All the Pros and Cons of EHRs (Electronic Health Records)

Every hospital can benefit from health record frameworks. Let’s review the key characteristics of this innovative technology and its implications.

Healthcare is a field dealing with one of the most complex mechanisms known to humans. This mechanism is the human body. The only thing that is even more fascinating than it is the Universe itself. In this light, we want to look at the pros and cons of EHR. What is the connection between our philosophical introduction and Electronic Health Records? If we continue our mechanism metaphor, the main goal of healthcare is to help fix the human body in situations when something breaks down in it. A coronavirus infection can be a perfect example of a threat to human bodily functions. A common problem for many doctors trying to heal this infection is that they don’t have full access to the medical history of an individual. Some allergies or past pathologies greatly influence the modes of treatment (by requiring additional healing or pushing one to abstain from medications). Here comes a high-quality Electronic Health Record. Due to its comprehensive nature and ease of sharing, this technology helps spread information about the patients among numerous doctors. Obviously, this also leads to major risks that are discussed below. Ultimately, this article will offer a full overview of the technology and inform you if modern businesses should invest in it.

What Are Electronic Health Records?

Let’s start with defining the essence of Electronic Health Records. It’s impossible to understand the EHR advantages and disadvantages without looking at the definition of the term. So, here it is: Electronic Health Records, or EHRs, are digital versions of a patient’s medical history. What do typical EHRs include? They tend to involve information on diagnoses, treatments, medications, and test results. The key goal of this technology is to give doctors the ability to quickly access patient data regardless of the location in which a person lives or receives the core treatment. 

And what about the history of EHRs? They’re an evolution of the traditional paper-based frameworks. All hospitals treating heavy cases of diseases provide full-scale descriptions of the patient’s state and their medications. EHRs appeared as a reaction to the non-portability of the past frameworks. In short, they resolve the key problem of paper systems. This advantage will receive a more in-depth discussion later. And what about the realistic examples of such apps? In this regard, the most typical approach is to have a program installed on either the local computers within an isolated local system or to feature a framework working on the cloud. The doctors can access this system via traditional consumer-grade devices such as computers and smartphones. 

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Different Types of EHR and Their Applications

One of the core advantages of using EHRs is that they come in many types. Electronic Health Records (EHRs) are an important tool in modern healthcare. There are several types of EHRs, each with its own unique applications. In our opinion, there are two major ways to categorize the EHRs. On the one hand, it’s possible to group them according to the overall functions. On the other hand, one can also deliver a categorization based on the installation type of the framework.

A. Categorization by Function:

1. General EHRs 

These are the most common types of EHRs. Their key feature is that they provide generic capabilities for all tasks without going in-depth on the particular features needed for tracking unique diseases. You’re the most likely to encounter a general EHR in a hospital targeting patients with light and medium cases of illnesses. The typical information you can get in those systems includes overall patient history and the medication they take.

2. Specialty EHRs 

Some diseases or even their types include unique characteristics. It’s possible to use a General EHR for them, but one may eventually need to use additional apps to store the core data about the patients. Some of the fields that are problematic for the general EHRs include oncology and psychology. Let’s look at the latter sector. One of the best ways to find out if a person has a pathology or hidden long-term problems with their psyche is to administer a detailed test of their personality. The most common option is the so-called MMPI (Minnesota Multiphasic Personality Inventory). Typically, MMPI tests require separate apps for the analysis of a patient. This creates the risk of losing data: a separate test and a separate profile on an EHR app end in major time waste. Psychologist-aimed EHRs solve this problem by adding the MMPI test right into the apps. Thera EHR is notable for this design choice. This means one can connect the testing data to the overall profile and even have the capability to compare the information with other records. All in all, specialty EHRs help healthcare providers better manage patient care in their specific field.

3. Personal Health Records (PHRs) 

Not all health records have to be hospital-managed. A disciplined person can track the long-term stability of their health via an app with similar functions. Personal Health Records (PHRs) exist for this goal. These are EHRs that are controlled by patients themselves. PHRs allow patients to access their own medical records and track personal health data. In a good PHR app, it’s possible to review past records from doctors and add some personal observation data (for instance, information on blood pressure management). This is useful for patients who want to take a more active role in their health management.

4. Practice Management EHRs 

A significant aspect of success in managing a hospital is proper organization. It’s not enough to track the patient data efficiently. One should also have strong processes for analyzing requests and payments. Practice Management EHRs exist for this exact reason. These are EHRs that are designed to help healthcare providers manage their practices. Practice management EHRs can assist with tasks such as scheduling appointments and billing. Typically, such functions are a part of the general EHR systems, but if you use a specialized framework or some custom approach, the relevant tools may be missing. Practice Management EHRs exist to cover the presented gap. One of the key advantages of Electronic Health Records is their ability to target diverging tasks that appear in the everyday work of healthcare professionals.

5. Telemedicine EHRs

The key goal of this EHR type is to assist doctors and telemedicine organizations with their everyday work. In many ways, their features are similar to the traditional general or specialized EHR systems (depending on the disease type). Nonetheless, there are also unique technologies that benefit these EHRs. Telemedicine EHRs allow healthcare providers to communicate with patients remotely. For this reason, they need to include the capabilities for high-quality video and audio communication. Often, diagnosis requires the ability to see certain regions of the body or even the facial expressions of a person in detail. In this light, the video capabilities should be, more or less, superior in the presented case. Another vital approach is the feedback system for the doctors. Telemedicine apps typically include healthcare platforms where users choose from numerous specialists. This means it’s a good idea to add scoring systems, too. Why invest in telemedicine apps? They’re a great framework for people who live in remote areas or have mobility issues.

B. Categorization by storage

Another way to categorize the core EHR systems is to review the way they interact with storage. This distinction is crucial concerning the pros and cons of Electronic Health Records. So, here are the key types of apps you should consider:

1. Server-based apps

You can host your EHR on the dedicated server. It may be within your organization, or you can hire a data center for that. The specific EHR advantages and disadvantages are visible here. What’s relevant is that those systems are under your full control. You get to configure every aspect of them. Simultaneously, security is also on you. If there’s any failure, it’ll inevitably be your fault. What’s our opinion on those systems? They’re great because there’s an option of isolating such frameworks from the Internet. By making a separate network without any access to the web, you get a chance to create an impenetrable system.

2. Cloud-based apps

Simultaneously, you can host your EHR in the cloud. The pros and cons of EHR systems belonging to this type are diverse. Many solutions are ready-made: all you have to do is insert the data and adapt the app to your needs. Still, you don’t control those systems. They belong to other organizations. Yes, they handle security, but these companies may close access to the service due to bankruptcy, for instance. A common situation is also the increase in fees. When subscription services (all cloud-based EHRs are subscription-based) gain popularity, they tend to raise prices.

Pros and Cons of Electronic Health Records in 2023

Now that we understand the essence of the technology, it’s time to look at the pros and cons of Electronic Health Records. In our opinion, the system is great for the majority of hospitals. Still, the issues associated with short-term costs and confidentiality may be problematic from the standpoint of some organizations. In this light, we believe that certain use cases require one to abstain from electronic health records. Still, the advantages of EHR are so numerous that 99% of hospitals and other healthcare organizations may still want to install them.

Advantages of EHRs

Let’s first review the positives of the technology. They’re numerous:

1. Improved Patient Safety Through EHRs

A significant problem with many chronic diseases, such as diabetes, is that patients sometimes miss vital information about their development. For example, blood sugar tracking results can appear more or less normal to a patient, but there may be disturbing trends. In this light, the advantages of Electronic Health Records shine. Using the trackers with online connections, they highlight the continuous trends in the health of an individual. EHRs also raise the long-term safety of patients by enabling doctors to review their medical history. A common problem with many treatments is that they don’t take certain conditions a person has into consideration. Early childhood records may showcase information on the allergies a patient has. They usually lay dormant due to the low concentration of certain chemicals. In treatment, however, this factor can manifest and lead to premature death of an individual due to an acute immune reaction. Thorough health records are a perfect framework for acknowledging such problems and preventing diverging tragedies from occurring.

2. Easy Access to Patient Information Anywhere

This element is among the key benefits of EHR systems. In fact, it involves the core reason for the creation of EHRs. To understand this advantage, let’s look at the traditional medical records. Their key medium is paper. One writes down the key information about the patients in a physical notebook and then puts it into an archive with a card system that makes the search easy. For the 19th century, such a framework was utterly revolutionary because it enabled centralized data collection for many people, paving the way for mass healthcare. 

Limitations of paper-based medical records

Still, it has major limitations. Firstly, such systems are notable for their low portability. To transition the data between diverging hospitals, one has to carry the records from one place to another or take time to copy the data. Secondly, they’re prone to physical damage, and making the relevant backups is too difficult. If a fire erupts in an archive, it can easily destroy all the information about thousands of patients. The incidents of this type affect diverging records: a massive fire in 1973 destroyed millions of profiles in the Military Personnel Records Center in the U.S., according to ABC. This archive had information on millions of servicemen of the American Army. Now, it’s impossible to track many of them. For some people, the destruction of records might have led to the inability to get certain benefits. To copy thousands or, sometimes, millions of records in a hospital, one may need to make a gigantic time and fund investment even with modern devices, such as printers. Lastly, finding information in the archives is extremely time-consuming. Documents are easy to lose and may require months to be found.

The advantages of EHRs over paper-based systems

The problems of paper systems are the best way to highlight the advantages of using EHR. In this respect, we have multiple elements to consider.

• Firstly, EHRs are much more portable than other systems. In the 19th and early-mid 20th centuries, one either had to rewrite a patient record or make a copy through photos or scanners due to its paper form. With EHRs, this entire process is much easier. You export user data and then send it via email or any other comfortable method to the individuals who can benefit from such information. 
• Secondly, the safety of data grows, too. How exactly? It’s much easier to store the information in multiple places and among the diverging data formats. As certain scientists note, modern electronic devices are indeed more prone to degradation than paper. Hard drives, for instance, break down fast. What makes the EHRs safer is, once again, the ability to replicate data. One can store the database of the key patients not in one place but in multiple locations, including the cloud, which guarantees the long-term maintenance of the data storage. In fact, it’s reasonable to presuppose cloud services will continue to exist even 100 years from now. With proper attention to hardware transition and the appearance of accessible long-term storage (for instance, devices that will be able to avoid degradation for thousands of years), many of our records will become impossible to lose.
• Lastly, the comfortable data format of EHRs makes them perfect for managing data in long-term scenarios. How exactly? Many medical records feature formats enabling an easy search of data. All that a user has to do is insert their name, and all the key data associated with them will appear. In such conditions, long searches for the archive data will be a thing of the past. With this technology, regardless of the other pros and cons of Electronic Health Records, the technology will rise in popularity in the upcoming years.

3. Reduction of Healthcare Costs Through EHRs

EHRs represent a perfect opportunity to reduce the majority of healthcare costs. In this respect, the key advantages will stem from two elements. The first element is the improvement of patient security through better access to information for doctors. Statnews, a major publication discussing the key statistics of the healthcare sector in the U.S., notes misdiagnoses end in tremendous human suffering: up to 800000 disabilities and deaths are the outcomes of wrong diagnoses. National Library of Medicine (U.S.) guidelines highlight that the reasons for the rise of medical errors are diverse. They may include the lack of proper education among the doctors, for example. A major problem, however, also comes from the insufficient spread of information. Due to the fragmentation of care, many hospitals don’t receive sufficient data on the real state of the patients. As we’ve mentioned before, a note about allergic reactions to sedatives can save the life of a person during some vital surgical intervention. EHRs reduce the number of negative incidents stemming from the lack of knowledge regarding the pathologies patients have. A properly informed doctor can make better decisions concerning the long-term health of the patients.

As for the second reason, EHRs decrease the administrative costs in healthcare. To maintain a vast database of information on the patients, modern hospitals have to spend significant sums. With modern EHR services, it’s possible to have only a skeleton crew of technicians and data experts who will be able to do the work of an entire data storage department. EHRs reduce the reliance on an army of skilled archive workers by allowing one to substitute them with one or two data technicians and helping delegate all other data search tasks to receptionists and medical professionals themselves. Yes, Electronic Health Records pros and cons are numerous. These systems aren’t without fault. Still, the labor-saving benefits of the technology are undeniable.

4. Better Tracking of Patient Behavior and Outcomes

A big problem for many hospitals is the inability to track the activities of the patients. It’s not enough to have a high-quality treatment. One also has to be disciplined with it. According to nonprofit organizations dedicated to supporting people with diabetes, Type 1 diabetes greatly reduces the life expectancy for many individuals. One can expect to live up to 20 years less than people without the disease. However, if one is disciplined regarding the proper intake of medication, the reduction isn’t so significant, as Kassem Sharif, an Israeli medical specialist, and his team note. EHRs are a notable technology because they help exactly in this domain. They’re capable of assisting the patients and doctors with the proper discipline.

By easing the tracking of patient outcomes, these technologies enable doctors to see irregularities associated with a lack of discipline or even analyze patient behavior. In the case of the aforementioned diabetes, for example, the doctors can connect an EHR system to the blood sugar implant and gain data about the measurements in real time. This approach boosts the ability to provide high-quality treatment fast.

5. Improved Communication Among Healthcare Providers, Patients, and Families

Another major reason to invest in the EHRs is their communicative element. Due to improving the tracking of the key data regarding the patients, EHRs allow doctors to communicate with more people about their diseases on time. In turn, EHRs also make it easier to create transparent health records for patients. One can, for instance, make the records available to patients on-demand via the Internet. Such an approach to Internet-based health records also promotes better communication. With it, the patients gain the ability to analyze the decisions of the doctors and then pose serious questions regarding their reasoning. All this is capable of boosting the long-term communication between specialists and patients. 

A common trend in the lack of medication compliance, for example, is the fear that doctors are out there to harm an individual or over-prescribe medication for them to get material benefits out of treatment. With paper records, even the individuals who aren’t initially prone to conspiracy theories may eventually support them because of the lacking progress in their treatment. Often, only one copy of these records exists, making their sharing difficult. EHRs solve this problem once and for all. They enable the patients to get immediate access to data on their diagnoses. Such a national system already exists in Ukraine. There, the patients can get key information about doctors and the results of visits in their personal accounts on the site called Helsi.me. We expect such innovations to spread across the world in the upcoming 30 to 40 years.

6. Patient Empowerment Through Access to Medical Records and Health Information

The preceding benefit eventually transitions into the next one. Despite all the disadvantages of EHR (for instance, in terms of data storage safety), they’re a crucial element of social justice.

Boosting experimental treatments

With these systems, patients can finally make full-scale decisions regarding their cases. Some diseases are difficult to treat. Information in an EHR, however, may give hope by allowing a person to see if they’re eligible for experimental treatment. In countries with a lacking rule of law, EHRs are also a perfect framework for avoiding repressions. 

Preventing governmental and profit-based injustices

A common threat EHRs may help combat is the political abuse of psychiatry. While considered a unique phenomenon confined to socialist states, this practice proved to be common even in democratic societies. Even though the U.S. and Canada do everything to avoid such a shameful practice today, many negative incidents came into being in the 1950s and 1960s, at the height of the struggle against socialism. Among the most notable cases is the situation with the so-called Duplessis Orphans, who were confined to the psychiatric wards to increase the funding of Quebec from the federal government between the 1930s and 1960s. To clarify the matter, the majority of the orphans were healthy before the beginning of the abuse. While the situation also included a complex intersection with religion, the ultimate reasoning for the rise of the incident involved the profit motive. 

If Canada had proper EHRs at the time and the various organizations weren’t capable of hiding the data within their archives, the scope of the abuses might have been discovered earlier. With proper access to EHRs, the victims would have been able to sue their abusers immediately after becoming adults. EHRs empower patients to disrupt abusive healthcare systems.

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Disadvantages of EHRs

No review of this technology can be objective without the analysis of its key problems. So, here they’re:

1. Potential for errors and inaccuracies

The first problem of EHRs is, more or less, similar to the traditional paper systems. Since humans manage the EHR frameworks, it’s reasonable to expect some errors will inevitably appear in the records. This means these systems continue to rely on the training of the users. Yes, EHRs resolve many of the problems paper systems have. Still, the disadvantages of Electronic Health Records are significant because they rely on humans. In fact, it’s dubious even a general AI would help. Why? In situations with limited data (for example, the attempts of the patients to hide information) or lacking knowledge on the new diseases, they can still make major errors.

2. Difficulties with adapting to the technology among older professionals

A significant part of the doctor and nurse workforce still belongs to the generation that didn’t have wide access to computers during their youth. This means their computer literacy isn’t as advanced as that of the younger specialists. These professionals typically have the largest scope of knowledge on proper treatments. By using modern systems of this type, we make it more difficult for these individuals to stay within the profession. Here, the pros and cons of Electronic Health Records shine especially strong. Yes, they improve many aspects of healthcare, but they also create major pressure on the specialists. With the rise of innovations, older experts eventually find them within a technologically hostile environment. While it may seem that the modern youth should have no problems adapting to future innovations even at an older age, the claim is dubious. With the rise of AI and augmented reality (AR), many Generation Z individuals may find their traditional intuition regarding everyday work challenged. Only a full-scale technological stasis will make this problem obsolete.

3. Privacy and security concerns

Among the Electronic Health Records pros and cons, this aspect is the most important one. Yes, Electronic Health Records, just like every computer system, greatly raise our productivity. At the same time, they have a major problem: these systems are extremely vulnerable to hacking if one isn’t careful about them. As Fierce Healthcare notes, quoting IBM, every data breach costs healthcare organizations 10 million dollars on average. These attacks are so common that the news about compensation claims for data breaches appear on a weekly basis. Minor breaches likely occur every day. In this light, it’s obvious that EHRs greatly decrease the long-term safety of the relevant patient information. 

Safety of vital data about patients

Why is this so important? Many EHRs contain vital data about the behavior of a person. A leak from a psychology or psychiatry EHR may ruin the reputation of the clients. For example, some forms of OCD (obsessive-compulsive disorder) include themes that are extremely antisocial. Millions of people suffer from this disease, obsessively thinking about harmful actions without having any real inclination to perform these activities. However, even a minor mention of certain OCD topics can end in serious repercussions within some countries, which may even include imprisonment. If the data from the psychiatrist dealing with their case leaks, it’s capable of destroying the life of an individual long after the end of treatment. According to Yahoo Finance reporter Jeff Lagerquist, this issue is extremely common for people with mental illnesses: nearly a third of workers have major fears of being fired for mental health issues in Canada.

Paper systems are sometimes superior

If such events are so common in one of the most progressive countries in the world, it’s not difficult to imagine how dangerous EHR hacking can be in countries with lower protection. The worst thing, however, is that there’s only one ‘cure’ to the problems with EHR safety. To achieve success, one must cut them off from the Internet in a radical manner. It’s not even enough to have a firewall: the computers must be physically isolated from any devices with Internet access. One shouldn’t connect any untested USB sticks to the relevant systems, too. Obviously, this solution is, in a way, as bad as the cure. Why? It removes the key benefit of these systems, the portability of information. If you’re serious enough about safety, sending data conveniently (via the network) will be possible only within one hospital. To send it to other locations, one may have to use secure USB sticks and transport them personally. It’s for this reason that paper systems may still be preferable in some cases. Data leaks from them are so unlikely that, despite all the pros of electronic health records, they remain the safest system of data storage accessible to humans. Organizations containing sensitive information (for instance, about certain psychiatric diseases) or VIP patients are likely to continue using paper-based frameworks as the key mode of storage. 

4. Dependence on technology and potential for system failures

The advantage of paper-based systems is that they rely on the easy-to-maintain technology. To keep a tremendous number of books in a library, you need specialists with the knowledge and skills that were developed between the 17th and 19th centuries. These skills get occasional upgrades, yes. For instance, many modern libraries use electronic systems to help the users find the relevant books. Nonetheless, the key knowledge and practices librarians have were developed in the 19th century. Are they efficient? Yes! We have books and even records dating back to the 16th century. You don’t need to train a whole workforce of specialists with Master’s and Ph.D. degrees to operate a library.

Complexity of EHRs

The situation with EHRs is much different. The technology behind them is incredibly complex. The majority of the human population is unlikely to have enough knowledge to even understand the underlying principles behind modern tech. Yes, one may have an approximate idea, but only experts with years in the relevant industry can fully understand its state. This means you start to rely on the frameworks requiring a definite set of hardware and, more importantly, specialists maintaining software for it. This leads to two major problems. 

Problem 1: Instability and dated software

Firstly, these frameworks are more prone to breakdowns. Complex computers and operating systems are likely to have multiple bugs, disrupting our ability to work with them properly. One incorrect update to your Linux server can crash your EHR for weeks. Secondly and more importantly, the cost of upgrades to new hardware and software is extremely high. The technologies are constantly progressing, with many apps created 20 years ago using outdated programming languages. Running Windows XP apps in Windows 11 is often impossible: many of them produce critical bugs even with proper compatibility layers. Imagine if your operating system for an EHR or some other electronic storage app is even older and doesn’t use DOS-based or Linux-oriented frameworks. It will be impossible to transition your software to the new system without a full rewrite. More importantly, its data will be in such an old format that any exporting will also be impossible. 

In such a situation, your only choice is to continue using the old machines or, at best, virtual environments for them if data export is possible at all. This issue can tie you to old hardware (for example, computers from the 1980s) for decades. CNN reports this situation is so serious that many state organizations dealing with unemployment management were forced to rehire COBOL programming language specialists, most of whom already were retirees, in 2020 (during the peak of the coronavirus crisis). Why? Their key apps relied on the software from the 1970s and the 1980s, with the organizations being, more or less, unable to transition to new systems quickly. 

Problem 2: Major maintenance costs and reliance on the complex infrastructure

Modern EHR frameworks will likely create the same risk. Considering that old systems also have a tendency to break down, the maintenance costs for them can be exorbitant. Sometimes, it’s more convenient to use a framework based on traditional paper records or combine it with electronic approaches. After all, the maintenance costs for the EHR systems are sometimes tremendous. You either have to upgrade the key systems every ten years to never end up relying on old software, or must pay more and more to maintain the outdated infrastructure.

As a Ukrainian company, we can note another vital aspect of this problem. Our country is currently defending itself against russian aggression, which started in February 2022. In November 2022, the invading russian army started to destroy our power-generating infrastructure, leading to widespread blackouts. In many cases, the EHR infrastructure in hospitals was incapable of working in such conditions. Yes, with time, our governmental and private organizations found a way to adapt, using diesel generators to power the core systems. Nonetheless, the cost of operating EHRs rose tremendously. If you work in an area that may encounter problems with access to electricity (for example, military hospitals), it’s better to invest in paper systems or in a mix of electronic and paper ones.

5. Difficulty in sharing information between different EHR systems

Lastly, a big problem for many EHRs is that there’s no common standard on the market. Yes, some core frameworks exist, but not every system supports all available frameworks. More importantly, the transition between different standards is unlikely to be as comfortable as it may seem. A system supporting one core data standard can have problems with adapting to another. Importing Excel spreadsheets into LibreOffice, for instance, is extremely difficult. If one hospital focuses on the XLSX format and another one uses SXC, compatibility exists only on paper. In reality, major errors in spreadsheet formulas are inevitable if your imported document has complex calculations. This problem touches upon the whole field. While we’ve listed portability as one of the key advantages of using EHR, the lack of a unified standard makes the real transition of data difficult. What’s a solution we deliver? In our opinion, a good option is to look at custom software. Our company helps develop custom solutions. In this regard, Keenethics can assist with adapting your EHR to the key standards on the market.

Conclusion

To summarize, the pros and cons of EHR systems are numerous. They boost portability for healthcare data and, at the same time, create massive security risks. Who do we recommend those frameworks for? On the one hand, it makes sense to install such systems in general-purpose hospitals and specialized organizations that don’t work with excessively sensitive data. On the other hand, if your organization works with sensible information (for instance, regarding mental health or VIP individuals), it makes sense to abstain from electronic health records. Another field where the pros of electronic health records are irrelevant includes any type of healthcare work in complex environments. If your hospital doesn’t have access to good electricity sources, it’s safer to use paper systems.

FAQs

What are the downsides of EHRs?

Electronic Health Records (EHRs) offer benefits like improved data access, but they also have downsides. Concerns include data breaches compromising privacy, interoperability challenges hindering data sharing, user interface complexities impacting efficiency, and potential for errors due to data entry or system glitches, affecting patient safety.

What are the positives of EHRs?

Pros and cons of EHR systems are diverging. EHRs can help healthcare providers access data faster, improve patient record accuracy, boost coordination of care among providers, reduce paperwork and storage costs, and use data analytics to upgrade research and patient outcomes. EHRs can contribute to more efficient and effective healthcare delivery.

Should I use EHRs?

The decision to use Electronic Health Records (EHRs) depends on your role and context. Healthcare providers often benefit from EHRs to enhance patient care, streamline operations, and meet regulatory requirements. Patients may not directly use EHRs but can benefit from improved care coordination and access to their health information through patient portals.