ELECTRONIC MEDICAL RECORDS

Paper-based records have been in existence for centuries* and their gradual replacement by computer-based records has been slowly underway for over twenty years in western healthcare systems. Computerised information systems have not achieved the same degree of penetration in healthcare as that seen in other sectors such as finance, transport and the manufacturing and retail industries. Further, deployment has varied greatly from country to country and from speciality to specialty and in may cases has revolved around local systems designed for local use. National penetration of EMRs may have reached over 90% in primary care practices in Norway, Sweden and Denmark (2003), but has been limited to 17% of physician office practices in the USA (2001-2003) [HHS, 2005]. Those EMR systems that have been implemented however have been used mainly for administrative rather than clinical purposes. Electronic medical record systems lie at the center of any computerised health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerised medical record, which has been a goal for many researchers, healthcare professionals, administrators and politicians for the past 20+ years, is however about to become reality in many western countries. Over the past decade, the political impetus for change in almost all western countries has become stronger and stronger. Incontrovertible evidence has increasingly shown that current systems are not delivering sufficiently safe, high quality, efficient and cost effective healthcare (see Public Reports section on OpenClinical), and that computerisation, with the EMR at the centre, is effectively the only way forward. As Tony Abott (Australian Minister for Heath and Ageing) said in August 2005: "Better use of IT is no panacea, but there's scarcely a problem in the health system it can't improve". For the first time, the responses have been national and co-ordinated. Governments in Australia, Canada, Denmark, Finland, France, New Zealand, the UK, the USA and other countries have announced - and are implementing - plans to build integrated computer-based national healthcare infrastructures based around the deployment of interoperable electronic medical record systems. And many of these countries aim to have EMR systems deployed for their populations within the next 10 years.

TERMS

Terms used in the field include electronic medical record (EMR), electronic patient record (EPR), electronic health record (EHR), computer-based patient record (CPR) etc. These terms can be used interchangeably or generically but some specific differences have been identified. For example, an Electronic Patient Record has been defined as encapsulating a record of care provided by a single site, in contrast to an Electronic Health Record which provides a longitudinal record of a patient�s care carried out across different institutions and sectors. But such differentiations are not consistently observed.

C. Peter Waegemann in his Medical Record Institute EHR Status Report provides, within a historical context, a summary of the different functions and visions implied by the various terms used to refer to EMRs.