EMRs vs. EHRs: What’s the difference?

In recent years, there has been a lot of discussion about electronic medical records (EMRs) and electronic health records (EHRs). Frequently, the terms are used interchangeably. However, this is incorrect, as there are several distinct differences between the two. 

Server-based vs. cloud-cased software

The two main differences between EMRs and EHRs are related to the inherent differences between server-based and cloud-based software.

Server-based software requires the storage of patient information on computer servers (hardware). For individual computers to access, share and modify this data, they need to be linked to the server via wi-fi or a hardwired network. Server-based systems require physical servers and peripheral hardware to operate, and require installations, regular updates, and periodic repairs.

Cloud-based systems, on the other hand, utilize web-based software that is easily installed and periodically and automatically updated by the vendor with little to no customer involvement. The software can be accessed and used by virtually anyone with security clearance on a computing device or smartphone with an internet connection.

Getting back to EMRs vs. EHRs—which is server-based, and which is cloud-based?

EMRs

Traditionally, EMRs are server-based, and with the changing federal laws, will be considered legacy technology in the future. The National Alliance for Health Information Technology (NAHIT) defines an EMR as "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health-care organization.”¹

While access to data on your server may be granted to team members who work from home or third parties, such as billing or scheduling companies, an EMR has limited sharing functionality beyond that. Therefore, it is not well-suited for total health management and interoperability, which are pending requirements.

EHRs

EHRs, on the other hand, are cloud-based systems. According to HealthIT.gov, an electronic health record is much more comprehensive than an EMR.² This is because electronic health records are designed to extend beyond your practice to readily share information with other health-care providers, such as dental specialists, medical laboratories, or physicians.

Another common feature of an EHR is the inclusion of a patient portal where the patient can view and download parts of their record at any time. In other words, EHRs are well-suited for total health management and interoperability.

To clarify, let’s compare managing cloud-based EHRs to managing patient care. When you manage patient care, you take the necessary radiographs, perform an intra/extra oral exam, and update the medical history to proactively manage the patient’s oral health status. Similarly, in managing the cloud, you will take time to gather information, become technology savvy, and understand the risks and benefits so you can effectively manage EHRs

Significance of EHRs

As noted by HealthIT.gov, EHRs provide the ability to electronically exchange health information in order to provide better, safer patient care as well as provide tangible benefits for a provider. Here are just a few EHR advantages:³

• Provide accurate, up-to-date, and complete information about patients at the point of care
• Securely share electronic information with patients and other clinicians
• Enable safer, more reliable prescribing
• Reduce costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health

When it comes to providing optimal patient care along with reliable security and a streamlined workflow, EHRs are superior to EMRs. 

Compliance and EHRs

When considering EHRs, there are two key compliance elements to keep in mind—the HIPAA Privacy Rule and the 21st Century Cures Act. 

HIPAA compliance. There are a number of pending updates to the HIPAA Privacy Rule. These prospective updates went through the public comment period earlier this year. The public comments are now in the process of being reviewed and considered by the Department of Health and Human Services (DHHS) as part of the final rule-making process. The proposed changes will strengthen patient access to their protected health information (PHI), facilitate data sharing, and ease the administrative burden on covered entities, such as dental practices. 

One of the proposed updates includes providing individuals (patients) the ability to access and direct disclosures of their own health information. In other words, this means a patient would need access to your system via a patient portal.

A second pivotal change is creating a pathway for individuals to direct the sharing of an electronic copy of PHI in an EHR among covered health-care providers and health plans. Among other things, this means the patient can allow others to access their records. Compliance with the pending changes may be greatly enhanced when using a cloud-based EHR solution.

The 21st Century Cures Act: The Cures Act supports an increase in the exchange of health information and interoperability of different systems, as well as giving patients greater access to their own health information. Think of interoperability as a two-step process.

First, your system must be able to exchange information with another system. That implies a two-way street, so to speak. Currently, while you can file insurance electronically from your computer system, the insurance company cannot exchange information with your network. Second, each system must be able to use the information that was exchanged. EHRs facilitate both the exchange and interoperability of patient information.

As a note of clarification, the Cures Act is frequently confused with the Cares Act 2020. In a nutshell, the Cares Act was designed to provide financial relief during the peak of the pandemic, whereas the Cures Act pertains to patient access to their information and the secure exchange of electronic health information.

Conclusion

EHRs are not only different than EMRs, they are better suited for today’s dental practice that is increasingly focused on total patient health, interdisciplinary collaboration, and quantifiable outcomes. However, practice owners must proactively manage the benefits of EHRs as well as any potential risks by becoming informed and leveraging this opportunity to enhance patient care and fulfill future regulatory requirements.

References

1. NAHIT, ONCHIT announce health information technology definitions. EHR Connection. July 14, 2008. https://www.hcpro.com/HOM-215033-2939/NAHIT-ONCHIT-announce-health-information-technology-definitions.html
2. What information does an electronic health record (EHR) contain? HealthIT.gov. April 9, 2019. https://www.healthit.gov/faq/what-information-does-electronic-health-record-ehr-contain
3. What are the advantages of electronic health records? HealthIT.gov. May 16, 2019. https://www.healthit.gov/faq/what-are-advantages-electronic-health-records