What does it mean to have a hospital EHR?

People talk about EHR, and EMR as though these things always mean the same things. Generally what qualifies as an EHR varies greatly. When you say the word “car” do you include trucks? trucks with 18 wheels? tanks? airplanes when they are on the ground? boats with wheels?

The frustrating thing about both the word “car” and “EHR” is that they can both be used as a “class” of things as well as a specific instance within that larger class.

Technically any “Practice Management System” is an EHR because its on a computer (electric) it has a record of what happened to a patient (health record). Most people specifically do not mean a Practice Management System when they say EHR. CCHIT is one effort to correct this, by creating a set of standards that EHR systems must live up to.

What happens when you specifically define an EHR in terms of functionality? You find out that almost no one has one.

Everyone is talking about the “bad news” that was just released at AHIC. But most industry insiders have know that deep adoption of EHR technology is laughable. What is interesting about the results above is how they defined an EHR, and how reasonable that definition is!

Here are the results.

Feature Comprehensive EHR EHR Lite EHR Really Lite
Patient Demographics X X X
Problem Lists X X X
Medication Lists X X X
Discharge Summaries X X X
Lab Reports X X X
Radiology Reports X X X
Medications X X X
Physician Notes X X
Nursing Assessments X X
Advance Directives X
Radiology Images X
Diagnostic Test Results X
Diagnostic Test Images X
Consultant Reports X
Lab Tests X
Radiology Tests X
Consultation Requests X
Nursing Orders X
Clinical Guidelines X
Clinical Reminders X
Drug Allergy Alerts X
Drug-Drug Interaction Alerts X
Drug-Lab Interaction Alerts X
Drug Dosing Support X

And the results out of the hospitals surveyed:

Comprehensive EHR Lite EHR Really Lite
1.7% 7.9% 12.0%

The whole point of EHR “Really” Lite was to get the score as high as possible… Even then the usage scores are very poor.

But consider this:

Jha noted in an aside that the percentage of U.S. hospitals with fully implemented EHR systems would double if the Veterans Health Administration at the Veterans Affairs Department were included, because virtually all of the VA hospitals have a comprehensive EHR under the survey standards.

According to this survey, at least, half the hospitals in the country that have comprehensive EHRs, are VA hospitals running VA VistA.

01-26-11 Update:

It is important to remember that one of the authors of this study was none other than David Blumenthal, currently the National coordinator for Health IT. He is the person most responsible for defining “meaningful use” which, supposed to fix precisely this problem.


2 thoughts on “What does it mean to have a hospital EHR?

  1. Here is a comment thread that I got from Larry Singer

    “There is also another confusion with EHR, that is between EMR and SEHR.

    An EMR is (generally) confined to a single practice.

    A SEHR is a cross-practice patient longitudinal summary record.”

    By what standard? Give me a reference that backs up your definitions….



    I am sure I read these definitions somewhere that I cannot now find, but I have found an ISO document that expands on this distinction: ISO/TR 20514:2005. The acronyms it uses are different. In Australia there has been a very recent introduction of the term IEHR (Individual Electronic Health Record) which is a cross practice record.

    Larry Singer
    Smart Health Solutions Pty Ltd

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