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

The price tag alone should not be the determining factor in whether an EMR vs. EHR is the right choice for your practice.

EHRs vs EMRs

At a Glance

  • EMRs (electronic medical records) and EHRs (electronic health records) have distinct features, applications, and regulations.
  • EMRs primarily serve as digital versions of paper records within a single practice, while EHRs offer a more comprehensive collection of records accessible across multiple healthcare facilities.
  • The choice between an EMR and an EHR depends on factors such as practice specialization, budget, and the need for interoperability and advanced features, with considerations including cost, accessibility, and compliance.

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:

  • Key differences of EHR vs. EMR systems
  • Their history and impact on healthcare practices 
  • Governmental compliance requirements 
  • Ideal use cases and who benefits the most from using an EHR vs. EMR
  • Leading EMR and EHR systems in the market
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What is the difference between an EMR and an EHR?

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 EHR vs. EMR

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.

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

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.

What you can expect from an EMR system

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

EMRs allow practitioners to:

  • Digitize a patient’s medical record within a specific practice
  • Make informed decisions based on a patient’s medical history at that practice, including diagnoses, medications, treatment plans, immunization dates, and test results
  • Streamline some administrative tasks, including appointment scheduling, billing, and coding
  • Improve patient recall by sending reminders for upcoming appointments or preventative screenings
  • Monitor and track the practice’s performance, patient care metrics, and regulatory compliance
  • Input legible notes in real time

EMRs cannot:

  • Easily exchange patient data between different practices and health systems
  • Connect with health information exchanges (HIEs) or other health information networks
  • Offer advanced analytics and reporting
  • Scale as your practice grows
  • Completely eliminate eliminate administrative tasks

What you can expect from an EHR system

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:

  • House a patient’s personal identifying information, traditional chart notes, lab orders and results, prescription history and activity, insurance information, and emergency care and hospital records in one place
  • Coordinate care across multiple specialities
  • Include a patient portal where individuals can access their information
  • Provide robust data analytics and reporting features to make meeting government reporting requirements easier
  • Help the practice maintain legal and regulatory compliance

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).”

A note about EHR interoperability 

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. 

What is the primary difference between EHR vs. EMR?

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. 

Components of EHR vs. EMR
Electronic medical records (EMRs)Electronic health records (EHRs)
Faster and more efficient patient chartingFaster and more efficient patient charting
Requires less storage space than paper filesRequires less storage space than paper files
Can be customizable to reflect previously used paper templatesCan be customizable to reflect previously used paper templates
Facilitates internal patient information storage and retrievalFacilitates internal and external patient information storage and retrieval
Provides a comprehensive view of patient information to allow for treatment decisionsProvides a comprehensive view of patient treatment decisions
Facilitates post-diagnosis outcome discussions
components of EHR and EMR

When EMR and EHR systems were developed

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. 

EHR development history

A study to bring improvement

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:

  • Patient health information and data 
  • Results management
  • Order management 
  • Decision support 
  • Electronic communication and connectivity
  • Patient support
  • Administrative processes and reporting 
  • Reporting and population health 

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.

An epidemic of medical errors

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. 

Looking forward

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:

  • Voice recognition, which simplifies data entry and navigation
  • Interchangeable patient-specific clinical support modules that provide tailored guidance
  • Enhanced mobile device access, ensuring critical patient data is always at healthcare providers' fingertips
  • Improvements in data entry applications, coupled with natural language processing, to streamline documentation
  • Cloud technology for more efficient data management and storage
  • Artificial intelligence (AI) to enhance functionality and efficiency

How to ensure your system complies with regulatory requirements

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.

Are there different compliance standards for EMRs compared to EHRs?

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.

Secured vs. unsecured PHI
SecuredUnsecured
Data is end-to-end encryptedData is encrypted (not end-to-end encrypted)
Encryption key is stored securelyEncryption key is unintentionally accessible to unauthorized parties
Digital PHI is destroyed according to best practicesDigital PHI is deleted from the front end only
Physical storage means (e.g., hard drives, laptops, tablets, film, paper files) are protected from physical and digital unauthorized accessPhysical storage means are not physically and digitally secured
Physical storage means are destroyed according to best practicesPhysical storage means are not destroyed according to best practices
Result: greater chance that only authorized parties may access PHIResult: greater chance that unauthorized parties may access PHI
difference between secured and unsecured phi

Associated fines for non-compliance

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:

TierAscertained level of intentMinimum fine per eventMaximum annual fine
1Did not or could not have known$100–$50,000$1,500,000
2Reasonable cause (not determined to be willful neglect)$1,000–$50,000$1,500,000
3Determined to be willful neglect but was corrected within 30 days$10,000–$50,000$1,500,000
4Determined to be willful neglect but was not corrected within 30 days$50,000$1,500,000

A better security solution: System certification

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

  • CEMRT: Certified Electronic Medical Records Technology
  • CEHRT: Certified Electronic Health Records Technology

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.

Do hospitals use EHRs or EMRs?

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.

Type of hospitalCEMRTCEHRTRationale
Private, stand-alone hospitals with in-house specialists  X Stand-alone facilities with internal access to the specializations that can provide patients with necessary care and treatments don’t typically require external agency involvement or patient information sharing.
Rural hospitals that outsource specialized care     XWhile, for budget purposes, the CEMRT may be more appealing, providing external partners (that may be hundreds of miles away) immediate access to a patient’s record via CEHRT will facilitate the best decisions around treatment. CEMRTs require manually copying the patient’s information via paper files or scans.
Urban hospitals with multiple specialization locations and partnerships     XNo matter in which location the patient meets with a provider, healthcare professionals can work from the same information without concern about ordering the same test multiple times or missing important prescription information.
National hospital systems   XThis assists with internal patient care and management and addresses the transitory nature of today’s culture, ensuring the patient’s complete record follows them to their new location.
do hospitals use EHRs or EMRs

Which practices should use an EMR?

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:

  • Facilities that do not plan to take advantage of Medicaid and Medicare incentive benefits as those are only afforded to CEHRT systems
  • Clinics with their own in-house specialists
  • Clinics in rural areas without reasonable access to specialists or hospital systems
  • Physical and occupational therapist offices
  • Independent psychological and psychiatric offices
  • Chiropractic specialists
  • Dental professionals
  • Stand-alone eye care clinics
  • Small clinics that plan to upgrade to EHR as they grow and budget allows
  • Research facilities

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

  • Facilities that want to have a comprehensive view of their patients’ healthcare
  • Comprehensive healthcare systems
  • Hospital systems
  • Pharmacies with multiple locations

Which practices should use an EHR?

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:

  • General practitioners
  • Internists
  • Cardiologists
  • Neurologists
  • OB/GYNs
  • Allergists
  • Radiologists
  • Ophthalmologists and optometrists
  • Psychiatrists and psychologists
  • Physical and occupational therapists
  • Dermatologists
  • Pharmacies
  • Hospitals

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.

EHR vs. EMR features and benefits

 Features and benefitsEMREHR
Direct clinical results
Consolidated patient information and timelines
Reduces paper clutter and misplaced or mismanaged records
More secure than paper files
Requires less physical storage space
Option to incorporate additional medical and administrative modules beyond PHI
Can be housed on a local server 
Can be cloud-based
Greater coordinated patient care between disparate providers 
Fewer prescription errors 
Improves patient/provider communication and information sharing 
Telehealth when requested 
EMR vs EHR

Is Epic an EMR or EHR?

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.

The best certified EMR and EHR systems on the market

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.

Top EMR software list 

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

  • SimplePractice: Offers clinical documentation, payment processing, and claims submissions to primary and secondary insurers, plus it supports HIPAA-compliant telehealth options. This EMR is a good option for small- to medium-sized practices. 
  • Athenahealth: A cloud-based EMR that offers billing and claims submission in addition to its clinical documentation functionality. It also has mobile functionality. It does not offer handwriting transcription, so users must type or dictate all information.
  • Tebra: An all-in-one, cloud-based EMR that provides significant flexibility and is ideal for independent practices with up to 10 practitioners. Tebra's EMR system offers clinical documentation processes in addition to telehealth, appointment coordination, record management, billing, reputation, and built-in analytics features. 
  • RXNT: This EMR, in addition to offering clinical documentation and billing options, is on iOS and Android for electronic prescription ordering and management, scheduling, and billing. It also can support telehealth.
  • WebPT EMR: In addition to the expected clinical documentation feature, this small practice system offers document scanning, billing (with 8-minute window for making corrections or amendments to submitted bills), scheduling, appointment reminder notices, and referral tracking.
 System featureSimplePracticeAthenahealthTebraRXNTWebPT EMR
Meets ONC certification standards √ √ √ √ √ 
Comprehensive charting √ √ √ √ √
Electronic prescriptions   √ √ 
Telehealth 
Internal and patient communication √ √ √ √ √
Clinical workflow management √ √ √ √ √
Scalable with additional modules for system expansion and flexibility√ Various tiered pricing options √ EHR upgrade optionDifferent plans according to practice needs√ Various tiered pricing options √ EHR upgrade option 

Top EHR software list 

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

  • Epic EHR: Epic is a robust cloud- or self-hosted software system with many bells and whistles and a price tag to match. It was designed with hospitals and ambulatory systems in mind, including community-based health settings.
  • Athenahealth: Athenahealth offers custom reporting tools and several features to help save time, like speech-to-text. However, Athenahealth can be difficult to navigate and is better for large practices and medical centers. 
  • eClinicalWorks: This robust EHR has been around since the 1990s. However, the company has paid $155 million to resolve claims that it falsely obtained meaningful use certification. 
  • AdvancedMD EHR: This cloud-based suite offers cafeteria-style options. One of its signature features is a dashboard that gives users a comprehensive overview of selected modules. It also allows for images along with text.
  • Tebra: This one-stop solution coordinates all healthcare functions and needs and consolidates them into one comprehensive cloud-based platform. Tebra offers a plethora of module options that range from HIPAA-compliant telehealth to routine scheduling and appointment reminders.
Tebra EHR
Here is a glimpse into Tebra's cloud-based, ONC-certified electronic health record (EHR) with integrated billing, telehealth, and eRx- and eLab-ordering workflows. Learn more here: www.tebra.com/care-delivery/electronic-health-records

Top EHR software comparison

Product nameEpicAdvancedMDAthenahealtheClinicalWorksTebra
Overview
Practice sizeLarge practices and health systemsLarge practices and medical centersLarger practices and hospitalsAmbulatory practicesIndependent practices
Cloud-based
On-premise
Mobile app
Fully integrated EHR
Compliance
ONC certified
HIPAA and HITRUST compliant
MIPS reporting
Features
Appointment management
Billing
Patient payments
Patient balance reminders
Clinical workflow
RPA
Lab integration
Patient portal
Telehealth
Virtual waiting room
Reporting and analytics
Online scheduling
Reputation management
Pricing notes
Varies based on number of providers, but starts at $1,200 for a small practice using an EMR. Charges a set-up fee and additional fees for features such as text messaging, eligibility checks, fax, telehealth, online scheduling, patient intake, EPCS, lab reporting. Charges for third-party software integrations. Practice management and billing tools are add-ons. Pricing is based on practice revenue. Has 2 monthly plans at $449 or $599 per provider. Charges a percentage fee for billing services (2.9% of practice collections). Pricing is easy to understand with no hidden or surprise fees. Includes one-time set-up fee and dedicated onboarding manager.

Questions to ask when interviewing system vendors

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:

References

  • Please provide a list of 3 to 5 clients who have purchased your product and have been using it for over a year that I can call to learn about their experience with the system.

System requirements

  • Is the system ONC certified?
  • What security protocols exist for the system?
  • What are the system requirements for this product, including space, operating system, internet connection speed, and screen size?
  • Is a seat license required for multiple people to access the system? If so, how many come standard as part of the package?

System features

  • Does the system include a mobile or tablet app?
  • What’s included in the base system package, and what additional modules are available?
  • What reporting functionality does this system include?

Implementation

  • Does this system integrate with or replace our existing billing, insurance, and prescription system?
  • How long does implementation take?
  • What’s involved in transferring patient information to the system?
  • If you’ve decided to start with an EMR with the intent to eventually upgrade to an EHR: How complicated is upgrading to an EHR product if or when we’re ready?

Ongoing support

  • What support is available, and for how long?
  • What type of training is available for our staff? What is the role of the person who will be responsible for the instruction? Note: The person to whom you are speaking is focused on sales and may not have the depth of information you will ultimately need or want.
  • How often is the software updated, and what is the average downtime during the update process?
  • What are your customer service hours? When we call, will we speak with a bot or person?
  • What support is available should the system ever be included as part of a practice’s regulatory audit?

Expense

  • What is the system base price?
  • How much is each separate, additional module?
  • How much is each seat license?
  • What discounts are available for our type of practice?

Which system will best meet your needs?

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.

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Karmin Gentili

Karmin Gentili has been a freelance writer and editor since 2016. She has over 25 years of experience in corporate HR and compliance consulting. She has worked to further elevate her skills by pursuing and receiving multiple certifications, including copywriting, video scriptwriting, effective content positioning, case study writing, and SEO. Her love of writing motivates her to use those skills to develop content for the medical field that ensures others can work toward achieving their goals.

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