Electronic Health Record
The electronic health record (EHR) is a computer-based record of patient health information. It is generated by one or more encounters in any healthcare delivery setting. The EHR includes information on patient demographics, progress notes, medications, vital signs, clinical history, immunizations, laboratory results, and reports of diagnostic procedures. The EHR documents evidenced-based decision-making, quality management, and patient outcomes. The term EHR is generally preferred over the term electronic medical record (EMR). The EMR most often refers to a single healthcare event, whereas the EHR includes the entire patient record of healthcare encounters. The EHR also emphasizes the role of the patient in viewing and even contributing to the record and may chronicle and even influence health status, not just a patient’s...
References and Further Readings
- Wachter, R. M. (2012). Information technology, chapter 13. In R. M. Wachter (Ed.), Understanding patient safety (2nd ed.). McGraw Hill Medical: New York, New York.Google Scholar