Your Guide to Software Selection

Ambulatory EHR vs Inpatient EHR: Understanding the Important Differences

As time goes on, paper medical records are swiftly becoming a thing of the past. The popularity of health information technology is rising at an ever-increasing rate, and EHR adoption is no different. The use of inpatient vs ambulatory electronic health records has been booming, but many struggle to understand the distinction between the two.

Inpatient and outpatient healthcare facilities are run differently, and with so many various EHR software solutions, choosing the correct one can be confusing and seem nearly impossible. This has medical practices, hospitals and healthcare businesses alike asking: “What is the difference between ambulatory EHR and inpatient EHR software?” Knowing the differences between the two can help you choose the best EHR solution for your healthcare facility.

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Type of Treatment

Before choosing an EHR for your practice, the first step is to identify what type of treatment your facility provides. Depending on whether your facility provides inpatient or outpatient treatment will most likely determine which EHR to use.

Inpatient and outpatient facilities both have unique challenges when it comes to adopting electronic health records. With outpatient facilities, patients are typically being seen at a number of clinics, labs, etc., so your EHR has to be able to pull up all that information, whereas an inpatient facility has to be able to integrate with different departments within a single hospital.

At times, patients are given the option as to which treatment they choose, typically for rehabilitation-related treatments. Outpatient tends to be more common and is usually the preferred treatment method chosen by patients for a number of reasons, including comfortability as well as lower costs. This is one of the reasons why ambulatory EHR is expected to have a 5.8 percent market-growth rate over the next two years.

When choosing your EHR software solution, it’s important to keep in mind your treatment center’s specific needs as well as type of treatment and government requirements for certification. More often than not, an inpatient facility will have to use an inpatient EHR to function properly; the same goes for ambulatory treatment centers. Below is an overview of these two specific pieces of EHR technology in our comparison of ambulatory EHR vs inpatient EHR:

What is Inpatient EHR?

As you probably guessed, inpatient EHR systems were designed to manage inpatient data. Therefore, inpatient EHR systems are most commonly used by hospitals. From an IT perspective, a hospital isn’t a single entity, but rather a group of various departments and systems.

In the not-too-distant past, hospitals purchased and installed software designed for each specific department, e.g., the in-house lab department, the radiology department, billing systems and several others that perform various functions for the hospital. Each department had to separately print out the results for all the different patients they collected. In addition, data entry was done manually by each department, increasing the likelihood of duplicate or inaccurate data.

EHRs have always been used to capture and document medical records, but as time went on, they became more and more sophisticated. This lead to an increase in integration between the EHR and the hospital’s different departments, rather than them all operating separately. However, this integration is limited to departments within a single practice and doesn’t do much help when it comes to a new patient.

Many hospitals still lie in this challenging stage where they can’t get their systems to communicate with each other. As EHRs have grown more refined, they’ve become the hub that links each and every department. The lab, pharmacy, x-ray and many other departments required customization and integration. An inpatient EHR integrates these systems, sharing patient information between each of the various hospital departments, ensuring consistent data throughout the hospital.

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What is Ambulatory EHR?

Ambulatory electronic health records, on the other hand, are designed for use in outpatient care facilities and smaller practices. Medical professionals can access a patient’s complete medical history, which is stored in an electronic database. These documents essentially include all records of surgeries or treatment which don’t involve being admitted to a hospital.

In general, ambulatory EHR solutions are simpler than inpatient EHRs, because they deal with a single practice and its patients rather than the complex web of hospital departments that any one patient may interact with.

Ambulatory EHR systems have the advantage of making it easier for physicians to track a patient’s medical records and long-term care. Physicians use these systems to collect detailed, specific information about each patient, providing complete documentation of their personal health records. The history documented includes injuries, diagnoses, treatments, prescriptions, visits and much more. This comprehensive database helps physicians see the big medical picture, which in turn makes future diagnosis easier.

For example, this capability makes patterns easier to recognize, which could help reveal anything from a seasonal allergy to a serious problem that has increased in frequency as time went on. Healthcare businesses have capitalized on this information by providing practices with patient portals. Integrating an ambulatory EHR solution with a patient portal gives patients access to their up-to-date medical records. In recent years, this has become more of a necessary EHR feature than a “nice-to-have” feature.

Practice EHR’s patient portal allows patients to view their history, schedule appointments and more

When it comes to outpatient treatment, there are many advantages for the patient. For starters, rather than sitting in a bland hospital room and eating from the cafeteria while they recover, patients can instead relax in the comfort of their own home or bed, eating their own food. Additionally, patients have more freedom to do what they want, whereas in a hospital their entertainment options are very limited.

With outpatient treatment being the preferred option for the majority of patients, ambulatory EHR use has gone up dramatically over the past few years. And this trend isn’t slowing down any time soon; the ambulatory EHR market is expected to reach $5.2 billion by 2021.

As opposed to hospital records all being on the same chart, a physician practice has to deal with a patient’s information from multiple clinics. Unlike inpatient treatment, outpatient facilities have to deal with a number of other pharmacies and other external labs or clinics. Unlike a hospital, which has its own x-ray department, imaging labs and pharmacy, ambulatory health patients are typically admitted to multiple clinics or labs. More often than not, patients choose these facilities based on health care coverage as well as other factors such as cost and proximity.

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Certification Criteria

Because ambulatory EHR and inpatient EHR are designed for two different types of healthcare practices, it’s only natural that the criteria needed for each to earn certification and incentives differ depending on the style of healthcare (inpatient/outpatient). Government incentives to promote the use of EHRs started in 2009. A year later, the Office of the National Coordinator for Health IT initiated another program to expand the use of certified health IT to more health programs and promote greater interoperability and initiatives for care improvement. This laid out the unique requirements for each type of EHR.

Inpatient EHR certification focuses mostly on orders and medication management. The features required to fulfill this need include electronic medication administration records and medication reconciliation. Ambulatory EHR certification, on the other hand, requires more patient-centric capabilities. For example, ePrescribing, patient reminders, clinical summaries and timely access are just a few ambulatory EHR certification requirements.

As I mentioned above, one example of how certification requirements vary by the EHR type has to do with the way medications are prescribed and filled out. An outpatient facility needs to be able to prescribe to outside pharmacies electronically — while an inpatient facility (such as a hospital) doesn’t because they typically handle medications themselves.

There are, however, several similarities between the two types of certifications. As with most healthcare systems, security and note taking are high priorities. This is also the case with drug-to-drug and drug-to-allergy interaction checks, privacy and security standards, medication lists, and allergy lists. Additionally, physician support in the form of computerized provider order entry (CPOE) and clinical decision support are often required for both certifications.

Ambulatory and inpatient facilities provide completely different types of treatment, but at the end of the day, they both provide the same general service: healthcare. The same goes for EHR certification — sure, they both require some of the same criteria, but different certification requirements are, indeed, necessary.

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Which to Choose?

So after all this information with regard to ambulatory vs inpatient, which system do you think will work best for you? If you’re a single practice, an ambulatory electronic health records system may be perfect. If you’re a part of a chain of practices, you could probably use either ambulatory or inpatient EHR. And if you’re a hospital or a chain of hospitals, you probably want to implement both.

As of now, an inpatient facility would not operate well using an ambulatory EHR and vice versa. Yes, you could access an ambulatory EHR through the cloud while in a hospital and copy that into inpatient documentation, but this still requires manual work. Interoperability between the two isn’t fully there yet, but we should expect inpatient and outpatient EHRs to connect in this way moving forward.

For the sake of cost-effectiveness, your healthcare facility may choose to go with a smaller, specialized EHR to accomplish what you need. While there are some nearly-do-it-all systems out there, small and specialty EHR vendors have become increasingly popular.

With that being said, each healthcare provider is different, and that means different needs and requirements out of your EHR software. The important thing isn’t whether you choose an ambulatory or inpatient EHR; the important thing is to know what you’ll be using it for. Make sure whichever EHR you choose has the proper capabilities and functionality that’s right for your facility, in particular. Take a look at our EHR software comparison report to find out which solution is best for you.

Do you use an EHR for your healthcare practice? Ambulatory software or inpatient? Let us know in the comments!

Evan HeierAmbulatory EHR vs Inpatient EHR: Understanding the Important Differences

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