What are Electronic Medical Records and Electronic Health Records?

Electronic medical records and Electronic health records
July 5, 2013

Posted by MedbillingExperts / 0 Comment

Electronic health records and electronic medical records refer to the digital storage of your health data at your doctor’s office. Over time, more offices have been adopting technology that allows them to collect and store electronic data. As more offices make the move to electronic records, vast amounts of patient data will be available at the click of a button, which will be much more easily retrieved than previous methods.

Slow To Adopt

Although some doctor’s offices and healthcare professionals are ahead of the curve when it comes to records management electronically, others are lagging due to issues surrounding privacy and a lack of a standard process. Ultimately, when used properly, electronic health records can help to streamline the process of reviewing past visits and history data. This process will result in better options for both physicians and patients, but in the meantime, the process is being refined in order to have standard processes in place.

As EMR and EHR is accepted by more physicians, the benefits will be seen by providers and patients alike.

Types of Records

There are two different kinds of records when it comes to electronic medical record classification. Any records before the year 2000 are generally scanned and stored as a pdf or in graphic format. If the records were taken by hand, it can be difficult to read them. Everything, including doctor notes and x-rays, might be included in this form of EMR. Unfortunately, this has led to many challenges are records were converted over, because past mistakes were either copied or created by the new digital systems.

Fixing those mistakes would require a great deal of effort and manpower, but the downside is that leaving mistakes in a patient file permanently could lead to confusion down the road. Other records are those that were stored digitally from the outset. Some doctors have simply implemented their own electronic systems that allow them to take notes while they talk to you and transfer patient information directly into a digital file.

Since EMR is relatively new, there are bugs and potential mistakes, which either require effort or the acceptance of inaccurate information within a record.

Electronic health records go beyond the data traditionally provided in an electronic medical record. They are filled with information that presents a total and more comprehensive patient history, like information from all of the providers engaged in a patient’s care. In this way, electronic health records stretch across multiple organizations.

Government Recommendations- EHR and EMR

The federal government has been a leader in helping to standardize electronic health records. They define a complete EMR system as one that has all of four foundational functions. These include computerized prescription orders, computerized test orders, test result reporting, and physician notes. While each healthcare office might keep varieties of different information, a complete system is one that has the capability for each of these aspects. In 2009, the government rolled incentives for participating in electronic record keeping for offices as part of the economic stimulus plan.

The government has played a key role in developing guidelines for electronic medical records collection and management.

Benefits of Electronic Medical Records

There are many benefits to electronic medical records. First of all, it provides alternative solutions in the event of a fire or other natural disaster. This makes it easier to backup files and ensure that patient records are safe even in the event of an unforeseen disaster.

Electronic medical records have more security protocol required, but they also protect patient data in the event of paper document destruction.

Electronic medical records first of all allow patients and physicians to track data over the course of time, which can help to inform diagnoses and treatment plans. When a physician is able to get a broader view of the patient’s overall history, it can be simpler to target small changes in lifestyle or medication that can make life better for the patient.

Overall quality of care in the practice is improved when EMR is used properly.

Electronic medical records can also play a key role in identifying patients for preventive visits and necessary screenings. Automatic reminders can help keep staff involved in contacting patients about necessary follow-ups or checkups, resulting in better patient care and vital doctor’s appointments that can help to flag problems before they get worse.

Additionally, electronic health records can compare how patients are handling vaccinations and blood pressure readings, providing even further insight into their health history and vital signs.

In an ideal scenario, patients will be able to receive copies of their electronic health data much more quickly than the traditional process of requesting paper records. This can also help to speed up referrals to other physicians and even the life insurance application approval process, cutting out the significant wait time associated with medical records.

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