An electronic medical record (EMR) is a medical record in digital format. A medical record, health record, or medical chart is a systematic documentation of a Patient 's Medical history and care.
In health informatics an EMR is considered by some to be one of several types of EHRs (electronic health records), but in general usage EMR and EHR are synonymous. An electronic health record (EHR refers to an individual patient's Medical record in digital format 
The term has sometimes included other (HIT, or Health Information Technology) systems which keep track of medical information, such as the practice management system which supports the electronic medical record. Practice management software (PMS is a category of software that deals with the day-to-day operations of a medical practice
As of 2006, adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Computerized physician order entry (CPOE, is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly Hospitalized Less than 10% of American hospitals have implemented health information technology, while a mere 16% of primary care physicians use EHRs. A primary care physician, or PCP, is a Physician / medical doctor who provides both the first contact for a person with an undiagnosed health concern as well  The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. The healthcare industry spends only 2% of gross revenues on HIT, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%.  The following issues are behind the slow rate of adoption:
In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged. 
In the United States, the development of standards for EMR interoperability is at the forefront of the national health care agenda.  EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing share patient information(lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Dr David J Brailer, MD is a Public health official from the United States. Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Regional Health Information Organizations (RHIOs are key to the US National Health Information Network (NHIN Congress is currently working on legislation to increase funding to these and similar programs.
The Center for Information Technology Leadership described four different categories (“levels”) of data structuring at which health care data exchange can take place.  While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization.
The four levels are:
|1||Non-electronic data||Paper, mail, and phone call.|
|2||Machine transportable data||Fax, email, and unindexed documents.|
|3||Machine organizable data (structured messages, unstructured content)||HL7 messages and indexed (labeled) documents, images, and objects.|
|4||Machine interpretable data (structured messages, standardized content)||Automated transfer from an external lab of coded results into a provider’s EHR. Data can be transmitted (or accessed without transmission) by HIT systems without need for further semantic interpretation or translation.|
To attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR, older paper medical records ideally should be incorporated into the patient's record. Patient safety is a new healthcare discipline that emphasizes the reporting analysis and prevention of Medical error that often lead to adverse healthcare events The digital scanning process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Historical precedent Scanners can be considered the successors of early telephotography input devices consisting of a rotating drum with a single Photodetector at Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that 22-25% of physicians are much less satisfied with the use of scanned document images than that of regular electronic data. 
A major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access.  Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws. The Health Insurance Portability and Accountability Act ( HIPAA) was enacted by the U  In the European Union (EU), several Directives of the European Parliament and of the Council protect the processing and free movement of personal data, including for purposes of health care. The European Union ( EU) is a political and economic union of twenty-seven member states, located primarily in  The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. The growth of EHR creates new issues, since electronic data may be physically much more difficult to secure, as lapses in data security are increasingly being reported.  Information security practices have been established for computer networks, but technologies like wireless computer networks offer new challenges as well. Information security means protecting information and information systems from unauthorized access use disclosure disruption modification or destruction A computer network is a group of interconnected Computers. Networks may be classified according to a wide variety of characteristics One issue with corporate Wireless networks in general and WLANs in particular involves the need for Security.
According to the Agency for Healthcare Research and Quality's National Resource Center for Health Information Technology, EMR implementations follow the 80/20 rule; that is, 80% of the work of implementation must be spent on issues of change management, while only 20% is spent on technical issues related to the technology itself. The Agency for Healthcare Research and Quality (AHRQ (formerly known as the Agency for Health Care Policy and Research) is a part of the United States Department of Health In 2004, the Agency for Healthcare Research and Quality of the United States Department of Health and Human Services created the AHRQ National Resource Center for Such organizational and social issues include restructuring workflows, dealing with physicians' resistance to change (or, alternatively, software engineers' evolving research in deep modeling of the physician's knowledge and workflow domains), as well as IT personnels' resistance to design and implementation flexibility needed in the complex healthcare environment, and creating a collaborative environment that fosters communication between physicians and information technology project managers. Exemplifying this need are several highly publicized HIT implementation failures, such as one at Cedars Sinai Medical Center in Los Angeles, in which physicians revolted and forced the administration to scrap a $34 million CPOE system  as well as others compiled at a collection of cases of health IT difficulties by medical informatics specialists. Cedars-Sinai Medical Center is a Hospital located in Los Angeles California.  There are, however, several successful examples of EMR implementations in large hospitals, usually hospital systems that have had years of experience developing custom EMRs, for example the Veterans Administration hospital system and the VistA EMR. The United States Department of Veterans Affairs ( VA) is a government-run military Veteran benefit system with Cabinet -level status The Veterans Health Information Systems and Technology Architecture (VistA is an enterprise-wide information system built around an Electronic health record, used throughout
Limitations in software, hardware and networking technologies has made EMR difficult to affordably implement in small, budget conscious, multiple location healthcare organizations. Until recently most EMR systems were developed using older programming languages such as Visual Basic and C++; however with many systems now being developed using Microsoft .NET Framework and Java technology EMRs can be securely implemented across multiple locations with greater performance and interoperability. Visual Basic ( VB) is the third-generation event-driven programming language and associated development environment (IDE from C++ (" C Plus Plus " ˌsiːˌplʌsˈplʌs is a general-purpose Programming language. Java refers to a number of Computer software products and specifications from Sun Microsystems that together provide a system for developing Application software  Prior to the recent introduction of IEEE 802.11 g and n wireless technology access to large files such as MRI and X-Ray images was slow. IEEE 80211 is a set of standards for wireless local area network (WLAN computer communication developed by the IEEE LAN/MAN Standards Committee ( IEEE 802 With these new wireless technologies data can be securely transferred at speeds of up to 108 Mbit/s, across extended distances and in older buildings built with brick or concrete walls. Tablet PC technology has significantly improved over the recent years with the introduction of Windows XP Tablet PC Edition, Li-Ion/polymer batteries for battery life of up to 8 hours, biometric security, low-voltage processors and lighter weight solutions. A Tablet PC is a Notebook or slate-shaped Mobile computer, equipped with a Touchscreen or Graphics tablet/screen hybrid technology which allows Windows XP has been released in several editions since its original release in 2001
Under data protection legislation and the law generally responsibility for patient records (irrespective of the form they are kept in) is always on the creator and custodian of the record, usually a health care practice or facility. The physical medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound, etc. The patient, however, according to HIPAA, owns the information contained within the record and has a right to view the originals, and to obtain copies under law.  Additionally, those responsible for the management of the EMR are responsible to see the hardware, software and media used to manage the information remain usable and not degraded. This requires backup of the data and protection being provided to copies. It will also require the planned periodic migration of information to address concerns of media degradation from use. 
Medical records, such as physician orders, exam and test reports are legal documents, which must be kept in unaltered form and authenticated by the creator.
Though there are few standards for modern day EMR systems as a whole, there are many standards relating to specific aspects of EHRs and EMRs. These include:
Various factors involving the timing, the right players, market history, utility, governance play a key role in the overall enrichment of the standard and certification development. The standardization and certification even though seem to bring uniformity in the EMR development, do not guarantee their acceptability and sustainability in the long run.  In 2005 the US Federal Government awarded a contract to CCHIT - Certification Commission for Healthcare Information Technology to develop certification criteria for EMR. The '''Certification Commission for Healthcare Information Technology''' (CCHIT is a private not-for-profit organization that serves as the recognized US certification authority for Electronic Starting in early 2007 vendors began to utilize these certification criteria for their EMR systems.
Pricing for EMR systems is highly dependent on each practice's unique needs. Because every medical practice has distinct requirements, systems usually need to be custom tailored. This is due to the majority of EMR systems being based on templates that are initially general in scope. In many cases, these templates can then be customized in co-operation with the vendor/developer to better fit a medical specialty, environment or other specified needs. There are also EMR systems available that do not use templates and therefore can be easily personalized by each individual user.
There are issues surrounding the generation and management of electronic medical records (EMRs), sometimes known as electronic health records (EHRs). An electronic health record (EHR refers to an individual patient's Medical record in digital format
There are a two primary categories of the EMR; the "born digital" record and the scanned/imaged record.
The "born digital" record, which is information captured in a native electronic format originally is information that may be entered into a database, transcribed from an electronic tablet or notebook PC, or in some other manner captured from its inception electronically. The information is then transferred to a server or other host environment, where it is stored electronically.
The second category are records originally produced in a paper or other hardcopy form (X-ray film, photographs, etc. ) that have been scanned or imaged and converted to a digital form. These records are best described as "digital format records", as their content is not able to be modified or altered (with the exception of the use of a third party software to make "overlay notations") as electronic records are. Most medical records generated preceding the year 2000 are of this category.
The process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact and accurate capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by any number of healthcare professionals over the life span of the patient, there exists a high probability of some of the content being illegible following conversion. In addition, the material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. Consideration should be given to developing a procedure to sample and verify images at a high ratio to determine the accuracy and usability of the scanned images prior to disposal of the physical records, if they are disposed of at all.
Further, all electronic repositories of information are subject to the need for periodic conversion and migration to ensure the formats they were captured in remain accessible over the life of the patient, and in some cases beyond, to the expected life of their heirs. Additionally, those responsible for the management of the EMR are responsible to see the hardware, software (applications) and media used to manage the information remain viable and are not subject to obsolescence or degradation. This will require generation of backup copies of the data and protection being provided to these copies in the event of damage to the primary repository. It will also require the planned periodic migration of information to address concerns of media degradation from use. These are all costly, time consuming processes that must be planned and budgeted for when making decisions to convert physical medical records to digital formats.
Another major concern is adequate protection of privacy of the individuals whose records are being managed electronically. This class of information (in the US) is referred to as Protected Healthcare Information (PHI) and its management is addressed under the Healthcare Insurance Portability and Accountability Act (HIPAA) as well as many State-specific privacy laws. The organization/individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties.
As of 2005, one of the largest projects for a national EMR is by the National Health Service (NHS) in the United Kingdom. The National Health Service is the name commonly used to refer to the four Publicly-funded healthcare systems of the United Kingdom collectively or individually (although The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The goal of the NHS is to have 60,000,000 patients with a centralized electronic medical record by 2010.
The Canadian province of Alberta's Alberta Netcare project is a large-scale operational Electronic Health Record (EHR) system. Alberta (ælˈbɝtə is one of Canada's prairie provinces. It became a province on September 1 1905 Alberta Netcare (formerly Wellnet is the province of Alberta's public Electronic Health Record.
Adoption of electronic medical records by US doctors is increasing slowly. The latest data from the National Ambulatory Medical Care Survey (NAMCS) indicate that one-quarter of office-based physicians report using fully or partially electronic medical record systems (EMR) in 2005, a 31% increase from the 18. 2 percent reported in the 2001 survey.  However, the survey also states that just 9. 3% of these physicians actually have a "complete EMR system", with all four basic functions deemed minimally necessary for a full EMR: computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes.  Barriers to adopting an EMR system include training, costs and complexity, as well as the lack of a national standard for interoperability among competing software options.  Advocates of electronic health records hope that product certification will provide US physicians and hospitals with the assurance they need to justify significant investments in new systems. The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U. The '''Certification Commission for Healthcare Information Technology''' (CCHIT is a private not-for-profit organization that serves as the recognized US certification authority for Electronic S. Department of Health and Human Services to develop a set of standards and certify vendors who meet them. The United States Department of Health and Human Services ( HHS) is a Cabinet department of the United States government with the goal of protecting On July 18 2006, CCHIT released its first list of 20 certified ambulatory EMR and EHR products.  and then on July 31 2006, additionally announced that two further EMR and EHR products had achieved certification. 
In the United States, the Department of Veterans Affairs (VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture or VistA. The Veterans Health Information Systems and Technology Architecture (VistA is an enterprise-wide information system built around an Electronic health record, used throughout A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders, including medications, special procedures, X-rays, patient care nursing orders, diets, and laboratory tests.