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Medical information systems for HealthTech startups: quick overview

Author: Alexandr Pavlushkin

Getting deeper into the Digital health area you can face a plethora of concepts and abbreviations. Sometimes meanings of these terms are not obvious.

In this post, we will clarify definitions and differences between the most commonly used *HRs: EMR, EHR, and PHR. In addition to that, we will go through expected benefits and examples of each class of health records.

Moreover, we will slightly touch upon interoperability aspects because the ability of data exchange and work in e-health ecosystem is an integral part and the key to success for any new and existing medical application.
EMR and EHR definitions and differences
Electronic Medical Record (EMR) is an electronic medical record is a provider-based medical record that includes all health documentation for one person covering all services provided within one enterprise (1).

Electronic Health Record (EHR) is a computerized repository of information regarding the health of an individual. It is real-time and patient-centric. The information is available instantly, "whenever and wherever it is needed".
It is also a generic term for all electronic patient care systems. EHRs imply a level of interoperability beyond the capability of an EMR, but are similar in terms of the information stored and the purpose of the system (1, 2).

EMR and EHR are very often used interchangeably (3). ONC does not differentiate these terms. However, there are some differences presented in Table 1.
Differences between EMR, EHR, and PHR
* EMR and EHR are often used interchangeably
EMR/EHR core features (2)
Contain information about a patient's medical history, diagnoses, medications, immunization dates, allergies, radiology images, and lab and test results
Offer access to evidence-based tools that providers can use in making decisions about a patient's care
Automate and streamline providers' workflow
Increase organization and accuracy of patient information
Support key market changes in payer requirements and consumer expectations
Benefits of EMR/EHR (10)
EHRs help providers better manage care for patients and provide better health care by:
Enabling quick access to patient records for more coordinated, efficient care
Providing accurate, up-to-date, and complete information about patients at the point of care
Enhancing privacy and security of patient data
Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
Enabling safer, more reliable prescribing
Securely sharing electronic information with patients and other clinicians
Enabling providers to improve efficiency and meet their business goals
Improving patient and provider interaction and communication, as well as health care convenience
Helping providers improve productivity and work-life balance
Helping promote legible, complete documentation and accurate, streamlined coding and billing
Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health
EMR/EHR examples
Top 3 most popular hospital inpatient and ambulatory EHR Systems in US (5, 6):
These solutions are mature and provide a ton of functionality. As a drawback, these solutions are too expensive for many, especially small and midsize practices.
There is a list of more affordable solutions (11):
EHR Your Way
NextGen Healthcare EHR
Practice Fusion
Even though the market seems pretty close to general-purpose EHR solutions, there is a huge room for SMART on FHIR apps that extend the functionality of EHR systems.
Personal Health Records
Personal Health Record (PHR) includes all healthcare information from different healthcare providers that have been used by a single patient. The information is typically gathered and maintained by the patient. A PHR can incorporate health records, medical history, personal health information, and dietary information (1).

A PHR is typically created and maintained by an individual for use by the person and, if shared with others, by those persons.

A PHR can include information from many sources including healthcare providers, pharmacies, laboratories, and hospitals.

EHRs typically contain the same basic information a patient would put in a PHR, such as a date of birth, medication list and drug allergies. But EHRs contain more extensive information because they're used by health care providers to store visit notes, test results and much more.
What information goes into a PHR?
Medications, including dosages
Living will or advance directives
Doctor's names and phone numbers
Allergies, including drug allergies
List and dates of illnesses and surgeries
Chronic health problems, such as high blood pressure
Family history
Exercise and dietary habits
Health goals, such as stopping smoking or losing weight
Immunization history
Home blood pressure readings
PHR examples
Apple Health
Flo Period Tracker & Calendar
juli chronic condition tracker (7)
Benefits of PHR
Seeing multiple doctors not using the same EHR system, a PHR is a good way to keep all of a patient's health information in one place. life.
A PHR also empowers people to manage their health between visits.
For example, a PHR enables users to:
Record and track the progress toward health goals, such as lowering a cholesterol level.
Track and assess health data
Being ready with questions for a doctor and information one wants to share, such as blood pressure readings since the last visit.
Make the most of doctor visits
Upload and analyze data from home-monitoring devices such as a blood pressure cuff. And remind the doctor's instructions from the last appointment.
Manage health between visits
Track appointments, vaccinations, medications and preventive or screening services, such as mammograms. In fact, studies have shown when parents use personal health records for their children, the children are more likely to get their preventive well-child checkups on time.
Get organized
PHR drawbacks
Despite the benefits, PHRs have some drawbacks. Building a complete health record takes some time. Patients have to collect and enter all their health information. Only a minority of doctors, hospitals, pharmacies and insurance companies can send information electronically to a PHR that isn't part of a patient portal. In most cases, patients have to update PHR manually each time they see the doctor, fill a prescription, have a test or go to the hospital.
Patient portal
A PHR that is tied to an EHR is called a patient portal. In some but not all cases a patient can add information, such as home blood pressure readings, to a record via a patient portal.

Patients could use an app such as the Health app for iPhones, which includes Medical ID, which makes critical information available via the lock screen for use by first responders in an emergency.
Appointment reminders
Most portals offer the following:
Medication list
Appointment summaries, sometimes with associated educational material
Secure messaging with a healthcare provider
Test results
Types of Patient Portals
There are two types of patient portals: integrated and standalone.

Many EHRs include an integrated patient portal. There are many advantages to selecting an EHR with a pre-integrated patient portal. These include increased efficiency and less need for costly custom development to build a bridge between systems. However, there can be drawbacks. Many all-in-one systems lack non-incentivized, but no less important, features like online bill pay, online patient registration, and patient scheduling.

Provider frustration with many pre-integrated, non-user friendly systems has led to the development of standalone patient portals. Standalone systems usually include more features and do not rely on sunk costs to keep their contracts. Additionally, third-party vendors are often more attentive to detail and offer a better user experience, but they are not without limitations.

Provider frustration with many pre-integrated, non-user friendly systems has led to the development of standalone patient portals. Standalone systems usually include more features and do not rely on sunk costs to keep their contracts. Additionally, third-party vendors are often more attentive to detail and offer a better user experience, but they are not without limitations.
Examples of standalone patient portals:
Solutionreach: the patient engagement platform
Updox patient portal
Allscripts FollowMyHealth
Increase patient participation in their care
EHRs, PHRs, and patient portals can help to increase patient participation in their care. Providers and patients who share access to electronic health information can collaborate in informed decision making. Patient participation is especially important in managing and treating chronic conditions such as asthma, diabetes, and obesity.
Electronic health records can help providers:
With EHRs, providers can give patients full and accurate information about all of their medical evaluations. Providers can also offer follow-up information after an office visit or a hospital stay, such as self-care instructions, reminders for other follow-up care, and links to web resources.
Ensure high-quality care
With EHRs, providers can manage appointment schedules electronically and exchange e-mail with their patients. Quick and easy communication between patients and providers may help providers identify symptoms earlier. And it can position providers to be more proactive by reaching out to patients. Providers can also provide information to their patients through patient portals tied into their EHR system.
Create an avenue for communication with their patients
As you can see the line between PHRs and EHRs is not always obvious. Data interoperability plays the main role for that. Fast Healthcare Interoperability Resources (FHIR) is a cornerstone of modern medical information exchange. Ability to support the FHIR standard makes any EHR or PHR system much more valuable for patients as well as for healthcare providers.
Data aggregators
There is another category of health record systems: data aggregators. Data aggregators facilitate information exchange between different EHRs and PHRs.
For instance, Health Gorilla's Patient360 and My360 solutions (8, 9). The first one is for physicians and provides care teams with a meaningful, usable view of their patients' medical history. It allows them to make more informed treatment decisions, eliminate duplicate tests, and avoid delays in care.

My360 is an out-of-the-box patient access solution that care teams can embed into their existing platforms. It enables patients to search, view, and share complete medical records aggregated from thousands of care sites. Additionally, patients can link data from health apps, wearable devices, and other SMART-on-FHIR endpoints.
Want to build a new EMR/EHR system, patient-facing app or portal?
So, in this post we have covered the most common classes of health records systems, its benefits and examples. As anyone can see, there are a lot of great apps as well as a big opportunities for new ones.

Our team has been providing consulting and developing world-class healthcare applications including EHR systems, patient-facing apps, SMART on FHIR apps embedded into Epic EHR systems for more than five years. We are ready to share our experience of integration apps using FHIR. If you have any questions about building such apps or setting up data exchange, we are ready to help.

Let's discuss your idea!