What differentiates an electronic medical record (EMR) from a computer based patient record (CPR)? Those distinctions, coupled with some clinicians’ reluctance to forsake their tried and true ways for technologies that lack a proven track record, make it hard for this particular technology to gain wide-scale acceptance among physicians.

For some in the industry, the terms EMR and CPR are used interchangeably, says Peter Waegemann, CEO of the Boston-based Medical Records Institute. “There is no consensus as to what an EMR or CPR is,” he notes.

But not for all. “We just use the term EMR,” says William F. Jessee, M.D., president and CEO of the Denver-based Medical Group Management Association (MGMA), the largest group practice association in America.

Larry Dolin, president and CEO of Mayfield Heights, OH-based Noteworthy Medical Systems Inc., says there is also confusion surrounding what constitutes an EMR, let alone a CPR. Dolin, whose company has developed a total system for medical data management, views an EMR as a total computer-based medical record that does not rely on paper charts, transcription or dictation, yet includes all doctors’ notes and prescription orders. He believes a true EMR requires physicians to do their own clinical documentation by entering data as they examine patients. Waegemann agrees, saying that you really don’t have an EMR unless the physician is using a computer in the examining room.

But Matthew Morgan, M.D., sees a clear-cut difference between EMRs and CPRs. As an assistant professor in the Department of Medicine at the University of Toronto, and director of healthcare informatics for Atlanta, GA-based Per-Se Technologies, Morgan says an EMR is a confined medical record offering little integration with other systems and is “much more restricted in its scope.” A CPR, on the other hand, “provides a longitudinal patient record over time” that goes beyond the walls of one organization or physician’s practice, he says. Because a CPR cuts across the entire spectrum of healthcare delivery, clinicians are provided with a total view of a patient’s medical history.

The CPR is not a new concept, Morgan says, Citing work done by the Institute of Medicine in 1991, which called for the adoption of CPRs by 2001. Other influential groups including the Agency for Healthcare Research and Quality and the Leapfrog Group are recommending implementation of CPRs as a way to reduce medical errors. But Waegemann says that attempts to compile a comprehensive, prenatal to postmortem medical record have shown few real benefits. “This specific vision has not been implemented and probably won’t be in the next couple of years,” he predicts.

Privacy Issues

One of the biggest barriers to implementing a life-long medical record is the issue of privacy. “It has too many `Big Brother’ overtones,” says Jessee, adding that having all that information in a single database, accessible to any number of caregivers during a lifetime, frightens most patients. It also raises the question of who owns that data and where it will reside. Nevertheless, he believes the kind of longitudinal patient record that has been debated since 1991 eventually will consist of “multiple electronic repositories of different data,” coupled with a linking mechanism, which will still allow for the exchange of specific information.

Morgan agrees that a single database can increase the risk of breaches in security, but says there are more potential breaches to patient privacy in a paper-based world. Dolin agrees. He says his company’s EMR, for example, helps ensure patient privacy because access to patient records is electronically restricted to those who have a need for access, and that user access levels can be defined on an individual or group basis.

Pointing to the ever-growing role of the Internet, Waegemann says, “The future medical record will be a record accessible on the Web.” But he raises the issue of what information patients may want included or excluded from their records. While many patients with chronic illnesses would feel secure knowing that their past histories are available in case of emergency, others may argue their “rights of anonymous care.”

Some people, for example, may not want it known that they experimented with drugs at the age of 15 or had an abortion at 18, he says. Dolin, however, retorts: “We’re not interested in everything that’s happened to you in the world.” Adds Morgan: “As a physician, I have the duty to protect the privacy of my patient.”

Slow but Steady Gains

Whether it’s called an EMR or CPR, physicians have been slow to fully adopt this technology. But that may be changing. “Physicians, by nature, are not opposed to change,” says Morgan. “They will adopt it if it can improve patient care.”

Morgan says physicians have perfected their use of paper over time and are reluctant to give up their methods until something better comes along. But now they’re finding that a computer-based record is better, he says. “In a paper-based world you don’t get real-time clinical decision support.”