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assists providers in the creation of new treatments or innovation in healthcare delivery to improve quality outcomes in healthcare 4 combining multiple types of clinical data within electronic health records has enabled clinicians to identify and stratify patients with chronic conditions ehr systems may also support improvements in quality of care through the use of data and analytics to help prevent hospitalizations among high risk patients ehr systems are designed to store data accurately and to capture a patient s state across time it eliminates the need to track down a patient s previous paper medical records and assists in ensuring data is up to date 5 accurate and legible it also allows open communication between the patient and the provider while providing privacy and security 5 ehr is cost efficient decreases the risk of lost paperwork and can reduce risk of data replication as there is only one modifiable file which means the file is more likely up to date 5 due to the digital information being searchable and in a single file emrs electronic medical records are more effective when extracting medical data to examine possible trends and long term changes in a patient the widespread adoption of ehrs and emrs may also facilitate population based studies of medical records terminology edit the terms electronic health record ehr electronic patient record epr and electronic medical record emr have often been used interchangeably but subtle differences exist 6 the ehr is a more longitudinal collection of the electronic health information of individual patients or populations the emr in contrast is the patient record created by providers for specific encounters in hospitals and ambulatory environments and can serve as a data source for an ehr 7 8 emrs are essentially digital versions of the paper documents used in a clinician s office typically functioning as an internal system within a practice an emr includes the medical and treatment history of patients treated by that specific practice 9 in contrast a personal health record phr is an electronic application for recording individual medical data that the individual patient controls and may make available to health providers 10 comparison with paper based records edit while there is ongoing debate regarding the advantages of electronic health records compared with paper records the research literature presents a more nuanced view of their benefits and limitations 11 increasing discontent and burnout among healthcare professionals is well documented as of 2023 12 with several studies finding that a leading cause of job frustration and increasing stress for most doctors and nurses is the increasing burden of increasingly complex record keeping paperwork and administrative workloads 13 proponents of ehr note that these systems can substantially reduce such burdens for example cutting time spent on insurance eligibility tasks by more than 80 14 but along with increased convenience transparency portability and accessibility there is also an increased risk that sensitive information may be accessed by unauthorized persons or unscrupulous users versus paper medical records this is acknowledged by the increased security requirements for electronic medical records included in the health insurance portability and accountability act hipaa and by large scale breaches in confidential records reported by emr users 15 16 meanwhile handwritten paper medical records may be poorly legible which can contribute to medical errors 17 pre printed forms standardization of abbreviations and standards for penmanship were encouraged to improve the reliability of paper medical records an example of possible medical errors is the administration of medication medication is an intervention that can turn a person s status from stable to unstable very quickly with paper documentation it is very easy to not properly document the administration of medication the time given or errors such as giving the wrong drug dose form or not checking for allergies and could affect the patient negatively it has been reported that these errors have been reduced by 55 83 because records are now online and require specific steps to avoid these errors 18 electronic records may help with the standardization of forms terminology and data input 19 20 digitization of forms facilitates the collection of data for epidemiology and clinical studies 21 22 however standardization may create challenges for local practice 11 overall those with emrs that have automated notes and records order entry and clinical decision support had fewer complications lower mortality rates and lower costs 23 emrs can be continuously updated within certain legal limitations see below if the ability to exchange records between different emr systems were perfected interoperability 24 it would facilitate the coordination of health care delivery in non affiliated health care facilities in addition data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement resource management and public health communicable disease surveillance 25 however it is difficult to remove data from its context 11 patient access to electronic health records edit providing patients with information is central to patient centered health care and has been shown to positively affect health outcomes 26 providing patients access to their health records including medical histories and test results via an ehr is a legal right in some parts of the world 26 there is evidence that patient access may help patients understand their conditions and actively involve them in their management for example granting people who have type 2 diabetes access to their electronic health records may help these people to reduce their blood sugar levels 27 28 29 challenges with sharing the electronic health record with patients include a risk of increased confusion or anxiety if a person does not understand or cannot contextualize the testing results 26 in addition many ehrs are not designed for people of all educational levels and do not consider the needs of those with a lower level of education or those who are not fluent in the language 26 accessing the ehr requires a level of proficiency with electronic devices which adds to a disparity for those without access or for those who have a mental or physical illness that restricts their access to the electronic system 26 use in research and development edit see also interoperability electronic medical records could also be studied to quantify disease burdens such as the number of deaths from antimicrobial resistance 30 or help identify causes of factors of links between 31 32 and contributors to diseases 33 34 35 especially when combined with genome wide association studies 36 37 this may enable increased flexibility improved disease surveillance better medical product safety surveillance 38 better public health monitoring such as for evaluation of health policy effectiveness 39 40 increased quality of care via guidelines 41 and improved medical history sharing 42 43 and novel life saving treatments issues edit privacy for such purposes electronic medical records could potentially be made available in securely anonymized or pseudonymized 44 forms to ensure patients privacy is maintained 45 37 46 47 even if data breaches occur there are concerns about the efficacy of some currently applied pseudonymization and data protection techniques including the applied encryption 48 42 documentation burden while such records could enable avoiding duplication of work via records sharing 42 43 documentation burdens for medical facility personnel can be a further issue with ehrs this burden could be reduced via voice recognition optical character recognition other technologies physician involvement in software changes and other means 43 49 50 51 which could possibly reduce the documentation burden to below paper based records documentation and low level documentation applications using software edit see also artificial intelligence in healthcare gnu health patient main screen as of 2013 theoretically free software such as gnu health and other open source health software could be used or modified for various purposes that use electronic medical records i e via securely sharing anonymized patient treatments medical history and individual outcomes including by common primary care physicians 52 decision support electronic health records could support clinical decision support systems 53 personalized medicine they could be used among other biodata for digital twins also called health avatars for personalized medicine 54 55 mhealth integration they could be coupled with mhealth mobile applications and wearable technology 53 43 screening artificial intelligence systems could use this data as well as other integrated data to screen for potential diseases via multimodal learning 56 syndromic surveillance real time analysis and data mining of the records could be used along with other data in syndromic surveillance to rapidly identify common exposures among patients suspected of being part of an outbreak for epidemic forecasting 57 and for early outbreak detection 58 59 60 61 especially in identified potential pandemic pathogen ppp hotspot regions and potentially as a means for pandemic prevention vaccination deployment interoperable collaboratively developed standardization based health records systems could increase the speed of vaccination campaigns and reduce their costs or workloads according to dr bob kocher as of 2021 there are 1 000 different electronic health record systems in the u s globalize and almost every hospital and clinic has a slightly different system tailored to its own needs which caused difficulties and delays during covid 19 vaccinations with similar problems being reported in other countries 62 63 43 medical outcomes data such records could also be used to match patients to clinical trials with software 64 reducing the burden on users to partake in research 43 and making previously siloed primary care data more valuable to society at larger or other patients emergency medical services edit ambulance services in australia the united states and the united kingdom have introduced emr systems 65 66 ems encounters in the united states are recorded using various platforms and vendors in compliance with the nemsis national ems information system standard 67 the benefits of electronic records in ambulances include patient data sharing injury illness prevention better training for paramedics review of clinical standards better research options for pre hospital care and design of future treatment options data based outcome improvement and clinical decision support 68 technical features edit ehrs enable health information to be used and shared over secure networks to track care e g prescriptions and outcomes e g blood pressure trigger warnings and reminders send and receive orders reports and results decrease billing processing time and create more accurate billing systems facilitate health information exchange 69 a technical and social framework that enables information to move electronically between organizations using an emr to read and write a patient s record is not only possible through a workstation but depending on the type of system and health care settings may also be possible through mobile devices that are handwriting capable 70 such as tablets and smartphones electronic medical records may include access to personal health records phr which makes individual notes from an emr readily visible and accessible to consumers citation needed some emr systems automatically monitor clinical events by analyzing patient data from an electronic health record to predict detect and potentially prevent adverse events this can include discharge transfer orders pharmacy orders radiology results laboratory results and any other data from ancillary services or provider notes 71 this type of event monitoring has been implemented using the louisiana public health information exchange which links statewide public health with electronic medical records this system alerted medical providers when a patient with hiv aids had not received care in over twelve months this system greatly reduced the number of missed critical opportunities 72 philosophical views edit within a meta narrative systematic review of research in the field various different philosophical approaches to the ehr exist 11 the health information systems literature has seen the ehr as a container holding information about the patient and a tool for aggregating clinical data for secondary uses billing audit etc however other research traditions see the ehr as a contextualized artifact within a socio technical system for example actor network theory would see the ehr as an actant in a network 73 and research in computer supported cooperative work cscw sees the ehr as a tool supporting particular work several possible advantages to ehrs over paper records have been proposed but there is debate about the degree to which these are achieved in practice 74 implementation edit quality edit several studies call into question whether ehrs improve the quality of care 11 75 76 77 78 one 2011 study in diabetes care published in the new england journal of medicine found evidence that practices with ehr provided better quality care 79 emrs may eventually help improve care coordination an article in a trade journal suggests that since anyone using an emr can view the patient s full chart it cuts down on guessing histories and seeing multiple specialists smooths transitions between care settings and may allow better care in emergency situations 80 ehrs may also improve prevention by providing doctors and patients better access to test results identifying missing patient information and offering evidence based recommendations for preventive services 81 costs edit at one time the steep price and provider uncertainty regarding the value they might derive from adoption in terms of return on investment lead to significant resistance to ehr adoption as late as 2010 doctors complained that such systems were too cumbersome eating up time otherwise spent with patients 82 83 in a 2008 project initiated by the office of the national coordinator for health information technology surveyors found that hospital administrators and physicians who had adopted ehr noted that any gains in efficiency were offset by reduced productivity as the technology was implemented as well as the need to increase information technology staff to maintain the system 83 at that time the u s congressional budget office concluded that the cost savings may occur only in large integrated institutions like kaiser permanente and not in small physician offices they challenged the rand corporation s estimates of savings noting office based physicians in particular may see no benefit if they 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