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Should I sign up for that Google Health thing?

August 1, 2008

The Difference Between an EMR and a PHR

What is an electronic medical record (EMR)?

An EMR is essentially an electronic version of the medical records normally kept by physicians in paper format.  This electronic record is kept and maintained by the physician and his or her staff.  It is considered to be an unadulterated history of any and all care a particular physician provides to a particular patient.  These systems are generally only accessible to medical staff, not the patients themselves (although some advanced systems are granting patients viewing access, but not editing privileges).

What is a personal health record (PHR)?

A personal health record is an online resource for storing relevant pieces of a patient’s medical history, but is not necessarily reflective of ALL care provided to a patient.  The most common examples of PHRs are Google Health and Microsoft HealthVault.  Both are online systems that individuals sign up for.  They may then enter their own medical histories or download information into their PHR from physicians who have the capability to share data electronically between their EMR and Google Health or Microsoft HealthVault.  Thus, these records are essentially user generated.  All information contained in them is editable by the patients themselves.  Aside from Google Health and Microsoft HealthVault, some healthcare systems have smaller, individual PHR systems for their program participants.  These types of systems are usually integrated with the EMR systems and can blur the line between a PHR and an EMR.

Ok, I read both of those definitions, but I still don’t really understand what makes them different.

An EMR is maintained by the physician; patients are not allowed to edit or censor information in it.  A PHR is generated by the patient (either by entering the information themselves or through downloads from their doctors) and is completely editable by the patient.  Patients decide what information they want in their own PHR.

Dr. Stanley Feld has a post detailing the whole electronic records thing in more detail.

Now I understand, but am caring less and less with each boring word I read.

One important implication for this subtle difference is how we share records with different providers.  Some people assume that if they create a Google Health file, they will be able to provide that as a comprehensive record of past medical care whenever they see a new physician (and avoid the hassle and cost of filling out a release form and having records photocopied/printed out and mailed to the new doc).  This is unlikely to work.  Because PHRs are user generated, physicians are unlikely to trust their content.  This is not because doctors don’t trust their patients (by and large they do) but more because a medical decision based on information from a PHR is unlikely to hold up in a malpractice lawsuit.  I am unaware of any instances where a PHR was implicated in a malpractice suit, but I’m sure one is not too far away and then we will have a legal finding on how doctors should treat these (and how their lawyers will treat them).

So, before you sign up for that Google Health account and put all of your health information in the public domain (I haven’t even touched the privacy issues of both systems) realize the utililty of such a record.  They are tremendously useful for people who like to keep a close eye on their health or have to deal with a chronic condition.  However, they may not be worth the effort for people who think it will be an easy way to share records between their primary care doc and their cardiologist or dermatologist or nephrologist or any other -ologist they see.

UpdateHere is an article from Medical Economics from about a month ago that gives a brief description of the difference between EMRs and PHRs.

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