An EHR is an integrated clinical information system that contains patient-centric, electronically maintained information about an individual’s health status and care. It focuses on tasks and events directly related to patient care and is predominantly used by clinicians. The electronic patient record (EPR) and electronic medical record (EMR) are synonymous terms used outside of the U.S. in countries like the U.K., Australia and New Zealand. An “enterprise EHR” provides functionality for all healthcare providers’ care settings, including specialty areas and associated patient administration functions. In particular, it minimally provides functionality for acute care settings, such as the medical/surgical wards, emergency departments, intensive care units (ICUs), operating theaters and attached clinics, and outpatient and ambulatory settings of the hospital.
Gartner defines revenue cycle management (RCM) software as healthcare financial software that tracks and captures revenue received from patients and healthcare payers related to an episode of care. The software combines the administrative and clinical aspects of healthcare delivery by coupling patient financial and clinical data required for reimbursement. The revenue cycle management process begins at the time of patient scheduling, and it includes the process of obtaining eligibility, prior authorization, billing and collections and ends with account reconciliation. This market definition includes offerings from enterprise RCM vendors and consists primarily of vendors selling stand-alone software solutions. Healthcare delivery organizations (HDOs) use RCM software to streamline and automate their encounter-based financial workflows and billing processes. The software enables patient access, claims submission, accounts receivable (AR) management, and federal and state regulatory compliance. When implemented in conjunction with an electronic health record (EHR) system, RCM software unifies administrative and clinical data for HDOs. This results in enhanced patient engagement; higher staff utilization; enhanced financial planning; reduced fraud, waste and abuse; and improved revenue capture.