Alphabet Soup – What do EMR, EHR, PHR, RHIO, HIE, etc. Stand for and What are They?

We’re hearing more and more aconyms when reading about Health Information Technology (HIT – there’s another one!) – what are they and what do they do? (updated Aug 2011)

People love to shorten things.  Part of the reason is expediency but I also think sometimes it makes them feel important to talk in a code that few understand.  This is bad enough in industries where the jargon is fairly stable but in health technology the alphabet soup is growing and changing almost daily.  Following are some of my favorites, including the real meaning (as I understand it today – that could change tomorrow!):

REC – Ragional Extension Center.  RECs were funded by the ARRA (stimulus) legislation, along with the EHR incentives for Meaningful Use of a certified EHR.  RECs are intended to operate much like agricutural extension centers, only instead of helping farmers they are designed to help primary care providers adopt and implement EHRs.  Each state has at least one REC and larger states (like Texas) have up to 4.  RECs may charge for their services and most do, as they are trying to become a going concern after their federal funding is exhausted.  Click Here for a list of state RECs.

EMR – Electronic Medical Record.  This is the old/passe term for the electronic version of a patient’s medical record that is used by an ambulatory physician’s office.  There has never been a good distinction between EMR and EHR (see below) so as the government has adopted the term EHR, so go the masses.

EHR – Electronic Health Record.  This is the new term for EMR.  Its really the same thing.  However, the governnment tends to use only this term so it is becoming more popular.  One reason the government is using EHR instead of EMR is that the EHR term has come to connote an ability or willingness to share data from the patient record – bring external data in and push out or share data with hospitals and other providers.

RHIO – Regional Health Information Organization.  This is the old/passe term for organizations that facillitate the sharing of patient’s key health information.  Think of these as similar to credit clearingouses where lenders send key credit information about lenders (you and I) so that information is available to all future potential lenders.  Similarly, a RHIO would capture key existing health information on patients so it could be shared with their future providers, including the ER (Emergency Room),  That is also the reason these scare some privacy advocates – but that is another story.  Data can be entered into the RHIO through a variery of sources including feeds from EMRs/EHRs and manual data entry.  RHIOs often also receive feeds from insurance companies, labs and other electronic sources.

HIE – Health Information Exchange.  This is the new term for RHIO.  Again, the government helped change the terminology as it made grant $s available to start HIEs.  The historical problem with RHIOs/HIEs has been finding sustainable financial support for the ongoing operation.  In general, there are two types of HIEs:

  1. Private HIEs – These tend to be run by hospitals that created the HIE as a way to “plug in” affiliated providers and enable them to receive lab results for the hospitals and share key patient data.  Some other privately run HIEs also exist for similar purposes.  Both, but especially the latter, are likely to charge fees to provider members and vendors.
  2. State HIEs – As part of the ARRA (stimulus) funding that created the EHR incentives and the RECs (Regional Extension Centers), funding was set aside for the creation of a state-wide HIE for every state.  States are in various stages of developing their HIEs.  Click Herefor a contact list of state HIEs.

PHR – Personal Health Record.  PHRs are patient controlled.  There are several web services that offer PHRs.  A PHR allows a patient to record their medical history and other key information so that they can share it with the emergency room or take it with them to a new provider’s office – helps when filling out all those forms.  It will be interesting to see how and if the patient’s data from their PHR will be used/imported into EMRs/EHRs and what will happen when the patient’s data differs from the providers.

CCR or CCD – Continuity of Care Record/Document.  The CCD is the portion of a patient’s EMR/EHR chart that the provider shares with other providers.  It is a document that can be printed or electronically sent from one provider to another or given to the patient.  Unlike an EMR/EHR which includes all office visits and all the details of those visits, a CCD only contains summary information such as diagnosis, medications, medical history and allergies.  Once again you can thank the government for choosing the name when they made the ability to import a CCD part of CCHIT requirements.  What is CCHIT?

CCHIT – Certification Commission for Health Information Technology.  CCHIT sets annual requirements for the functionality EMRs/EHRs must contain in order to be certified for that year.  Vendors apply for certification and must be tested by CCHIT and pass with a 100% in order to be certified.

MU – Meaningful Use.  Typically this refers to the Core and Menu requirements a provider must meet to demonstrate Meaningful Use of a Certified EHR and qualify for the EHR incentives under the ARRA (aka Stimulus) bill.

CDS (new one I just heard) – Clinical Decision Support rule.  This is one of the meaningful use requirements – specifically #11 of the Core requirements.

These are some of the key terms as they are generally used today.  However, you will often see them used interchangably which is really confusing.  For example, it is quite common to see PHR and CCR/CCD interchanged.

Cathy Huddle, VP Market Development