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Alphabetical Order

Harry Potter has his dark lords and demons; the insurance world has its twisting maze of acronyms and relentlessly battling exclusions and riders.  But this is nothing compared to medicine and health care and its bewildering alphabet brew.

Consider, if you will, EMR and EHR.   I was skimming through a very thoughtful blog this morning, written by an articulate and pragmatic physician, when I realized I had missed the difference between these two.  The ‘M‘ is for medical; the ‘H‘ is for health.  We have Electronic Medical Records on one side, and Electronic Health Records on the other.  Who knew?

Kevin, of KevinMD and MedPage Today, was making a great point in his article.  He noted his concern that the doctor-patient relationship may well be threatened by a preoccupation with a laptop screen.  A time-pressed doctor scrolling through records and reports and lab results is not looking at his or her patient, nor listening as intently.  He concludes by suggesting that the doctor not bring the laptop into the exam room; documenting the visit should be done later.

Now, on to the difference between an electronic medical record and an electronic health record:

Electronic Medical Record: EMR

A digital or electronic version of paper charts, recording a patient’s medical and treatment history in one practice or facility.  It is a physician’s own electronic record of his or her patient’s medical care.  The information in an EMR does not necessarily go easily or quickly from that office to other medical facilities or specialists; they may even have to be printed out before being sent on.

Electronic Health Record: EHR

An EHR focuses on a patient’s total health picture and contains information from all the physicians and caregivers involved in a patient’s care.  This is an altogether more ambitious and inclusive undertaking.  And it goes with the patient – from doctor to doctor, hospital to clinic, even state to state. In theory, anyway.  In a perfect world.

Obviously, there is a lot involved here: security, communication, cooperation, responsibility, software compatibility.  And the patients themselves are to have access to the files.  The point is to emphasize and facilitate the team effort aspect of health care.  At its best, the system will see that information gathered from a primary care provider is accessible in emergencies, will motivate the patient to take medications on time and as prescribed, will let specialists know what tests have already be run so there is no costly duplication, and so on.

Lots to think about here.  And to return to our thoughtful doctor, cited above, there is still no substitute for a hands-on doctor who can devote himself or herself completely to the patient in front of him.  Listening, asking, thinking in real-time.  And looking at the patient, patiently.

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