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 12th 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.


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 Physicians 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.

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


June 4, 2011. Medical, Points to Ponder, Science, Technology. Leave a comment.

Newton’s Apple Tree Bound For Gravity-Free Orbit

Sir Isaac Newton’s famous apple tree is about to leave gravity behind.

Flying aboard space shuttle Atlantis next week will be a 4-inch sliver of the tree from which an apple supposedly fell nearly 350 years ago and inspired Newton to discover the law of gravity.

British-born astronaut Piers Sellers is flying the piece of wood for The Royal Society of London.

“I’ll take it up into orbit and let it float around a bit, which will confuse Isaac,” Sellers said in an interview with The Associated Press earlier this week.

When Sellers last flew in space in 2006, he carried up a gold medal that the society later presented to British physicist Stephen Hawking. This time, he told them, “What about something for you?”

The small slice of Newton’s apple tree they offered is “from THE apple tree, from the one that he was looking at when the apple fell down and he got the idea,” stressed Sellers.

“It’s his personal apple tree … that’s really something, isn’t it?”

Sellers said the president of the Royal Society assured him the piece is authentic.

“Written on it in very old 18th century lettering is I-S-dot-Newton,” the astronaut told the AP. “He had a very nice hand. So I think it is his tree.”

It’s big enough to see the grain in the wood and is curved, he said.

Sellers will return it to the Royal Society following Atlantis’ 12-day flight.

The Royal Society — the national academy of science of the United Kingdom — is celebrating its 350th year. As part of the anniversary celebration, the society in January made available online the 18th-century document detailing Newton’s account of the famous apple incident, which occurred in the mid-1660s.

Here’s what William Stukeley wrote as told to him by Newton: “It was occasion’d by the fall of an apple, as he sat in contemplative mood. Why should that apple always descend perpendicularly to the ground, thought he to himself … Why should it not go sideways, or upwards? But constantly to the earth’s center? Assuredly, the reason is, that the earth draws it. There must be a drawing power in matter.”

Newton was a physicist, mathematician and astronomer, among other things. He was born in 1643 in Lincolnshire, England, said to be the site of the famous apple tree. In 1687, he published his book Principia in which he described his theory of gravity and the laws of motion. He died in 1727.

Sellers, 55, who has a doctorate in biometeorology, became an astronaut in 1996. Born in Sussex, he’s been a U.S. citizen since 1981. Next Friday’s launch to the International Space Station will be his third space shuttle mission.

Sellers also is taking along a flag for the 2012 Olympics, to be held in London.

by The Associated Press
The Associated Press

Copyright 2010 The Associated Press

I found the following story on my NPR iPhone App:

May 8, 2010. Science. Leave a comment.