What is EHR?

EHR is the larger umbrella that covers all Healthcare-IT systems that store or help in storing healthcare records. Examples of systems coming under EHR are Hospital Information Systems (HIS), Electronic Medical Records (EMR), Clinical Information Systems (CIS), Patient Medical Records (PMR), Lab Information System (LIS or LIMS), Radiology Information System (RIS), Picture Archival and Communication System (PACS) etc..

Healthcare Records is a vague term and has many meanings derived out of it. To my mind it means all Health Records of patients from cradle to grave and beyond. If these records are stored in electronic format then its called a EHR. EHR could be created by collecting the primary data at the point of care, Lab, Pharmacy etc. and/Or EHR could be created by scanning old paper based records and keeping them for future reference.

Secondary data derived by analysis of primary health records also keeps getting added to the EHR once created. Examples of such secondary data are disease trend analysis for the chronic diseases such as Diabetes or Hypertension.

Reports generated by Evidence based medicine also get added to the EHR. Also population level epidemiology analysis is an anonymised view of the EHR.

The effective use of information technology is a key focal point for improving healthcare in terms of patient safety, quality outcomes, and economic efficiency. A series of reports from the U.S. Institute of Medicine (IOM) identifies a crisis of "system" failure and calls for "system" transformation enabled by the use of information technology. Such a change is possible by "an infrastructure that permits fully interconnected, universal, secure network of systems that can deliver information for patient care anytime, anywhere. A critical foundational component for resolving these system and infrastructure issues is the Electronic Health Record System (EHR-S).

The IOM's 1991 report, The Computer-Based Patient Record: An Essential Technology, and updated in 1997 (Dick, R.S, Steen, E.B., & Detmer, D.E. (Editors), National Academy Press: Washington, DC) defined an EHR System as:

• The set of components that form the mechanism by which patient records are created, used, stored, and retrieved.
• A patient record system is usually located within a health care provider setting. It includes people, data, rules and procedures, processing and storage devices (e.g., paper and pen, hardware and software), and communication and support facilities.
  

The 2003 IOM Letter Report, Key Capabilities of an Electronic Health Record System, defined the EHR System as including:

• Longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual
• Immediate electronic access to person- and population-level information by authorized, and only authorized, users
• Provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care;
• Support of efficient processes for health care delivery
  

The 2003 ISO/TS 18308 references the IOM 1991 definition above as well as CEN 13606, 2000:

• A system for recording, retrieving and manipulating information in electronic health records.

In developing the EHR-S Functional Model, HL7 relied on three well-accepted definitions: two provided by the U.S. Institute of Medicine and one developed by the European Committee for Standardization/ Comité Européen de Normalisation (CEN). This Functional Model leverages these existing EHR-S definitions and does not attempt to create a redundant definition of an EHR-S.