June, 2023

How to Use EHRs for Effective Medical Records Management

What we can do — and what we must do — with patients’ medical information is changing.

Some of these changes are driven by shifts within the healthcare industry and often involve adopting new technology to provide better care, like electronic health records and remote patient monitoring. Others, however, are inspired by federal laws aiming to protect patients’ privacy. Yes, we’re talking about the Health Insurance Portability and Accountability Act, or HIPAA.

Some of HIPAA’s regulations and requirements are common sense:

Don’t leave patient medical records in public places.
Verify a patient’s identity before sharing their sensitive medical information.
Don’t share patient medical data with third parties without patient authorization.

The transition from paper health records to digital medical health records is changing the ways we store, organize, and dispose of this sensitive, protected information. But even though security is a top priority for medical records management, it’s not the only thing you should consider if you want to offer a truly excellent patient experience — and below, we’ll share our top tips for medical records management using EMRs and EHRs.

What is medical records management?

Medical records management refers to the process of organizing, storing, retrieving, and maintaining patient health records within a healthcare organization. Medical records encompass any information or data related to a patient’s medical care: intake sheets, symptoms and incidences, test results, diagnoses, prescriptions, immunizations, and more. Furthermore, any identifying information on patient files — name, phone number, address, or date of birth — is considered part of those patients’ medical records.

Managing those records encompasses all activities related to the creation, maintenance, and utilization of patient records to ensure accurate and efficient retrieval of patient information throughout their time in your care — and beyond, if their records need to be released.

HIPAA requirements for medical records management include:

Privacy: Protected health information (PHI) must be protected from any individual or business other than those authorized by the patient.

Security: Physical and technical security measures must be used to authenticate users and bar access to patient data from outsiders.

Enforcement: If HIPAA-protected patient data is exposed, providers and practices must launch an investigation into the breach, and the cause of the breach must be corrected or eliminated.

Breach Notification: Patients must be informed any time a data breach compromises their protected health information.

Benefits of EMRs and EHRs for Effective Medical Records Management

EMRs are simply electronic medical records, or a digitized form of the same information traditionally stored in paper files. This information is often stored in a platform, allowing clinicians to navigate between panels and tabs that organize patient data, or export a patient’s entire profile and medical history into a printable format.

EMRs are typically somewhat limited in their scope when compared with electronic health records (EHRs), but both are valuable tools for efficient record keeping within medical practices. EMRs are digitized patient charts and focus on strictly medical data: diagnoses, test results, treatment plans, and prescriptions. EHRs, on the other hand, are more holistic, more complete, and more easily shared with specialists and pharmacists outside the provider’s practice.

Here are some key differences between EMR versus EHR:

Electronic Medical Records

EMRs are used by healthcare providers and healthcare organizations to record diagnoses of a patient’s health and recommended treatment plans.

An EMR system is typically siloed to one medical practice and its software platform, making it difficult to share patient health information with other healthcare providers. If an EMR is transferred to a new provider, the receiving provider’s staff must spend time entering the patient’s data into their records management system.

Electronic Health Records

An EHR enables healthcare providers and healthcare organizations to share a patient’s medical information with other care providers or authorized organizations, like pharmacies.

As a patient moves to a new doctor’s office or needs to visit a specialist healthcare professional, they need to share records. An EHR makes this process easy so a patient’s electronic records move with them.

EHR systems can enable patients to access their medical history when coupled with practice management software, empowering them to understand their healthcare in detail.

Benchmark EHR

Both EMRs and EHRs can streamline office workflows and save medical professionals time so they can focus on patient care instead of paperwork and document management. However, a patient’s care rarely starts and ends with one single practice and provider, and EHRs introduce more flexibility and interoperability for improved collaboration between providers.

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Top Features of EHRs for Effective Medical Records Management

Electronic health records are purpose-built for collaborative care throughout the entire lifecycle of patient records. EHRs offer numerous benefits to healthcare providers and patients alike, improving the accessibility and portability of patient information.

Additionally, EHRs streamline administrative tasks, enhance efficiency, and reduce paperwork for healthcare teams and support evidence-based practices and treatments for improved patient outcomes.

If you’re evaluating available EMRs or EHRs for your practice, consider whether they possess these key features for maximum efficiency and compliance:

Security

When handling patient records, privacy and data security compliance must be front of mind — both for the patients’ safety and to avoid penalties and legal issues stemming from data breaches. Regulations like HIPAA’s Privacy Act require certain protections for medical information, such as user authentication.

HIPAA also dictates that medical records must be “adequately destroyed” after its predetermined retention period, or the amount of time a practice retains records after a patient has ceased seeking treatment. Each practice is free to determine its own records retention schedule, but it should be adhered to and communicated to patients as soon as their medical record is created. Digital records are easy to protect and destroy, when necessary.

Automation

Automation is a powerful capability that can both save time and money for medical offices and reduce incidences of human error or forgetfulness. By integrating EHRs with practice management software, patient records and services rendered can automatically update one another in real time. This automatic updating saves practices from investing in time-consuming data entry, while automatic ICD and CPT code suggestions ensure that billing is accurate and reimbursement is not delayed.

Accessibility

HIPAA also requires that patients’ health records be easily accessible. EHRs have responded to this requirement with the proliferation of patient portals, which allow patients to verify their identity, sign in, and review the medical data collected by their provider’s practice from anywhere. Cloud-based EHRs allow both patients and providers to access their EHRs from anywhere, so patients can continuously engage with their care at any time without burdening clinicians with phone calls and in-person appointments. More information shared between patients and providers leads to more patient engagement — and better patient outcomes.

Ultimately, EHRs help improve the overall quality of care, enhance patient outcomes, and promote a more connected and efficient healthcare system.

Benchmark Solutions Can Revolutionize Your Medical Records Management — And So Much More

Benchmark EHR is an intuitive, user-friendly electronic health records management system that can save providers, practice staff, and even patients time. Our customizable dashboards, automated workflows, templates, and forms can all be compiled and configured to create the perfect system for your practice.

Benchmark EHR is just one part of our comprehensive suite of medical software solutions, including practice management software, revenue cycle management services, remote patient monitoring, and more. Each of these tools can individually save your team time and money, but their combined power can reduce stumbling blocks and bottlenecks at every step of your patients’ healthcare journeys.

If you’d like to learn more about how Benchmark EHR can serve you — and how integrating it with our other offerings can revolutionize your patient relationships — contact us for a complimentary consultation.