Certified Electronic Health Record Specialist Program (CEHRS) Overview

An electronic health record (EHR), also an electronic patient record (EPR) or computerized patient record, is a record in digital format that is capable of being shared across different health care settings through being embedded in network-connected enterprise-wide information systems. The electronic medical record (EMR) can be defined as the legal patient record created in hospitals and ambulatory environments that is the data source for the EHR, which in turn gives patients, physicians and other health care providers, employers, and payers or insurers access to a patient's medical records across a number of relevant entities. Just a short while ago, the acronym EHR didn't mean much to many people. But since Congress passed the health-care reform law in 2010, physicians and hospitals have become intimately acquainted with it ? and patients and job-seekers alike are following suit.

Electronic Heal Records may include a whole range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. These records allow for the automation and streamlining of the workflow in health care settings, increasing safety through evidence-based decision support, quality management, and outcomes reporting. While, physicians and other professional medical personnel use these records on an everyday basis, an entirely new group of trained personnel is quickly arising to handle these new kinds of records as well.

EHRs are slowly but surely being adopted by hospitals and physicians as the federal government begins to pay out billions of dollars in extra Medicare and Medicaid payments. And bit by bit, digital records are replacing the file folder that has typically held handwritten information about a patient. EHRs' advantage is their easier accessibility. Rather than being locked in a doctor's office, the information, in theory, can be accessed by other health-care providers all over the world. If an American patient winds up in a hospital in China, his/her records are instantaneously available. In essence, information moves with the patient. If a patient has been to six different hospitals and three different doctor's offices, all of that data can be viewed easily. For this reason, EHRs are expected to reduce unnecessary tests and treatment, thus limiting the potential for medical errors.

Electronic health records systems provide medical facilities with great functionality, including interactive alerts to clinicians, interactive flow sheets, and tailored order sets, most of which cannot be easily done with paper-based systems. At best, electronic health records help lessen patient suffering due to medical errors and the inability of administrators to assess quality. They can also reduce costs in some circumstances.

Realistically, these benefits may only be realized if the systems in place are widespread enough so that various facilities can easily share information. That requires best practices in software engineering and medical informatics to enable connectivity to many electronic medical record systems. On the downside, some physicians report spending more time entering data into an empty EHR than they used to spend updating a paper chart with simple dictation. But such hurdles can be overcome once the software has some data, as physicians and their staff learn to use templates for data entry, and as workflow in the practice changes. Still, there are legitimate questions about the need to increase information technology staff to maintain the EHR systems as well as the cost savings to be realized by smaller operations.

One risk of electronic health records is the potential for the information being leaked, lost, altered or merely read by an unauthorized person. Leaks can be purposeful or accidental. Therefore, the software is designed with an audit function, in which administrators are able to see who looks at a patient's data, when they did so, from what computer and what piece of data they examined. To set up EHR systems, hospitals and doctors in this country choose from a list of federally approved software that must conform to certain standards that allow them to communicate with a health information exchange.

Privacy concerns in healthcare apply to both paper and electronic records. Roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a typical hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access as well. Recent revelations of "secure" data breaches at centralized data repositories, in banking and other financial institutions, in the retail industry, and from government databases, have caused concern about storing electronic medical records in a central location. It is not surprising that records exchanged over the Internet are subject to the same security concerns as any other type of data transaction.

The Health Insurance Portability and Accountability Act (HIPAA) was passed in the US in 1996 to establish rules for access, authentications, storage and auditing, and transmittal of electronic medical records. This standard made restrictions for electronic records more stringent than those for paper records. However, there are concerns about the adequacy of these standards. One major issue concerns how to secure the privacy of patients. While various government officials have called for the creation of networks, others fear that there is no clear strategy to protect the privacy of patients, particularly as the use of electronic medical records expands throughout the country and computer networks linking insurers, doctors, hospitals and other health care providers proliferate. What will happen, they ask, when the number of people who will need to have access to electronic records reaches 12 million? This is a significant barrier to the adoption of a nationwide EHR system and is leading to a surge not only in the number of court cases, but in the cost of every aspect of healthcare and healthcare technology.

For reasons of both confidentiality and of maintaining standards, the U.S. federal government has issued various rules governing electronic health records. But because each healthcare environment functions differently, it is difficult to create a "one-size-fits-all" EHR system. An additional consideration concerns the planning for the long-term preservation and storage of these records. Professionals in the field will need to come to consensus on the length of time to store EHRs, methods to ensure future accessibility and the compatibility of archived data with yet-to-be developed retrieval systems, as well as how to ensure the physical and virtual security of the archives.

In summary, the rise of Electronic Health Records is inevitable. We are not likely to return to handwritten files, just as we are not likely to reverse the trend to digitization. Still, the fact that EHRs have the potential to be created, used, edited, and viewed by multiple independent entities - primary care physicians, hospitals, insurance companies, and patients alike ? gives us pause. That is the basis for both the cheers and the fears expressed about EHRs.