The Concept, the Future Confluence of Electronic Mohs Mapping (EMM) with Electronic Medical Record (EMR) and Electronic Health Record (EHR)

Author and Disclosures

Ulysses L. Labilles, DMD, MHT

In his 12^th year as Mohs histopathology supervisor and member of Dr. Christine Brown’s Skin Cancer Team in Dallas Texas-Uly as everybody call he is responsible in all facets of Mohs histotechnology, as well as pulling pre, intra, and postoperative values needed for Mohs operative summaries. He is also responsible in managing “Photo EMR” needed in pre-operative planning, patient education, and intra- and post-operative references. He currently developed a modified rapid immunohistochemistry protocol for frozen sections.

Disclosure: Uly Labilles has no financial relationships with Apple, Google, or with any company who develops Android based tablets and touch screens.

INTRODUCTION

The prestigious commonality of Bill Gates, Steve Jobs, Steve Ballmer, Scott McNealy, and Eric Schmidt is not that all five of these IT industry gurus were born between 1954 and 1956, but the epitome of work ethics and dedication. I just cannot help but wonder what will be Steve Jobs’ plan for the next iPad upgrade. From patient monitoring units, to blood pressure machines and operating room displays, tablets and touch screens are being integrated into an ever-expanding list of medical devices. Before we explore its future in fully-integrated healthcare e-support systems, let me discuss the basic definition of EMR and EHR. Conceding the fact that Electronic Medical Record (EMR) and Electronic Health Record (EHR) are often used interchangeably-these terms are completely different in concept and definitions. EHRs are reliant on EMRs being in place, both are prized for its crucial role in improving patient safety, quality and efficiency of patient care and reducing healthcare delivery costs. EMRs will never reach its full potential without interoperable EHRs in place. It is important to establish clinical information transaction standards that can be easily adopted by the different EMR application architectures now available. Until we open and expand the limited environments of existing EHR, the meaningful confluence of the concept of EMM and EMR will be a challenging endeavor.

Understanding the Difference between EMR and EHR

While qualified physicians already receiving incentive payments as high as $18,000; it is important to understand the difference between EMR and EHR to reduce confusion. EMR is the source of data for EHR, the legal record created in hospitals and ambulatory environments. The EHR represents the ability to easily share medical information among patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government and its agencies. Patients’ information follows the stakeholders through various modalities of care engaged. HIMSS Analytics defined EMR and EHR as follows:

Electronic Medical Record is an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. This environment supports the patient’s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO). The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.

Electronic Health Record is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs within a community, region, or state. It is a subset of each care delivery organization’s EMR, presently assumed to be summaries like ASTM’s Continuity of Care Record (CCR) or HL7’s Continuity of Care Document (CCD). ASTM International (ASTM) is originally known as the American Society for Testing and Materials, while Health Level Seven (HL7) is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards. In the US, EHR will ride on the proposed National Health Information Network (NHIN). The EHR can be established only if the electronic medical records of the various CDOs have evolved to a level that can create and support a robust exchange of information between stakeholders within a community or region.

Replacing the Physician’s Old Clipboard

While Apple’s Windows-based competitors running in Android OS is catching up, the day is not far of where a tablet like iPad becomes a healthcare provider’s primary portal into the spectrum of their health IT system. The tablets will be replacing the old physician’s clipboard. Outpatient practices already running a Mac-based EMR, an iPad interface will be a perfect upgrade. Development of apps that will allow patients to fill out registration, medical history, and other forms on the iPad. Could the iPad become the new e-sidekick of healthcare providers? There will be challenges, but the opportunities are exciting. The next generation of iPad will integrate with MacPractice EMR to manage schedules, view patient records, and enter clinical notes, and perhaps reciprocal consultation between physicians, surgeons and doctors in other field of Medicine and Research. Apple’s Face Time Protocol will not only the new video telephony solution for telemedicine, but also could expand its capabilities to link specialties like Mohs Surgery-bridging the surgeon, pathologist and histotechnologist into one seamless body. The new iPad 2 with its built in front facing VGA camera and a 720P HD rear facing camera will give the possibility of EMR/EHR FaceTime to healthcare. Handwriting functionality and dictation are among the challenges that need to be met, as well as developing EMR/EHR integrated apps like in microscopy and diagnostic imaging that Electronic Mohs Mapping (EMM) being part of its bundle. Just think about a fully integrated system which allows you to collaborate with your colleagues when developing or trying out a new protocol. For example, clinicians could easily exchange side by side comparisons using split sampling correlations between melanoma H & E slides and slides stained with a new immunohistochemistry protocol for validation. While Steve Jobs may already have the timeline for the coming upgrade of iPad replacing the old physician’s clipboard, Android are focused to replace Windows CE and Linux in medical devices. The Android platform is built on the Linux OS by providing a full-featured embedded system framework that is easy to use without the additional cost. Android is being adopted by companies in many industries for devices that require embedded operating systems. The medical industry has taken notice of Android since it is based on Linux. Linux is already a well established system in the medical industry. Medical industry has taken notice of Android’s future into Class I and II medical devices, taking note its known risk to FDA-regulated devices.

References
1. Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference
Dave Garets and Mike Davis
2. From Meaningful Use to Meaningful Care
William F. Bria, II, MD; Michael B. Blackman, MD, MBA; Geeta Nayyar, MD, MBA
3. Apple iPad and Electronic Medical Records-Could it replace the Physicians Clipboard?, Satish Misra, MD, 04 February 2010
4. Android + Touch Screens=Future of Medical Devices, Tech Girl, 02 March 2011
5. IQMax Releases Healthcare Dictation App IQSpeak for Android OS, EMR and EHR News, 18 February 2011