What is an electronic health record (EHR)?

The benefits of EHRs

EHRs offer numerous benefits to both patients and healthcare organizations, such as the following:

• Improves care coordination and quality. EHRs make standardization of services and patient care easier for healthcare organizations, often improving patient outcomes. Healthcare professionals have quick, easy access to patient information, which can help them make better-informed medical decisions.
• Increases efficiency. EHRs can help patients streamline processes such as appointment scheduling, billing, medication refills and other healthcare-related communications. They can quickly share and update multimedia information, such as medical imaging results, among different healthcare offices and organizations.
• Improves emergency care. Healthcare professionals have immediate access to critical patient records, including allergies, medications and illnesses, enabling them to make life-saving decisions.
• Enhances access to data. Both patients and healthcare providers have easier access to electronic medical records, as data is stored in a secure format that's accessible only to the patient and authorized stakeholders. This also encourages patients to engage with their healthcare providers and take a more active role in managing their health.
• Offers cost savings. Although EHR systems can be expensive to maintain, they reduce the need for paper-based systems, which provides healthcare organizations with more efficient storage and retrieval of medical records. EHRs also require less redundancy of effort for healthcare practitioners.
• Provides population health management. EHRs enable healthcare organizations to aggregate patient data for population health management and quality of care programs like clinical decision support.

The governments of many countries are working to ensure that all citizens have standardized electronic health records and that all records include the same types of information. The major barriers for the adoption of electronic health records are cost and privacy.

These complexities have affected EHR adoption worldwide. For example, whereas most primary care physicians in the Netherlands and the U.K. have implemented EHRs, challenges such as security have hindered EHR adoption in countries like India.

Regulations around EHRs

For EHR vendors' products to qualify for use in U.S. government programs such as Medicare and Medicaid, their EHR platforms must meet certain criteria. The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) created the Medicare and Medicaid EHR Incentive Programs to help ensure EHRs meet certain standards and other criteria. Furthermore, the programs assure healthcare users -- such as hospitals and healthcare systems -- the technology that the EHR system they purchased has the necessary technical capabilities, functions and security in place to meet meaningful use requirements. In addition, healthcare organizations and EHR vendors must also attest and demonstrate that they haven't knowingly and willfully taken action to restrict interoperability of their EHR. CMS and ONC have implemented this attestation requirement to prevent information blocking.

It's important to note that while the regulations governing the storage of EHRs in the U.S. are uniform, the term of retention can vary, state to state. Regulations governing duration of EHR storage are subject to change over time.

It's also important to note that as mobile devices and systems have become ubiquitous, the creation of regulatory policies and best practices governing EHRs and data protected under the Health Insurance Portability and Accountability Act (HIPAA) in such devices hasn't kept pace. This is an essential ongoing effort within all relevant governing agencies.

EHR standards

EHR standards are in place to certify that electronic health records fulfill meaningful use -- in other words, to ensure that EHRs possess necessary technical capabilities and security safeguards.

Another purpose of standards is to help facilitate interoperability. The health IT community has already created the following interoperability standards:

• Health Level Seven International (HL7), a set of international criteria for transfer of clinical and administrative data.
• Fast Healthcare Interoperability Resources, a web-based series of tools that fall under HL7.
• SMART Health IT, an open, standards-based technology platform that enables people to create applications that can run across a healthcare system, including EHRs.

While European standards provide the same features and value, some differ from those used in the U.S. For instance, the CEN/TC 251 and DICOM (Digital Imaging and Communications in Medicine) standards are used in communication of EHR data, while the Continuity of Care Record -- developed with U.S. input -- is popular internationally.

How EHRs improve patient care

EHRs can improve patient care in several ways. For example, they can aid in diagnosis by giving providers access to patients' complete health information, which provides a comprehensive view and helps clinicians diagnose problems sooner.

Furthermore, EHRs can help reduce medical errors, improve patient safety and support better outcomes. While EHRs do contain and transmit data, they also manipulate patient information in meaningful ways and provide that information to the provider at the point of care.

EHRs can also help improve public health outcomes by providing a view of the entire patient population's health information, which lets providers identify specific risk factors and improve outcomes.

The difference between EHR and EMR

EMR stands for electronic medical record. These days, the terms EHR and EMR are used interchangeably and are essentially the same thing. However, government entities such as ONC use the term EHR exclusively.

EHRs vs. paper records: Pros and cons

While many agree that, overall, EHRs offer more benefits than paper health records, EHRs aren't without their flaws. The following are some major differences between paper and electronic records:

• Time. Some providers have reported that EHRs have saved them anywhere from 10 to 20 hours per week in documentation, giving them more time with their patients. However, others argue that EHRs pose a learning curve and force providers to become data entry staff. All of that clicking and typing, some argue, causes physicians to focus on the computer rather than the patient in the room.
• Environment. Going digital with patient records saves paper because a patient's medical record is usually made up of hundreds, and sometimes even thousands, of pages.
• Security. Some believe that paper records can be more vulnerable to being compromised due to a break-in, loss of a paper record due to human error, or damage to paper records because of a natural disaster. However, EHRs have had their fair share of cybersecurity data breaches involving thousands of medical records.
• Cost. Large healthcare organizations can pay $1 billion or more to purchase and install EHR systems, and it could take months to implement the technology. There are also long-term digital storage costs associated with EHRs. Paper records require more human administrative maintenance in terms of storing the files and arranging access to them, and physical space costs are involved. Any healthcare organization needs a significant cost analysis to examine what is spent versus what is saved with EHR systems. Meanwhile, the U.S. government heavily subsidized the initial push to EHRs in the U.S. by offering hospitals financial incentives to install this technology.
• Access. The process of sharing paper records can be more arduous than sharing digital patient information; it includes finding the paper record -- possibly, in a large warehouse -- and then either mailing, faxing or scanning copies. In theory, sharing EHRs should be easier, but the reality is that practices by organizations and vendors could lead to EHR information blocking.
• Readability and accuracy. With paper records, physicians' penmanship might be difficult to read, which could lead to inaccuracies. Furthermore, with paper records, often there isn't enough room for a physician to write everything down legibly. With EHRs, there's basically an unlimited amount of space, and typing and natural language processing can eliminate concerns about illegibility.

Common features of EHRs

There are a series of common and essential features that any EHR system offers. For starters, EHR platforms often set up a patient portal for consumers to access information as well as allow for secure data sharing and data access from other healthcare organizations.

EHRs also typically place patient care orders for clinicians, such as medication orders and diagnostic test requests. In terms of medications, EHRs can manage doses for specific patients and alert physicians to any possible drug interactions. The systems can also manage order sets, results and patient consents and authorizations.

EHR systems also often help coordinate clinician workflow management and scheduling.

Finally, these systems can assist in completing clinical, financial and administrative coding. This feature includes support of service requests and claims for reimbursement.

Top EHR vendors for hospitals

According to Market.us Media, the global market for EHR is predicted to grow from $27.1 billion in 2023 to $45.9 billion by 2033. The market is broken down by product type with cloud-based EHR software accounting for $12.47 billion and on-premises EHR software contributing $14.63 billion.

As of 2024, the inpatient hospital EHR market is dominated by Epic Systems Corporation and Oracle Health, formerly Cerner Corp. and Oracle Cerner. Epic possesses a 37.7% market share to Oracle Health's 21.7%, according to the Atlas Technology Install Dataset. Meditech ranks third with 13.2% of the market and Evident fourth with 6.9% market share.

EHRs and security

All EHRs in the U.S. must be HIPPA-compliant. This requirement is enforced by the Department of Health and Human Services Office for Civil Rights (OCR).

HIPAA is broken up into two rules: the Privacy Rule and the Security Rule. The HIPAA Privacy Rule protects medical records and other personal health information (PHI) via national standards. This applies to covered entities, such as health plans, healthcare clearinghouses and healthcare providers that conduct transactions electronically.

The HIPAA Security Rule protects electronic PHI that's created, received, used or maintained by a covered entity by establishing national standards.

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 also provides regulations meant to ensure the security of EHRs.

However, HIPAA and the HITECH Act are just the baseline for EHR security. EHRs should also have other security features built into the platform, such as audit trail systems, access controls, encryption, monitoring and artificial intelligence and machine learning.

Despite the security precautions EHRs take, fear of a data breach is rampant in the healthcare industry. This isn't surprising, given that healthcare data breaches where patient records and personal information are compromised happen quite often.

According to the HIPAA Journal, several major cyberattacks and data breaches were reported in the first half of 2024. Ransomware attacks on St. Louis-based Ascension and Change Healthcare caused major disruptions and took a financial toll on both healthcare systems.

For more than four weeks, Ascension was forced to shut down its EHR services and switch to manual record keeping as well as close critical systems at many of its 136 hospitals.

Change Healthcare, a subsidiary of UnitedHealth Group, lost several terabytes of patient data in its breach -- including insurance records, payment details and other PHI. According to UnitedHealth Group CEO Andrew Witty, the company paid a ransom of $22 million in bitcoin to the attackers -- one of the largest payouts in history.

The future of EHRs

Experts agree that there's work to be done when it comes to EHRs. Some changes experts hope to see in future EHRs include the following:

• Reducing the data entry burden.
• Creating a more comprehensive narrative of the patient.
• Enabling better patient engagement.
• Allowing for more precision medicine.
• Working to include remote monitoring.
• Increasing transparency.
• Offering more patient-centered care delivery.

A noteworthy factor motivating these anticipated changes is user dissatisfaction with the current state of EHRs. In a survey conducted by the Deloitte Center for Health Solutions in conjunction with U.S.-based members of the College of Healthcare Information Management Executives, 19% of respondents reported dissatisfaction with their organization's EHR system, with another 11% registering ambivalence. Of those 70% who were on some level satisfied, many stated that they didn't believe that current EHR systems would be able to adequately address future requirements they're anticipating.

With more and more healthcare organizations investing in the cloud, maintaining HIPAA compliance is more crucial than ever. Learn what steps organizations can take to ensure they maintain a HIPAA-compliant relationship with their cloud service provider.