Introduction

Health systems are essential frameworks that ensure the delivery of healthcare services to meet the needs
of populations.

According to the World Health Organization (WHO), a health system includes all organizations, people,
and actions aimed at promoting, restoring, or maintaining health. These systems go beyond hospitals and
clinics, encompassing public health programs, private providers, insurance systems, and even families
caring for their loved ones.

Across the world, health systems vary widely, shaped by each country’s history, culture, and economic
situation.

However, common goals remain the same: providing good health outcomes for the population, being
responsive to people’s needs, and ensuring fair financing to make healthcare accessible to everyone.

These goals are achieved through four main functions: delivering healthcare services, generating
resources, financing healthcare, and providing effective leadership and governance.

Countries adopt different models to organize and finance their health systems:

1. Beveridge Model: Healthcare is funded by the government through taxes and provided to everyone, as
seen in the UK and Spain.

2. Bismarck Model: Healthcare is funded by employers and employees through insurance, common in
countries like Germany and Japan.

3. National Health Insurance Model: The government provides insurance, but services are delivered by
private providers, like in Canada and South Korea.

4. Private Model: Access to healthcare depends on individuals' ability to pay, which is prevalent in
countries like the United States.

Health systems rely on several key components to function effectively. These include a trained and
motivated workforce, well-maintained infrastructure, reliable access to essential medicines, and sound
health policies. Financing is also a crucial aspect, as it determines whether people can afford the care they
need. Countries use various methods to fund their health systems, including taxes, insurance
contributions, out- of-pocket payments, and donations.

A well-functioning health system ensures not only treatment but also prevention, rehabilitation, and
ongoing care. However, challenges like inadequate funding, unequal access to services, and workforce
shortages often hinder progress. Integrating services like rehabilitation at all levels of care is vital to
improving outcomes and ensuring continuity of care for patients.

EHR systems evolution

Electronic Health Records (EHR) systems have significantly evolved over the past few decades,
transforming the way healthcare is delivered and managed. Initially, health records were paper- based,
which limited accessibility, created inefficiencies, and increased the potential for errors. The digital shift
to EHRs brought numerous benefits, including better data organization, improved patient safety, and
more efficient care coordination.

Early Development

The first attempts to digitize medical records began in the 1960s with academic and government -driven
projects. However, early EHR systems were expensive, difficult to use, and mainly focused on storing
basic patient information rather than integrating healthcare workflows.

Growth in the 1990s and Early 2000s

In the 1990s, advances in computing and the increasing use of the internet helped EHR systems evolve
from simple record-keeping tools into more sophisticated platforms capable of managing larger sets of
patient data. These systems started to integrate decision-support tools, electronic prescribing, and the
sharing of patient information across different healthcare providers.

However, widespread adoption remained a challenge. EHR systems were often costly, and healthcare
providers were reluctant to shift from paper-based systems due to the complexity of implementation,
privacy concerns, and lack of standardization.

Government Incentives and Mandates

The turning point came with government intervention. In the United States, the Health Information
Technology for Economic and Clinical Health (HITECH) Act of 2009 provided incentives for healthcare
providers to adopt EHR systems. Countries around the world followed similar initiatives, recognizing the
potential of EHRs to improve healthcare quality and reduce costs. This led to a surge in EHR adoption
and the development of systems that were more user-friendly, secure, and interoperable.

Modern EHR Systems

Today, modern EHR systems are far more advanced, incorporating artificial intelligence (AI), machine
learning, and predictive analytics to help healthcare providers make data-driven decisions. EHR systems
now integrate with other healthcare technologies, including telemedicine platforms and wearable devices,
to offer more comprehensive care. Additionally, patient portals have become more common, allowing
patients to access their medical records, communicate with providers, and take a more active role in their
healthcare.

Future Trends

Looking ahead, the future of EHR systems will likely focus on interoperability, enabling seamless data
exchange between different healthcare providers and across borders. There is also a growing emphasis on
enhancing user experience for both healthcare providers and patients, reducing administrative burdens,
and improving EHR integration with other technologies like mobile health (mHealth) applications.

As EHR systems continue to evolve, their role in improving patient care, streamlining operations, and
supporting public health initiatives will only expand, contributing to a more efficient and connected
healthcare ecosystem.
What is EMR?

Electronic Medical Records (EMR) encompass digital versions of patients' paper charts,
containing comprehensive information about their medical history, diagnoses, medications,
treatment plans, immunization dates, allergies, radiology images, and laboratory test results.
Unlike traditional paper records, EMR systems offer a centralized and easily accessible
repository of real-time patient data.

Main Features of EMR Systems:

 Patient Records Management: Centralized storage of patient information and medical history.
 Clinical Workflow Automation: Automated processes like charting and reminders.

 Appointment Scheduling: Tools for scheduling and managing appointments, including telemedicine
integration.

 e-Prescribing: Electronic prescription management and pharmacy integration.

 Lab Integration: Electronic lab ordering and result management.

 Billing and Coding: Automated coding and billing, insurance integration, and invoice management.

 Clinical Decision Support: Alerts and recommendations for diagnoses and treatments.

 Patient Portal: Secure patient access to health records, appointments, and messaging.

 Interoperability: Integration with other healthcare systems and devices.

 Security and Compliance: Data protection measures and regulatory compliance (e.g., HIPAA).

 Reporting and Analytics: Customizable reports and health data analysis.

 Telehealth Support: Integration of telemedicine and remote monitoring capabilities.

Fragmentation of Records & Limited Accessibility:
 Centralized Information Access: EMRs (Electronic Medical Records) consolidate
patient data, making it accessible across healthcare providers.
 Interoperability: EMRs support communication between different systems, enabling
data sharing.
 Real-Time Updates: Changes to patient records are instantly available to all authorized
users.
 Patient Portals: Patients can view and manage their records and appointments,
improving collaboration.
 Streamlined Documentation: EMRs reduce paperwork, allowing more focus on patient
care.
Privacy Concerns:
 Access Controls: Strong authentication ensures only authorized personnel can access
sensitive data.
 Data Encryption: Encryption protects health data from unauthorized access.
 Audit Trails: Logs track who accessed and altered records, promoting accountability.
Data Exchange & Integration:
 Improved Patient Care, Efficiency, and Security: Integrating EMRs with other systems
like telehealth or labs enhances healthcare.
 Types of Integration: Methods include point-to-point (direct) or middleware (indirect,
for scalability).
 Cloud Integration: Supports real-time sharing across platforms and devices.
EMR Tools:
 APIs & HIEs: Enable data exchange between systems.
 Telehealth & Device Integration: Links EMRs with telemedicine, lab, or pharmacy
systems for better care coordination.
Pros of EMRs:
 Lower long-term costs, fewer errors, quicker access, better security, reduced duplicate
testing, more patient involvement, supports research.
Cons of EMRs:
 High initial costs, risk of malfunctions, and potential for data breaches.
Pros of Paper Records:
 Lower upfront costs, easier for some to use, customizable.
Cons of Paper Records:
 Takes up space, time-consuming, poor security, no backup, limited accessibility.

EMR Paper healthcare management system

EMR Paper healthcare

management system
Data Exchange Cloud Integration,Point-to- Physical Transfer of
Point Integration,Middleware Records,Telephone and Verbal
Integration Communication,Faxing
 Documents

Privacy Concerns Access Controls:only authorize Unauthorized Access,No

user,Data Encryption,Audit Encryption,Difficulty in
Trails Auditing Access

Cost Can be expensive to Lowers upfront costs

implement
Time consuming Takes up less time and space. It’s time-consuming
Operational Costs lower operational costs high operational costs

2.1 What is Electronic Health Record(EHR)

In the days before healthcare digitization, everything was written down by hand and stored
disparately ,In Electronic Health Records (EHRs), providers are able to capture more data than
ever before — and centralize it all in one place. So what is EHR?

Definitions of EHR

(Michael & Thomas) Researchers have defined Electronic Health Records (EHRs) are computer
systems that medical practices use instead of paper charts. Everything that used to be
handwritten by health care providers and staff is now entered into a computer, directly into the
EHRs.

The Electronic Health Record (EHR) is a vital element of clinical information systems enabling
sharing of patient information (Lauren M.HessShailendra ,2024).

Electronic Health Records (EHR’s) are also widely known as Electronic Medical Records (EMR’s)
and many people use the term interchangeably (Torrey, 2011). An EHR is an electronic version
of a patient's health record that was historically created, used, and stored in a paper chart. A
patient EHR is created, managed, and held by a healthcare organization (Roman, 2009).

HER comprehensive collection of health information ,stored and managed electronically. and
that information is maintained by the provider over time, and may include all of the key
administrative clinical data relevant to that persons care under a particular provider Included in
this information are patient demographics, progress notes, problems, medications, vital signs,
past medical history, immunizations, laboratory data, and radiology reports. , In short EHR
transformed healthcare for better.

2.2 CLINICAL AND ADMINISTRATIVE NEED FOR AN HER

There are many clinical and administrative needs that a hospital or a physician’s office requires
an EHR to be able to perform. The EHR will be the central data base of information that will
drive patient documentation, billing, quality, and clinical decision support

Patient Documentation:
The EHR must be able to document the complete face-to-face encounter between a doctor and
patient (Hufford, 1999). information included in the patient EHR documentation are doctor’s
notes, patient history, pharmacy prescriptions, physician orders, laboratory and radiography
reports, and other medical interventions (Hufford, 1999).

Quality Assurance :
The EHR will enable hospitals and physicians the ability to track the information they need to be
in compliance with insurance companies and federal regulations (Hufford, 1999).

Track Patient Utilization and Healthcare Costs :

Healthcare facilities spend a great deal of time tracking patient statistics and utilization such as
number of tests, number of patient visits, and almost every service that is available in a
hospital. This data is used to track utilization trends, financial reporting and for budgeting and
resource allocation. An EHR can streamline these processes and supply accurate and real-time
data. These utilization statistics, when paired with financial data, can be used to track
healthcare costs and improve efficiencies (Hufford, 1999).

Health Record Portability:

When a patient move or sees another healthcare physician a patient must have photocopied
from the chart and sent to the new location.. An EHR takes care of this problem as the patient
record can be sent anywhere the patient may be.

Laboratory Systems:
Most laboratories in healthcare settings already use lab information systems (LIS), which are
usually interfaced into the EHR for patient data and testing results exchange. (Electronic Health
Records Overview, 2006).

2.3 Advantages and Disadvantages Of Electronic Health Records(EHR):

Advantages of EHR Disadvantages of EHR

 Initial implementation and setup costs can be high.
Improved patient care: Electronic health records
(EHRs) provide easy access to complete and up-to-
date patient information, allowing healthcare
providers to make informed decisions and provide
more effective care.
There may be a learning curve for healthcare
Increased efficiency: EHRs can streamline providers to use the system:
managing patient records, reducing the time and
effort required to enter, retrieve, and share
information.
The systems may require ongoing maintenance and
Better communication: EHRs facilitate updates.
communication between healthcare providers,
enabling them to collaborate more effectively and
share important patient information in real-time.
The systems may be prone to technical problems or
Reduced errors: EHRs can help reduce the risk of downtime.
errors and improve patient safety by providing alerts
for potential drug interactions, allergies, and other
important information.

The systems may not be compatible with all devices

Improved patient engagement EHRs can provide or software.
patients access to their health information and tools
to manage their care, empowering them to take a
more active role in their health and wellness.
There may be issues with data security and privacy.
Enhanced privacy and security: EHRs can be
designed with robust security measures to protect
patient privacy and sensitive health information.

It may be difficult to fully transition to electronic

Improved quality of care: EHRs can help records, especially if some healthcare providers
healthcare providers track and monitor patient resist change.
progress, allowing them to identify opportunities for
improvement and make necessary changes to
treatment plans.
Electronic record systems may not be user-friendly.
Cost savings: EHRs can reduce healthcare costs
by increasing efficiency and reducing the risk of
errors.

The electronic record system may not be accessible

Enhanced research and public health reporting: to all healthcare providers, which can impact the
EHRs can provide a wealth of data that can be used patient's quality of care.
for research and public health reporting, helping to
advance our understanding of diseases and health
outcomes.
2.4 SECURITY AND BRIVACY IN EHR:

Security and privacy in EHRs can be seriously threatened by hackers , and

viruses . Healthcare organizations can fortify patients' information within electronic health
records by implementing strategies such as safeguarding mobile agents for data transmission,
using usernames and passwords for individual privacy and access control, and ensuring
employees log out of the system to prevent unauthorized access. These steps can help address
the security and privacy concerns associated with electronic health records.

What security and privacy features do current EHR systems

have?
The three security-safeguard themes namely physical, technical and
administrative have been applied in the analysis of a number of research
administrative safeguard: comprise of relevant techniques like performing
audits, employing an officer in charge of information security, and coming
up with contingency plans.
physical safeguards: which includes techniques listed in organizational
safeguards and in addition, it focuses on protecting the health information
physically so that their software or hardware are not accessed by
unauthorized persons or those who could misuse them .
Technical safeguards: and they carry out protection of the whole
information system found in the network of a health organization

2.5 Type of Electronic Health Record Systems:

EHR systems are crucial in modern healthcare, providing a comprehensive digital version of a
patient's paper chart. They are designed to streamline the clinician's workflow and improve
patient care. Below, we explore the various types of EHR systems, their features, and their
implications for healthcare delivery.
EHR systems can be categorized based on their deployment models and functionalities. Here
are the primary types:
1. Cloud-Based EHR Systems: Cloud-based EHR systems are hosted on remote servers and
accessed via the internet.
2. On-Premise EHR Systems: On-premise EHR systems are installed locally on the healthcare
provider's servers
3. Hybrid EHR Systems: Hybrid EHR systems combine both cloud-based and on-premise
solutions. They provide flexibility and can be tailored to the needs of the organization.
4. Specialized EHR Systems: Some EHR systems are designed for specific medical specialties,
such as Pediatrics ,Psychiatry ,Obstetrics

2.6 HEALTHCARE EHR STANDARDS

One major reason that EHR’s were slow to be adopted by healthcare was the lack of industry
standards. The health information systems had a difficult time communicating with one
another. The federal government helped this along by setting the EHR messaging standard in
the United States as Health Level 7 or HL7 (Electronic Health Records Overview, 2006). HL7
standard allows clinical information systems to communicate with one another using encoded
data exchange.
Other common standards that are integrated into EHR’s are Current Procedure Terminology
(CPT), International Classification of Disease (ICD), and Diagnosis-Related Groups (DRG)
(Electronic Health Records Overview, 2006) used for billing and are contained within databases
in the EHR.

Overview of EHR:
Figure 1.

Figure 2:
Explain the Configuration of the electronic health record data exchange system in hospitals. CDA:
Clinical Document Architecture; DICOM: Digital Imaging and Communications in Medicine; HIS: hospital
information system; MOHW: Ministry of Health and Welfare; NHI-VPN: National Health Insurance-
Virtual Private Network.

Figure3: Interoperability using the HL7-CDA standard

HL7-CDA is a document markup standard developed by

HL7 for clinical documents like discharge summaries,
progress notes, or imaging reports. It defines the
structure and semantics of clinical documents to ensure
that different healthcare systems can understand and
use the data exchange

Figure4: EMR VS EHR

EMR is a digital version of medical records used by a

single healthcare provider or practice, focusing on

diagnosis and treatment within that organization.

EHR is a more comprehensive, shareable record that

includes a patient’s complete health information,

designed to be accessed by multiple providers across

different healthcare settings.

Key Terminologies for EHR Systems

To ensure smooth operation, data consistency, and effective communication in EHR systems, it’s
essential to use standardized terminologies. These terminologies help improve patient care, streamline
processes, and facilitate interoperability between different healthcare systems. Below are some of the
most important terminologies used in modern EHR systems:

EHR Electronic Health Record

EMR Electronic Medical Record

ICD (International Classification of Diseases) Global standard for diagnosing diseases, used for
coding health conditions and billing.

CPT (Current Procedural Terminology) Standard codes for medical, surgical, and
diagnostic procedures, widely used for billing.

SNOMED CT (Systematized Nomenclature of Comprehensive clinical terminology covering

Medicine – Clinical Terms) diseases and medical procedures, ensuring
consistency across systems.

4. LOINC (Logical Observation Identifiers Standard for identifying lab tests and clinical
Names and Codes) observations, used for uniform data exchange.

HL7 (Health Level 7) Set of standards for health data exchange;

includes FHIR for modern web-based data
sharing.

RxNorm Standardized naming system for drugs, used in e-

prescribing and drug data integration.

DICOM (Digital Imaging and Communications Standard for storing and transmitting medical
in Medicine) images, ensuring they are integrated into patient
records.

CCD (Continuity of Care Document) A format for sharing patient summaries to

improve care coordination between providers.

PHR (Personal Health Record) A patient-controlled record allowing access to

health information and integration with EHRs.

MPI (Master Patient Index) A system that links patient records across
different healthcare providers.
CDA Clinical Document Architecture

DICOM Digital Imaging and Communications in Medicine

HIS: hospital information system hospital information system

NHI-VPN National Health Insurance-Virtual Private

Network

MOHW Ministry of Health and Welfare

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