EHR explained: A guide to electronic healthcare systems

What is an electronic health record? In this article, we go deep into the world of EHR systems, unraveling the complexities and showcasing how these digital tools can help healthcare practices. With over 75% of office-based clinicians and 96% of hospitals in the United States using an EHR system, according to HealthIT.gov, the shift from traditional paper records to digital platforms is nearly ubiquitous. Yet, despite their widespread adoption, EHRs are often a significant source of frustration for healthcare providers.

EHRs are often badly designed and don’t integrate with other systems, leading to wasted time and unnecessary friction. Providers often feel frustrated because their EHRs promised them flexibility and efficiency — but what they’ve got is rigid and inefficient.

However, when effectively implemented, EHR systems can automate key processes, enhance patient engagement, improve health outcomes, and boost operational margins. In sum, they allow healthcare professionals to focus more on patient care and less on administrative tasks. 

Let’s learn how to make an informed decision about your practice’s EHR.

An EHR is a digital version of a patient's medical record. Think of it like a comprehensive online chart that securely stores and organizes a patient’s important health information, usually in reverse chronological order, including:

EHRs are accessible by authorized healthcare providers involved in a patient's care, who can view and share crucial data instantly and securely. They streamline communication, promote coordinated care, and reduce the risk of errors due to incomplete or outdated information. EHRs can combine large databases of patient information to follow healthcare trends, develop new treatments, and innovate healthcare delivery. These features were especially beneficial during the COVID-19 pandemic.

The history of EHRs and EMRs began in the 1960s, but there were challenges around technology limitations and lack of standardization. EMRs and EHRs were also so expensive that primarily the government used them in partnership with health organizations. In the early 1990s, widespread EHR adoption was further delayed due to physician reluctance because of a lack of any real incentive. 

The early 2000s saw the introduction of government incentives in the United States, like the Medicare and Medicaid EHR Incentive Programs. These incentives encouraged healthcare providers to implement EHR systems, which led to a surge. By 2020, nearly 90% of hospitals and 75% of office-based physicians in the U.S. had adopted at least a basic EHR system.

However, the widespread adoption of EHRs led to concerns about patient privacy and data security. As a result, several laws and regulations were established to protect patient data and ensure proper use of EHRs. 

Some key examples of these regulations include:

These regulations outline various requirements for healthcare providers using EHRs, including:

As a result of improved safety and security, EHRs now help physicians determine optimal patterns of care while preserving privacy. EHRs have also changed the dynamics of the doctor-patient relationship with better communication and documentation.

An EHR solution is a dynamic and secure information hub accessible across different healthcare providers. 

We’ve covered the core elements of an EHR, such as medical history, medications, labs, vital signs, and clinical notes. But there’s more to the story, as recognizing health is more than just a history of electronic medical records.

EHR records can also contain the following information for full patient context: 

There are 3 major types of EHR software: software as a service (SaaS), on-premise (also known as enterprise), and custom.

Cloud-based EHRs

In this EHR model (also known as a SaaS solution), your practice accesses the system via the Internet. You do not need servers and other infrastructure on-site.

Typically, a SaaS solution has lower upfront costs but requires a monthly or annual subscription, making it suitable for smaller practices or those with limited IT resources. 

SaaS EHRs have some customization, but are not as customizable as on-premise EHR software.

On-premise EHR software

Choosing an on-premise EHR solution means you buy the software product from an EHR supplier and install it on your own servers. 

You need to invest upfront in software, servers, and local network connectivity — plus ongoing maintenance. However, this type of EHR software generally does not require a subscription fee.

Most on-premise EHR software can be used immediately, but your practice will probably need to customize clinical content, templates, reports, or other functions to fit your needs and workflows.

Hybrid EHR systems

This hybrid method combines elements of both on-premise and cloud-based models. 

Typically, some data is stored locally, while other information is hosted in the cloud. A hybrid option offers greater flexibility and personalization than a true SaaS model, but still needs local IT management and support.

For example, a hybrid approach for your practice may look like building custom interfaces, templates, and reports into a flexible enterprise on-premise EHR.

There are also 3 main EHR data storage options:

On-site EHR data storage

On-site data storage means your enterprise or custom EHR system will store all data on your in-house servers. This allows your practice to closely monitor privacy and security, and helps you keep control of your EHR data. However, this option can be costly, so this is typically a more practical solution for large practices. 

On-site data storage requires you to develop a plan to regularly back up your systems in case servers fail. You will also need to adopt a high-availability plan — access to an EHR at all times is critical to patient care.

EHR data hosted remotely on dedicated servers

Many EHR suppliers allow you to store data off-site on dedicated servers. Your practice effectively rents external space instead of needing an in-house server room. 

This way, you remain in control of your data without needing to buy, house, and maintain local servers. Medium and large practices benefit the most from a remote hosting option — especially if there’s a challenge with setting up and maintaining in-house servers.

Cloud-based EHR data storage

Cloud-based data storage is most common for SaaS EHRs. 

It’s often cheaper to store your EHR data in the cloud than local or dedicated remote servers. Cloud-based storage also enables your providers and patients to access data from anywhere with an internet connection.

Because cloud-based storage typically has lower upfront costs, it’s a wise choice for smaller practices. A monthly or annual fee is required. You should also check the data ownership provisions of the cloud storage contract to ensure you’re in control of your data — in case you decide to switch EHR systems down the road.

The EHR concept has transformed healthcare practices, both by streamlining workflows and by improving data management. But what about the patient experience? 

One of the key benefits we've mentioned — convenient access — is vital in strengthening the patient-provider relationship. This is how.

A strong patient-provider connection relies on more than just efficient information flow. 

Here's how EHRs — when used thoughtfully — can bridge the gap and cultivate trust with patients:

Shared stories, not just charts: Accessible EHRs allow patients to actively review their medical history, lab results, and even progress notes alongside you. This fosters trust and often means they’re more confident to ask questions, discuss concerns openly, and collaborate in treatment decisions. Improved documentation may include examples such as before and after photos, radiology or pathology images, and graph representations of data such as blood glucose or blood pressure readings.

From transactions to partnerships: Medical consultations shouldn't feel like rushed transactions. Patient portals built into EHRs are an excellent way to communicate with patients to answer questions, address concerns, and securely share educational resources. This ongoing dialogue builds trust, ensures you hear them, and empowers patients to be active participants in their health journey.

Empathy through knowledge: Healthcare professionals who already understand the context of a patient's situation are able to engage in deeper, more nuanced conversations. This demonstrates empathy and genuine interest in their unique experiences — ultimately strengthening the bond and create ongoing trust in your expertise.

It’s important to remember that the technology that delivers EHRs should enhance, not replace, human connection. 

Look beyond the data and see the person with a story. Use EHRs to build bridges and cultivate patient trust. By doing so, you'll not only improve outcomes but also create a more rewarding experience for your team and your patients.

Independent providers face the challenges of operating within tight budgets, limited resources, and keeping pace with rapid technological advances. 

With this in mind, it’s interesting to consider whether EHRs, despite their transformative impact on healthcare, help or present new obstacles for independent providers.

The first consideration is cost. 

For independent healthcare providers, the financial burden is substantial. This includes the upfront costs of software, hardware, and training, along with the ongoing cost of maintenance. These expenses may strain the resources of independent providers, so careful budgeting and resource allocation is essential.

Nonetheless, incentive payments from Medicare and Medicaid EHR incentive programs are available to eligible independent providers, providing some financial relief.

Ensuring continuity of care is vital, as it ensures all providers have access to up-to-date and comprehensive patient information for informed decision-making and improved patient outcomes.

This is why sharing patient records can become problematic if independent providers use their own EHR. Using the same EHR facilitates access to any patient’s records, ensuring seamless continuity of care. 

Despite the challenges they pose, EHRs offer several benefits that can positively impact independent providers and their practices:

Unlike larger healthcare institutions, independent providers often have smaller teams with limited administrative support. 

EHRs can streamline workflow processes by automating tasks such as appointment scheduling, charting, and billing. This allows independent providers to manage their practice more efficiently with fewer resources. EHRs may allow independent physicians to access large data resources including local and national trends, clinical studies, and pharmacologic formularies.

Independent providers rely heavily on building strong relationships with their patients. 

EHRs provide tools such as patient portals and secure messaging systems. These allow providers and staff to engage directly with their patients, answer questions, provide educational resources, and involve them more actively in their healthcare decisions.

Independent providers often specialize in niche areas of medicine or serve specific patient populations. As such, providers can customize their EHRs to meet the unique needs of these practices. For instance, tailor templates, workflows, and decision support tools to align with specialized areas of expertise and provide more personalized care to patients.

Independent providers must comply with the same regulatory requirements as larger healthcare organizations, such as HIPAA for patient privacy and security. EHRs designed specifically for independent providers incorporate built-in compliance features and updates. This helps providers maintain regulatory compliance without additional burden or complexity.

Let’s turn now to some of the key EHR advantages and disadvantages.

CMS.gov describes an ideal EHR with “the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.”

But what else does an EHR bring to the table?

Improved efficiency: EHRs eliminate the need for manual data entry or searching for records, reducing errors and saving time for both providers and patients. This allows providers to spend more time focusing on patients and less time worrying about technology.

Decreased waiting times: Options like telehealth enable patients to connect with their doctor virtually for consultations, medication reviews, or follow-up visits — saving them valuable time and travel. For instance, Tebra’s Telehealth equips patients with secure messaging, provider unique URLs, group appointments, and virtual waiting rooms so you can deliver the effortless experience patients expect.

Easier medication management: Alleviate frustration on all sides with faster, easier ePrescriptions that give patients a transparent view of their medication orders and providers a better way to document medications, and manage refills, changes, and cancellations. EHRs can also flag potential drug interactions based on a patient's complete medication history to ensure medication safety and reduce adverse effects.

Enhanced accuracy and accessibility: Patient information is readily available from anywhere with an internet connection, which mitigates the risk of lost or misplaced records. Moreover, electronic health records can help to reduce errors by using features such as drop-down menus and automated checks.

Better care coordination: Real-time data sharing across different healthcare providers ensures informed treatment decisions and can reducethe risk of medication conflicts.

A survey by the Center for Connected Medicine (CMM) involving technology executives from U.S. hospitals and health systems reveals that nearly a third acknowledge their data-sharing efforts are insufficient, even within their own organizations. Less than 40% of these technology executives state that they are successfully sharing healthcare data with other health systems.

Personalized care: Data analysis can identify potential health risks and tailor preventive measures or treatment plans to individual needs. 

Patient engagement: Secure patient portals can empower patients to review their records, schedule appointments, and communicate with providers to promote active participation in their care.

Maximize revenue: Maximize reimbursements and earn positive performance-based payment adjustments.

Research and innovation: De-identified EHR data can contribute to research initiatives and lead to advancements in healthcare and improved population health.

Initial cost and implementation: Transitioning from paper records to EHRs can involve significant upfront costs and training.

Potential for workflow disruption: Learning and adapting to new EHR systems can initially disrupt established workflows and impact productivity levels.

Potential for health disparities: Unequal access to technology or digital literacy skills might create barriers for certain populations; potentially exacerbating existing disparities.

Privacy and security concerns: EHR platforms give your practice a secure, care-focused means of maintaining PHI (protected health information), such as patient records.

Under HIPAA, EHR data is considered PHI because of the amount of sensitive demographic information collected and stored in EHR platforms. To safeguard this data, you need robust security measures in place and adhere strictly to regulations like HIPAA.

HIPAA regulation mandates that healthcare providers comply with national privacy and security standards to safeguard PHI. This includes any demographic information that can be used to identify a patient — such as names, dates of birth, Social Security numbers, insurance information, phone numbers, and full facial photos. It’s vital for EHR providers to be HIPAA compliant to protect clients’ healthcare data from security incidents and to avoid government fines.

While paper records have stood the test of time, they come with significant limitations and vulnerabilities that can create serious challenges in healthcare settings.

Here's a closer look at some of the potential issues:

Medication mistakes: Handwritten notes are susceptible to errors and misinterpretations — potentially causing incorrect diagnoses and medication issues.

Alterations: Paper records can be physically altered, added to, lined out, or erased, leading to issues for medical liability. Digital records eliminate these concerns and ensure a more secure method of documentation, because even digital records that are erased can be retrieved.

Unauthorized access: Because paper records are physically accessible to anyone who can get into the storage area, they pose a serious risk to patient privacy and confidentiality.

Limited audit trails: Tracking paper-based record changes is difficult, hindering accountability and making it hard to identify potential fraud or tampering.

Limited accessibility: Retrieving specific information can be time-consuming and inconvenient.

Sharing challenges: Sharing information with other healthcare providers or specialists becomes tedious and cumbersome, potentially delaying diagnoses and treatment.

Misplacement: Physical documents can easily be misplaced, lost, or stolen. Missing information and disrupting patient care can be common.

Damage: Prone to tears, spills, fires, and natural disasters, paper records can become illegible or even destroyed, resulting in permanent data loss.

Deterioration: Over time, paper and ink degrade, making records difficult to read or even unusable, hindering access to crucial historical information.

The issues with paper records, from potential medication errors to limited accessibility, necessitate a more efficient and secure solution. Let's dive into the top EHR software systems and their features.

Some of the common EHR software systems on the market today include:

Practice Fusion is a cloud-based EHR that consolidates provider and staff responsibilities with a comprehensive system. It promises to organize patient information before, during, and after the visit.

Features include:

Epic’s cloud-based EHR system is well suited for large healthcare systems, such as multi-hospital systems and institutions.

Expect features like:

eClinicalWorks provides scheduling and check-in through documentation, labs, prescribing, billing, and follow-up, as well as:

Tebra is a cloud-based EHR, specifically designed for independent practices. Its all-in-one solution combines patient engagement and practice management into an easy-to-use EHR software system. 

Beyond this, Tebra's EHR software is packed with essential features designed to streamline your practice’s operations and enhance patient care:

Now that we've explored some of Tebra's key features, it's time to dig deeper. Specifically, how can these features translate into real-world improvements for small practice operations?

Independent practices face tight budgets, limited resources, and the pressure to deliver high-quality care. EHR companies with exceptional, fit-for-purpose EHR systems can help overcome all of these challenges and more.

If you're a small practice owner considering an EHR solution, the first step is exploring a list of EHR systems tailored to your specific needs and budget. This will help you compare features, pricing, and functionalities to find the perfect fit for your practice.

Reduced reliance on dedicated IT staff: It’s common for smaller practices to lack the resources for dedicated IT personnel. Cloud-based EHRs with intuitive interfaces minimize the need for extensive IT support and give staff more time to focus on patient care.

Scalability for fluctuating patient volume: Varying patient loads can be hard to manage, so flexible subscription models and modular functionality in EHRs allow practices to adjust their system seamlessly as needs evolve.

Automated reminders and follow-ups: Automations, such as medication refill prompts, help reduce patient no-shows and improve adherence, which maximizes efficiency with limited staff.

Decreased administrative costs: Automation saves time and reduces the need for additional administrative staff — equalling practice-wide cost savings.

Improved insurance coding and billing: Accurate and standardized documentation facilitates faster and more accurate insurance claims processing and improved cash flow.

Psychiatry: Track patient progress, manage medication adherence, and leverage secure messaging for confidential communication.

Dentists: Manage dental charts, track treatment progress, and integrate digital X-rays for improved diagnosis and communication with patients.

Urgent care: Optimize patient flow with efficient registration, triage tools, and streamlined documentation for faster diagnoses and treatment.

Trent Carter, founder and nurse practitioner at Curednation, has some key advice for choosing the right EHR for private practices:

Assessing practice needs: Understand the unique workflows of the practice to identify areas where an EHR can enhance efficiency. Choose a system that can adapt to the evolving needs and potential growth of the practice.

User-friendly interface: Opt for an EHR system with an intuitive interface to minimize the learning curve for staff to reduce both training time and potential disruptions.

Integration capabilities: An EHR that seamlessly integrates with existing systems and technologies ensures a cohesive and connected healthcare environment.

Cost considerations: Beyond the initial investment, consider long-term costs — including maintenance, support, and potential upgrades.

Vendor reputation: Explore user reviews and testimonials to gauge the experiences of other practices with similar needs. Also, assess the EHR vendor's quality of customer support and ongoing assistance.

Choosing the right EHR system is crucial for making your operations run smoothly and enhancing patient care. 

At Tebra, we know that common pain points in EHR systems include elements like excessive clicking, data transfer hassles, and lack of specialty-specific features. 

With this in mind, this checklist is your go-to when you’re checking out potential EHR systems:

It’s also worth noting that EHRs that offer flexible, build-your-own treatment plans can help improve practice synchronization and kickstart comprehensive treatment options. 

Build-your-own treatment plans enable clinical decision-making that guides patients toward their goals. Of course, better adherence to treatment plans means better outcomes and a higher percentage of collecting practice revenues.

Tebra Care Delivery is a modern, certified EHR solution designed to equip today’s provider with clinical tools that support rather than interfere with patient care. This includes all the innovative features your practice needs — from robust clinical charting and streamlined patient documentation to a comprehensive view of the patient and their history, eLabs, telehealth, and more.