The life insurer’s guide to EHR terminology is a blog series that defines the terms carriers most often encounter tied to electronic health records (EHRs). As access to electronic medical data plays a growing role in life insurance underwriting, a new vocabulary has entered the conversation — one borrowed from healthcare, vendor marketing, and federal regulation. Starting with the foundational concepts, this first installment covers what an EHR actually is, the difference between structured and unstructured data, and what it really means for systems to "talk" to each other.
EMR (Electronic Health Record vs. Electronic Medical Record) vs. EHR
An EMR is a digital chart of medical information on an individual accessible only by a single practice or medical facility. An EHR is designed to be a digital chart that can be shared across different providers and settings, allowing multiple connected providers to view and contribute information on a single patient.
One way to think of it is that all EHRs are EMRs, but EMRs are NOT always EHRs. A standalone EMR lacks the broader connectivity of an EHR. It is the EHR network that enables the life insurance industry to digitally access and retrieve medical data for underwriting.
Structured vs. Unstructured Data
Structured medical data consists of discrete, coded fields (e.g., lab values, diagnosis codes, vitals, etc.). Unstructured data includes free-text clinical notes, imaging reports, and discharge summaries. Some estimate approximately 80% of clinical data is unstructured, making it more challenging to extract, standardize, and use at scale.
When medical data is retrieved electronically through an EHR, structured data can flow directly into underwriting engines, while unstructured data may still require human review and interpretation. By contrast, an Attending Physician’s Statement (APS) delivers all data in document format, requiring human review of both structured and unstructured medical data.
Interoperability
In healthcare, interoperability is the ability of health information systems to securely access, exchange, and cooperatively use health data. NOTE: Interoperability does not necessarily facilitate the use of information for purposes outside the treatment use case. As such, it is important to understand that “interoperable” does not automatically mean “accessible for life insurance purposes.”
For the life insurance industry, interoperability allows medical data to be retrieved digitally instead of manually. But because the underlying standards and networks were built primarily for treatment purposes, interoperability addresses how data is exchanged and for what purpose — it does not format, filter, or organize the information to optimize it for use in insurance risk selection.
Interoperability vs. Semantic Interoperability
Electronic data exchange is simply moving a digital file from one computer system to another, like sending an email attachment. Interoperability means that the data is sent in a consistent manner such that another system can extract that data. Semantic interoperability goes beyond the technical exchange of data by establishing a shared language that helps networks communicate accurately and consistently. Because providers may use different terms for the same illness or diagnosis, a common language is essential to correctly interpreting the data exchanged.
Most modern EHRs support interoperability; however, achieving semantic interoperability (where every system uses the same codes and terms to mean the same thing) remains a challenge. One EHR may record a diagnosis with a standard code, another with a custom code, and a third in a free-text note.
For underwriters, this challenge isn’t new. APSs have always arrived with different layouts, terminology, and levels of detail. The difference with EHR data is that it arrives digitally and faster, which makes it easier to organize and summarize into a consistent view before it reaches an underwriter’s desk. Full semantic interoperability is still developing, but underwriters don’t need to wait for it to benefit from the value of EHRs today.
Consider these basics to be a working vocabulary to ground the EHR conversation before it gets more complex. The life insurer's guide to EHR terminology will pick up the pace from here with Part 2 covering laws shaping EHR access. Be sure to keep reading the series to deepen your understanding of these areas.
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