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Electronic Health Records Overview


An Integrated Electronic Physician Practice


In 2007, 85% of small physician practices and 75% of medium and large physician practices in the United States still use paper medical records. Over the next few years, the wide-spread adoption of Electronic Health Records across all physician practices, regardless of size, will increasingly improve as EHRs become a necessity.

Physicians need to be more aggressive about improving both the efficiency and the effectiveness of their practices. It is imperative to use appropriate process improvement techniques and technology tools. Automating a bad process only makes things worse. Technology tools by themselves will not sufficiently improve the care setting.

The best approach for a physician practice is to first improve processes, where necessary, and then install  a system that would create an Integrated Electronic Practice that addresses both the clinical and business needs of the practice in as seamless a fashion as possible. Most vendors have products to do both. EHR software addresses the clinical side and Practice Management software provides tools for the business needs of billing and collections, scheduling (patient, provider, equipment), and productivity and revenue analysis.

The vision for the Integrated Electronic Physician Practice is to have seamless interoperation between all offices of the physician practice and with the systems at the practice's affiliated hospitals, clinics, laboratories, etc. This holistic environment produces an up-to-date, accurate, and complete clinical picture of the patient that enables the best quality care to be provided regardless of where the patient is treated. It also allows the business side of the practice to run in a more effective and profitable manner.


There are several terms used for the electronic tools that replace paper medical records. The most common ones are: Computer-based Patient Record (CPR), Electronic Health Record (EHR), and Electronic Medical Record (EMR). The following definitions are contained in the “EHR vs. CPR vs. EMR” article in the May 2003 issue of Healthcare Informatics:


Term Definition
EHR Electronic Health Record Generic term for all electronic patient care systems
CPR Computer-based Patient Record Lifetime patient record that includes all information from all specialties (even dentist, psychiatrist) and requires full interoperability (potentially internationally)
EMR Electronic Medical Record Electronic record with full interoperability within an enterprise (hospital, clinic, practice)


Electronic Health Records Synergy

The key to delivering quality care and maximum profitability is Electronic Health Records (EHRs), where synergy is achieved by effectively integrating:

Provider/Patient, Processes, and Technology.

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8 Core Functions of an EHR1

Health Information and Data
Patientsä©¡gnoses, allergies, and lab results
Results Management
New and past test results by all clinicians involved in treating a patient
Order Management
Computerized entry and storage of data on all medications, tests, and other services
Decision Support
Electronic alerts and reminders to improve compliance with best practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments
Patient Support
Tools offering patients access to their medical records, interactive education and the ability to do home monitoring and testing
Administrative Processes
Tools, including scheduling systems, that improve administrative efficiencies and patient service
Electronic data storage that uses uniform data standards to enable physician offices and healthcare organizations to comply with federal, state and private reporting requirements in a timely manner
Electronic Communication and Connectivity
Secure and readily accessible communication among clinicians and patients

1Key Capabilities of an Electronic Health Record System
Institute of Medicine
(IOM), July 2003

Typical Phases of an EHR Implementation

Study healthcare provider's work environment, including work flow, and create report;
Develop project plan
Use functional requirements to create a Request for Proposal (RFP);
Establish the business case for the initiative (e.g., project Return on Investment [ROI] and Total Cost of Ownership [TCO]);
Select vendors for hardware, software, and network
Negotiate acquisition of hardware, software, and network;
Purchase hardware, software, network
Install hardware, software, network;
Fully document configurations and System Administration functions;
Customize EHR system, as needed (e.g., additional forms and templates);
Integrate EHR system with existing embedded system, as needed (e.g., billing, scheduling);
Perform data conversions (e.g., paper to digital, digital from existing system to digital of new system), as needed;
Test new environment
Initially train all staff users;
Evaluate, on an ongoing basis, staff's feature usage and retrain/coach, as needed;
Train new staff users
Arrange for HELP desk for all issues (e.g., user questions, repair, outages, new installations) with dispatch capabilities - 24x7 (e.g., 24 hours/day, 7 days/week) or limited, as required;
Install hardware, software, network upgrades;
Arrange for routine daily maintenance (e.g., backups, preventive maintenance);
Develop and test disaster recovery plans
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