable of seamlessly exchanging relevant data with other systems. In fact, she said, a specialty EMR with interoperable functionality may actually be better than a large-scale, generalist EHR for many providers—especially those in niche fields. With these types of systems, providers are able to maximize their workflows and processes with solutions that are well-suited to their specific needs—and still thrive in this new era of connected, collaborative care. In this February’s Founder Letter—titled, “Too Big to Scale: The Fallacy of One-Size-Fits-All Software”—WebPT President Heidi Jannenga, PT, DPT, ATC/L, took the discussion one step further, reporting that some large-scale EHRs appear resistant to integrating with specialty EMRs—primarily because they’re so focused on “hospital-to-hospital integrations.” However, she believes that’s short-sighted for everyone involved and urges niche providers—such as PTs, OTs, and SLPs—to take a stand: “By raising our collective voices, we can demonstrate how EMR and data-tracking software built specifically for our clinical needs can help our partners in the hospital space save money and improve care quality,” she wrote. Ultimately, that’s what we all want, right?

EMRs and EHRs Do Much More Than Their Name Implies

No matter what you call these systems—or how you define them—neither is simply a record storage program anymore. In fact, most EMRs and EHRs on the market today do much more than house patient data (although that’s obviously still mission-critical); they also provide practitioners with a suite of other practice management tools, such as billing, scheduling, reporting, outcomes tracking, compliance alerts, and analytics.

The Way, Way Back

Less than a decade ago, the majority of healthcare providers were creating and storing patient records on paper. Less than a century ago, providers weren’t documenting much at all. According to this paper from the National Assembly on School-Based Health Care, physicians wrote down their diagnoses and the treatment they provided—and that’s about it, which means they certainly weren’t taking down comprehensive notes regarding each patient’s medical history, quality measures scores, or even his or her symptoms.

1960s

However, electronic record systems aren’t anything new. According to this resource, in the early 1960s, medical care began to increase in complexity—and physicians began to acknowledge the potential danger of not having access to a patient’s medical history. In an effort to improve access—and, therefore, care—the first electronic information storage systems were developed. The Mayo Clinic in Rochester, Minnesota, and the Medical Center Hospital of Vermont were two of the first organizations to implement them.

According to HIMSS—as cited in this Becker’s Hospital Review article—by 1965, approximately 73 hospital and clinical information projects (as well as 28 projects that addressed the storage and retrieval of medical documents and other clinically relevant information) were in progress. Then, in the late 1960s, Larry Weed developed the Problem-Oriented Medical Record—an innovative and more thorough documentation system that would enable third-party practitioners to independently verify diagnoses and treatment decisions.

1970s

Just a few years later, in 1972, Dr. Clement J. McDonald, MD, developed and launched the Regenstrief Medical Record System (RMRS). Via clinical trials, McDonald “illuminated the ways in which electronic records can improve patient care.” According to his biography on the Lister Hill National Center for Biomedical Communications website, “he published the first randomized trials showing the benefits of computer reminder systems and of physician order entry systems.” Per this resource, RMRS “was widely hailed as a major advance in medical practice.” Unfortunately, though, according to this University of Scranton article, the high cost of the system prevented it from gaining popularity among physicians; instead, it was used primarily by “government hospitals and visionary institutions.”

The Way Back  

1980s-ish

According to this resource, in the 1970s and ’80s, several academic and research institutes developed their own electronic record systems in order to track and monitor patient treatment. Around the same time, new features and functionality became available for providers—all designed to further improve patient care: specifically, electronic systems started to house drug dosages, interactions, side effects, and allergies. Plus, the integration of electronic diagnostic and treatment plans made it easier for providers to care for their patients. In the late 1970s, the US federal government implemented an EHR in the Department of Veteran Affairs, which—according to this resource—was renamed the Decentralized Hospital Computer Program in 1981 and eventually became the Veterans Information Systems and Technology Architecture (VistA) in the early 1990s.

1990s

According to the University of Scranton, in 1991, the Institute of Medicine—a well-respected US think tank—urged the medical community to adopt electronic health records, making the case that every physician’s office should be using technology to improve patient care by 2000. To help move the industry toward technology adoption, the think tank also released policy recommendations as to how healthcare professionals might go about achieving that goal. While EMR use continued to grow in popularity among hospitals and institutions, the expense—which often included server upkeep, maintenance, and IT support in addition to the cost of the system itself—was often too much for office-based practitioners to bear.

2000s

By 2004, only a little more than 20% of office-based physicians had adopted an electronic record system. However, the advent of web-based technology in the early 2000s made it possible for more providers to reap the benefits of electronic record systems without having to spend a lot on hardware or upkeep. According to the University of Scranton, “The ability to access information remotely or store on a remote-system, made the electronic method of keep records more appealing and ultimately more affordable for physicians to implement into their practice.” This technology also became paramount as more and more compliance regulations began taking effect. Cloud-based software vendors were able to regularly update their systems to address new documentation and compliance regulations, meaning the burden of keeping systems up-to-date no longer fell on providers’ shoulders. Furthermore, these cloud-based systems were able to expand their service offerings to address providers’ needs beyond documentation. Many began offering suites of additional features to help providers better manage their practices—everything from tools and functionality that help streamline front-office operations to integrated billing options (software and RCM) that help improve cash flow. Ultimately, the market forerunners became all-encompassing practice management platforms.

By 2008, almost half of all office-based physicians were documenting electronically.

Today

To say a lot’s changed in health care since the ’60s would be quite the understatement. Today, more and more providers in every discipline are making the switch from paper charts to software platforms. In fact, according to the Office of the National Coordinator for Health Information Technology, as of 2015, 86.9% of office-based physicians were using an electronic record system. And in this ever-evolving, regulation-intensive healthcare environment, those electronic systems must do their best to keep up. With the shift toward a more value-based, patient-centric healthcare paradigm, today’s platforms must enable providers to better collaborate with one another and take advantage of alternative payment models such as bundles. That means those platforms must allow providers to not only collect and share risk-adjusted patient outcomes data using measures familiar to—and respected by—the rest of the healthcare community, but also use that data to improve patient care and payment rates. More specifically, today’s practice management platforms must include integrated outcomes tracking functionality as well as intuitive analytics.

Tomorrow

Providers aren’t the only ones feeling the push toward consolidation; EMR and EHR companies are feeling it, too. As Jannenga wrote in this article about industry predictions, “There are simply too many disparate systems that aren’t evolving fast enough, and private equity investors see this as an opportunity to create larger companies that have the resources to keep up with the pace of healthcare change.” She explained that we’ve already seen evidence of this shift in the rehab therapy space as TherapySource became Casamba and PTOS went out of business—and we’ll continue seeing similar changes over the next several years. “While it may not feel like these changes are good (especially if you were a PTOS user), this transformation—this tightening up—will help enable software companies to provide the type of technology (e.g., interoperability) healthcare providers need to thrive in the new era of health care,” Jannenga said.

Speaking of interoperability, it’s the buzzword of the moment for practice management platforms as healthcare reform efforts continue to call for more integrative, collaborative care. According to Jannenga, “The need to share and exchange patient information and data across healthcare sectors that were previously siloed will continue to grow—at an even faster pace. In 2017—and beyond—interoperability among software systems will be much less of a nice-to-have and much more of a mission-critical must-have.” Unfortunately, though, in a webinar Jannenga and Ham co-hosted, Ham pointed out that the path to interoperability still has a few bumps in it: “Achieving interoperability often still hinges on a point-to-point conversation—or some might say, a game of telephone,” she said. “And that’s because achieving interoperability is never as simple as it should be.” Still, the challenges associated with interoperability aren’t deterring anyone. In fact, both Jannenga and Ham made it clear that WebPT “is dedicated to being an industry leader in interoperability as a critical requirement for our Members and the patients they serve.”

What has been your experience with the evolution of EMR, EHR, and practice management? When did you adopt your first electronic record system—and where do you see these platforms going? Tell us your thoughts in the comment section below.

[node:embed-code:https://www.webpt.com/wp-content/uploads/2018/11/201703_blog_theevolutionofemrehrandpracticemanagement_infographic.png]

‍