EMR vs. EHR explained: A guide to the differences and when to use each

Electronic medical records and electronic health records are foundational to modern healthcare, yet they fulfill different roles. So, what is an electronic medical record (EMR)? And what is an electronic health record (EHR)? And what is the difference between an EHR vs. EMR?

Both EMRs and EHRs are transforming how patient information is stored and accessed. However, recognizing their distinct features and applications is vital for healthcare practices striving for efficiency and regulatory compliance.

In this article, we'll demystify EHR vs. EMR systems by exploring:

Electronic medical record (EMR) and electronic health record (EHR) systems have similar names and maintain patient information digitally. Compared to their paper predecessors, both systems offer significant improvements in terms of efficiency, customer service, and security. Yet they are distinct in terms of their information sharing, functionality, features, and legal and regulatory requirements. So what is the difference between an EMR and an EHR?

EMRs are essentially a digital version of a patient’s paper record used by healthcare providers within a particular practice. Some more sophisticated, but not all, EMRs may include a patient portal, which allows patients to access their medical record, lab and test results, and appointment scheduling with that particular practice electronically. 

EHRs are more comprehensive. They are a longitudinal collection of individual patients’ or population’s records, and can be used by providers across multiple healthcare facilities to coordinate care. This means that EHRs can quantify disease burdens, a capability EMRs lack. For instance, EHRs have been instrumental in gathering data during the COVID-19 pandemic and in tracking the number of deaths from antibiotic resistance. Furthermore, EHRs play a pivotal role in enhancing disease surveillance and developing quality-of-care guidelines.

EHRs also have more advanced and comprehensive patient communication options with everything from electronic appointment scheduling to lab result reports.

Choosing between EMRs and EHRs involves considering their features and also their fees. Generally, EMRs are more affordable but offer fewer capabilities compared to broader and more versatile, but more costly, EHRs. This cost difference reflects the tradeoff between a more straightforward system designed for internal use within a single practice (EMR) and a more comprehensive solution that facilitates information sharing across various healthcare settings (EHR). However, the price tag alone should not be the determining factor in whether an EHR vs. EMR is the right choice for your practice.

Given that people are increasingly mobile across or between regions, and increasingly expect seamless access to health records, many healthcare providers now opt for EHRs despite the higher initial investment.

EHRs offer accessibility and interoperability, which meet the needs of a changing patient demographic and the demand for more adaptable healthcare delivery systems.

EMR systems offer significant benefits to practices transitioning from paper-based charting.

EMRs allow practitioners to:

EMRs cannot:

An EHR vs EMR takes a more holistic approach to patient care and record-keeping. The key advantage of EHRs is that they provide up-to-date and complete access to patient records.

The ability to share critical patient information facilitates better opportunities for coordinated patient care. EHRs also keep patients informed by providing them with electronic access to their doctor’s visit notes and electronic prescription refill requests.

EHRs allow practitioners to do everything they can do with EMRs, plus:

In its guide to EHR privacy and security, the Office of the National Coordinator for Health Information (ONC) states, “All types of EHRs outperform paper medical records when it comes to providing better access to and use of electronic personal health information (ePHI).”

Interoperability among EHRs is not universal, despite ongoing efforts to enhance compatibility and data sharing across different platforms. 

A key initiative addressing this challenge is the implementation of Fast Healthcare Interoperability Resources (FHIR), developed by Health Level Seven International (HL7) over a decade ago. FHIR aims to standardize the exchange of healthcare information so that patients can have a single, comprehensive health record as they receive care from multiple providers across various systems. This record would offer an integrated overview of medications, problems, allergies, and more by converting data from diverse formats, thereby facilitating improved care coordination.

In 2020, the Centers for Medicare and Medicaid Services (CMS) reinforced the importance of interoperability through its Interoperability and Patient Access Final Rule, derived from the 21st Century Cures Act, mandating the adoption of FHIR by various healthcare payors. The FHIR standard has gained significant traction, finding applications in mobile health apps, cloud services, EHR data sharing, and server communications across the healthcare sector. 

Four key objectives of EHR interoperability include enhancing user interaction with applications like eRx, standardizing messaging protocols, facilitating the exchange of health information (e.g., progress notes, lab results), and integrating consumer devices, such as tablets, with healthcare systems. 

The primary distinction lies in their scope of use: EMRs are designed for internal use within a single practice, focusing on the medical history and treatment of patients. On the other hand, EHRs are built to share patient records across different healthcare organizations, facilitating a more integrated approach to patient care. 

As computers started to make a difference in business operations and efficiency, there was an opportunity to improve the medical records process. 

Before they became adopted as they are today, businesses, academic institutions, and the government all tried to create systems similar to what we now know as EMRs, according to Jim Atherton in the AMA Journal of Ethics.

In terms of the initial industry development, in the mid-1960s, Lockheed Martin developed what was then referred to as a clinical information system. That particular system, which had speed and multi-user functionality, is still partly in use today. 

Also in the mid-1960s, the University of Utah partnered with 3M Company and created one of the first clinical decision support systems, Health Evaluation through Logical Processing (HELP). According to an article published in the Journal of the American Medical Informatics Association, HELP, like COmputer STored Ambulatory Record (COSTAR), demonstrated that computer systems could not only replace paper information storage but also improve patient care by helping providers access that information.

In 1968, Massachusetts General Hospital implemented COSTAR, an automated medical record system it developed with Harvard. COSTAR supported patient care, quality assurance, and billing. It could also recognize multiple terms for the same disease, and so allow for terminology differences at different facilities, according to Atherton.

Government development lagged but in the 1970s the U.S. Department of Veterans Affairs implemented a computerized patient record system known as Decentralized Hospital Computer Program (DHCP), and later VistA, according to Atherton.

The widespread use of electronic record systems was delayed because of physician resistance, high costs, data entry errors, and lack of incentives. Most electronic records in the early stages complemented but did not replace paper records. 

In the mid-1980s, the Institute of Medicine, part of the National Academies of Sciences, Engineering, and Medicine, conducted a study to evaluate paper records in healthcare. The study was completed by 1991, with a follow-up report in 1997. The initial report argued in favor of adopting computer-based health records within a decade as a way to improve patients’ medical records, though progress would ultimately be slower. It aimed less to have a fully paperless record, and more to make patient data easy to access and use. It outlined 8 core features of electronic health records, namely:

The 1991 Institute of Medicine report also noted that there were roadblocks to widespread adoption, including cost and security concerns, and that funding from both private and public sources could foster development. 

By 1992, interface standards were developed by HL7 and IEEE P1157. These standards make sure that different components of electronic medical record systems can easily communicate, regardless of which vendor created them. This interoperability is a key part of the overall system working.

However, by 1999, adoption was still not universal. The Institute of Medicine issued another report, “To Err Is Human,” in which it noted that the U.S. was in an “epidemic of medical errors.” It wrote: “A variety of factors have contributed to the nation's epidemic of medical errors. One oft-cited problem arises from the decentralized and fragmented nature of the health care delivery system — or ‘nonsystem,’ to some observers. When patients see multiple providers in different settings, none of whom has access to complete information, it becomes easier for things to go wrong.”

In response, Congress appropriated $50 million to support efforts to reduce medical errors. 

Later, the Office of the National Coordinator for Health Information Technology (ONC) was established to help implement interoperability to reduce medical errors. And President Barack Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act, which also supported widespread EHR adoption. 

Much like smartphones, EHR systems are continually being refined, shifting away from paper-based records, with a focus on human-technology integration and user-friendly, intuitive interfaces.

The next generation of EHR technology is set to embrace innovations that cater to modern healthcare professionals. Among the advancements anticipated for widespread adoption are:

Implementing an electronic records system doesn’t automatically mean your practice is in compliance. The system itself must meet all applicable regulatory requirements — and it’s your responsibility that it do so.

The ONC is responsible for updating and providing relevant documentation and guidance regarding the steps and processes to ensure your practice satisfies:

Although the EMR or EHR vendor delivers the internal component requirements of the system, the practice is ultimately responsible for compliance. Therefore, you must make sure your vendors have the relevant certifications and security measures.

The practice is also responsible for hardware maintenance, software upgrades, patches, and encryption. Cybersecurity is also a big concern, as breaches interrupt practice operations, compromise security, and threaten patient privacy and safety. Many medical professional liability policies include cyber coverage options.

Because both EMRs and EHRs house ePHI, they have the same standards for managing, storing, and sharing it. It doesn’t matter if the system lives on a practice’s private server, as an EMR might be, or cloud-based, as EHRs are.

Oversight is the practice’s responsibility. This may entail stress-testing servers or periodic scheduled vendor meetings for security updates.

There is no question that there are bad actors in the world who aim to breach computer databases to obtain data sets that they can sell for profit. To address this danger, the ONC specifies various security measures, such as implementing and managing firewalls, among other safeguards.

The ONC also enforces tiered fines for non-compliance — particularly when that non-compliance results in a data breach. Since the danger is to the exposure of private patient information. According to the ONC, the fine schedule is as follows:

The ONC has also developed and implemented a certification program for both EMRs and EHRs. These programs are:

The ONC established this designation and involves standards applied to health IT developers and modules. This means that as you evaluate a new electronic system for your practice, ask whether it is ONC certified. Again, although you aren’t the product’s developer, you are accountable for its compliance or lack thereof.

Does that mean that you need to be an IT expert? Absolutely not. However, it does mean that just as you surround yourself with competent medical and administrative staff, you must hire or outsource strong IT talent. That may come in the form of a professional consultant or vendor from whom you purchase the product.

Hospitals benefit from digital health record systems, particularly for their capability to share patient charts across various departments. However, does this mean all hospitals opt for the same type of system? The answer is no. 

Hospitals, like medical practices, have different needs and budgets. So, the question arises: which system is more suitable for different hospital settings? Is it more beneficial for hospitals to partner with an EMR or to seek out an EHR? 

In this discussion, we focus exclusively on certified systems, considering that hospitals must leverage Medicaid and Medicare incentives to manage their budgets effectively.

If your practice is specialized and doesn’t need to share patient information with external healthcare providers, an EMR may be in your best interest. 

An EMR is not only likely to be less expensive to implement, but also easier to manage due to its limited scope.

Examples of organizations that may want to consider an EMR over an EHR include:

Examples of organizations that may want to consider an EHR over an EMR include:

An EHR, vs. EMR, is a better fit if your practice needs easy access to clinical tests, radiology, and pathology, and the ability to interface medical device data. This could include a variety of practices, such as:

Because of their flexibility and features, EHRs typically require a larger investment. 

As a key part of your evaluation, examine how often your practice needs to share patient information with multiple external healthcare providers. How often do you need to receive or grant access to their full records? How long does it take you to do so? If you’re still uncertain about which system will work best for your practice, consider the features and benefits of each.

Epic is an EHR, and is one of the most popular systems for hospitals and large health organizations. Epic’s EHR system is cloud-based. It offers comprehensive functionality, including patient records management, scheduling, billing, clinical workflows, and interoperability features that allow it to exchange patient information across different healthcare providers.

This section will focus on certified products because most practices partner with Medicare and Medicaid and prefer to take advantage of their related incentives. This approach ensures the featured systems meet the government’s associated requirements.

If an EMR is the direction you want to pursue, there are some excellent options available:

Because of their flexibility and interoperability, EHRs are the future of healthcare information management.

Although there is a lot of information in the above sections, including a selection of top-ranked electronic records management systems, there are still questions to ask vendors as you decide which product is best for your practice.

Here are some sample questions or requests:

Whether you determine an EMR or an EHR is best for your practice, facility, or healthcare system, converting from a paper-based charting process to a more holistic electronic process will save you space, time, and energy.

Learn more about Tebra’s ONC-certified EMR and EHR solutions and how easy it is to make your clinical and administrative processes more efficient and less time-consuming.