An ambulatory EHR is the electronic health record that a clinic runs on, for patients who visit and go home the same day. Ambulatory care means care without a hospital stay, such as a visit to a family doctor, a skin specialist or an eye clinic. The record holds each patient's history, current medicines, allergies, test results and doctors' notes. The doctor also places orders from it, such as a blood test or a prescription, and the bill is produced from it. Most of these products are sold to clinics in the United States, and engineers in Hyderabad, Bengaluru and Pune build much of them.
Why is the American market so large? From 2009, the United States government paid clinics and hospitals to adopt certified EHRs, and later reduced its payments to those that did not. So almost every American clinic now runs on one. Many are specialist records, built for one kind of doctor. A skin doctor's record has body diagrams on which to mark each mole. An eye doctor's record has fields for eye pressure and vision tests.
Consider a visit to a family doctor in Wisconsin. A 58-year-old woman with diabetes comes for her check-up every three months. Before she arrives, the record shows the doctor her last HbA1c result, a blood test for average blood sugar: 8.1%. It also shows her medicines and her allergy to sulfa drugs. The doctor examines her and writes a note. The doctor raises her dose of metformin, a diabetes medicine, and orders a new HbA1c test. When the doctor enters the prescription, the record checks it against her allergies and her other medicines. The test order goes to a reference laboratory, and the result comes back into her record two days later. Meanwhile, the visit is turned into medical codes: one code for diabetes, and one for the type of visit. Those codes go to the revenue cycle management system, which sends the claim to her insurer.
A clinic's record has three main parts. The clinical part holds the notes and the orders. The business part, the appointment book and the billing, is called practice management software. The patient portal lets patients see their own results and send messages to the clinic.
The record also exchanges data with many other systems. Appointments arrive from scheduling software. Draft notes arrive from an AI medical scribe. Prescriptions go to pharmacies. Other apps read the record in a standard format through FHIR APIs. Exchanging records between systems in this way is called interoperability.
How is it different from a hospital EHR? A clinic's record is built around short visits, with one doctor's note per visit. A hospital's record must also run wards, theatres and an emergency room, with many teams writing in it at once.