Personal Health Record Software Global Market Report 2025

Description

Personal health record (PHR) software encompasses digital tools and platforms intended to enable individuals to manage and store their health-related information electronically. This software plays a crucial role in enhancing communication, care coordination, and public health initiatives, empowering individuals to take an active role in managing their health.

The primary components of personal health record software include software and mobile applications, along with associated services. Software and mobile applications are computer programs and applications developed to operate on a range of computing devices, including desktop computers, laptops, smartphones, and tablets. These solutions can be deployed in various modes, such as cloud-based and web-based deployments, and may incorporate different architectures, including payer-tethered, provider-tethered, and standalone setups.

The personal health record software market research report is one of a series of new reports from The Business Research Company that provides personal health record software market statistics, including personal health record software industry global market size, regional shares, competitors with a personal health record software market share, detailed personal health record software market segments, market trends and opportunities, and any further data you may need to thrive in the personal health record software industry. This personal health record software market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The personal health record software market size has grown strongly in recent years. It will grow from $10.14 billion in 2024 to $11.09 billion in 2025 at a compound annual growth rate (CAGR) of 9.4%. The growth in the historic period can be attributed to the market demand and supply, government initiatives, integration with traditional record keeping, increased chronic disease management, consumer demand for accessible healthcare information.

The personal health record software market size is expected to see strong growth in the next few years. It will grow to $16.09 billion in 2029 at a compound annual growth rate (CAGR) of 9.8%. The growth in the forecast period can be attributed to increasing demand for centralizing and streamlining healthcare information, rising initiatives to promote patient-centric care, increasing awareness and adoption among consumers. Major trends in the forecast period include increasing government initiatives to promote patient-centric care, growing demand for centralizing and streamlining healthcare information, rising awareness among patients about medical information storage and management.

The increasing demand for digital health solutions is poised to drive the growth of the personal health record software market in the foreseeable future. Digital health solutions involve the incorporation of technology and digital tools into healthcare delivery to enhance efficiency, accessibility, quality of care, and patient outcomes. Personal health record software plays a crucial role within digital health solutions by empowering patients, facilitating care coordination, improving clinical decision-making, and ultimately promoting better health outcomes. For example, as reported by the Australian Digital Health Agency in August 2022, a significant number of telehealth services were provided between 2020 and 2022, benefiting millions of patients and practitioners. Additionally, a survey conducted by Rock Health in February 2023 revealed a surge in telemedicine adoption, with a substantial percentage of respondents accessing care remotely. Consequently, the escalating demand for digital health solutions is fueling the growth of the personal health record software market.

Major companies in the personal health record software market are directing their efforts towards advancements in AI technology, exemplified by solutions such as AWS HealthScribe, owing to the significant benefits of AI integration in healthcare software. AWS HealthScribe is a novel generative AI-powered service that automatically generates clinical documentation from patient-clinician conversations. For instance, in July 2023, Amazon Web Services (AWS) launched AWS HealthScribe, a HIPAA-eligible service aimed at helping healthcare software providers develop clinical applications utilizing speech recognition and generative AI to create initial clinical notes from doctor-patient discussions. This service is designed to expedite clinical documentation, improve consultation efficiency, and enhance medical scribe workflow efficiency. By leveraging speech recognition and generative AI, healthcare software vendors can develop clinical applications that generate preliminary clinical notes, thereby streamlining consultations and optimizing medical scribe workflows.

In November 2023, Thoma Bravo, a software company based in the United States, completed the acquisition of NextGen Healthcare for $1.8 billion. This strategic move is anticipated to position NextGen Healthcare for long-term growth, as it will leverage Thoma Bravo's operational expertise and strategic flexibility to accelerate its leadership in delivering healthcare solutions. NextGen Healthcare, headquartered in the US, is a provider of cloud-based Electronic Health Record (EHR) solutions.

Major companies operating in the personal health record software market report are GE Healthcare, Cerner Corporation, Allscripts, eClinicalWorks, Athenahealth, NextGen Healthcare, Meditech, Greenway Health, CareCloud Inc., Kareo, Zapbuild, E-MDs Inc., SoftClinic Software, Practice Fusion Inc., AdvancedMD, Practice Fusion, HealthFusion, CureMD, Epic Systems Corporation, NoMoreClipboard, Amazing Charts, Validic Inc., Health Companion, Patient Ally, Healthspek, 75Health (Kaaspro), Knapsack Health, Records For Living Inc., DrChrono, ChARM Health

North America was the largest region in the personal health record software market in 2024. The regions covered in the personal health record software market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East, Africa.

The countries covered in the personal health record software market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The personal health record software market includes revenues earned by entities by providing services such as accessibility, security, and privacy, medication management, health tracking and monitoring, and health data management. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included. The personal health record software market consists of sales of health devices, medications, and test tools. Values in this market are 'factory gate' values, that is, the value of goods sold by the manufacturers or creators of the goods, whether to other entities (including downstream manufacturers, wholesalers, distributors, and retailers) or directly to end customers. The value of goods in this market includes related services sold by the creators of the goods.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD, unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

Personal Health Record Software Global Market Report 2025 from The Business Research Company provides strategists, marketers and senior management with the critical information they need to assess the market.

This report focuses on personal health record software market which is experiencing strong growth. The report gives a guide to the trends which will be shaping the market over the next ten years and beyond.

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Where is the largest and fastest growing market for personal health record software ? How does the market relate to the overall economy, demography and other similar markets? What forces will shape the market going forward? The personal health record software market global report from the Business Research Company answers all these questions and many more.

The report covers market characteristics, size and growth, segmentation, regional and country breakdowns, competitive landscape, market shares, trends and strategies for this market. It traces the market's historic and forecast market growth by geography.

The market characteristics section of the report defines and explains the market.
The market size section gives the market size ($b) covering both the historic growth of the market, and forecasting its development.
The forecasts are made after considering the major factors currently impacting the market. These include:

The forecasts are made after considering the major factors currently impacting the market. These include the Russia-Ukraine war, rising inflation, higher interest rates, and the legacy of the COVID-19 pandemic.

Market segmentations break down the market into sub markets.
The regional and country breakdowns section gives an analysis of the market in each geography and the size of the market by geography and compares their historic and forecast growth. It covers the growth trajectory of COVID-19 for all regions, key developed countries and major emerging markets.
The competitive landscape chapter gives a description of the competitive nature of the market, market shares, and a description of the leading companies. Key financial deals which have shaped the market in recent years are identified.
The trends and strategies section analyses the shape of the market as it emerges from the crisis and suggests how companies can grow as the market recovers.

Scope

Markets Covered:1) By Component: Software And Mobile Applications; Service
2) By Deployment: Cloud-Based; Web-Based
3) By Architecture: Payer-Tethered; Provider-Tethered; Standalone
Subsegments:
1) By Software And Mobile Applications: Personal Health Record (PHR) Software; Mobile Health (Mhealth) Apps; Cloud-Based Health Record Systems
2) By Service: Implementation Services; Maintenance And Support Services; Training And Consulting Services
Companies Mentioned: GE Healthcare; Cerner Corporation; Allscripts; eClinicalWorks; Athenahealth
Countries: Australia; Brazil; China; France; Germany; India; Indonesia; Japan; Russia; South Korea; UK; USA; Canada; Italy; Spain
Regions: Asia-Pacific; Western Europe; Eastern Europe; North America; South America; Middle East; Africa
Time series: Five years historic and ten years forecast.
Data: Ratios of market size and growth to related markets, GDP proportions, expenditure per capita,
Data segmentations: country and regional historic and forecast data, market share of competitors, market segments.
Sourcing and Referencing: Data and analysis throughout the report is sourced using end notes.
Delivery format: PDF, Word and Excel Data Dashboard.

Product Code: r28724

1. Executive Summary

2. Personal Health Record Software Market Characteristics

3. Personal Health Record Software Market Trends And Strategies

4. Personal Health Record Software Market - Macro Economic Scenario Including The Impact Of Interest Rates, Inflation, Geopolitics, Covid And Recovery On The Market

5. Global Personal Health Record Software Growth Analysis And Strategic Analysis Framework

5.1. Global Personal Health Record Software PESTEL Analysis (Political, Social, Technological, Environmental and Legal Factors, Drivers and Restraints)
5.2. Analysis Of End Use Industries
5.3. Global Personal Health Record Software Market Growth Rate Analysis
5.4. Global Personal Health Record Software Historic Market Size and Growth, 2019 - 2024, Value ($ Billion)
5.5. Global Personal Health Record Software Forecast Market Size and Growth, 2024 - 2029, 2034F, Value ($ Billion)
5.6. Global Personal Health Record Software Total Addressable Market (TAM)

6. Personal Health Record Software Market Segmentation

6.1. Global Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
Software And Mobile Applications
Service
6.2. Global Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
Cloud-Based
Web-Based
6.3. Global Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
Payer-Tethered
Provider-Tethered
Standalone
6.4. Global Personal Health Record Software Market, Sub-Segmentation Of Software And Mobile Applications, By Type, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
Personal Health Record (PHR) Software
Mobile Health (Mhealth) Apps
Cloud-Based Health Record Systems
6.5. Global Personal Health Record Software Market, Sub-Segmentation Of Service, By Type, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
Implementation Services
Maintenance And Support Services
Training And Consulting Services

7. Personal Health Record Software Market Regional And Country Analysis

7.1. Global Personal Health Record Software Market, Split By Region, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
7.2. Global Personal Health Record Software Market, Split By Country, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

8. Asia-Pacific Personal Health Record Software Market

8.1. Asia-Pacific Personal Health Record Software Market Overview
Region Information, Market Information, Background Information, Government Initiatives, Regulations, Regulatory Bodies, Major Associations, Taxes Levied, Corporate Tax Structure, Investments, Major Companies
8.2. Asia-Pacific Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
8.3. Asia-Pacific Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
8.4. Asia-Pacific Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

9. China Personal Health Record Software Market

9.1. China Personal Health Record Software Market Overview
9.2. China Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F,$ Billion
9.3. China Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F,$ Billion
9.4. China Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F,$ Billion

10. India Personal Health Record Software Market

10.1. India Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
10.2. India Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
10.3. India Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

11. Japan Personal Health Record Software Market

11.1. Japan Personal Health Record Software Market Overview
11.2. Japan Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
11.3. Japan Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
11.4. Japan Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

12. Australia Personal Health Record Software Market

12.1. Australia Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
12.2. Australia Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
12.3. Australia Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

13. Indonesia Personal Health Record Software Market

13.1. Indonesia Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
13.2. Indonesia Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
13.3. Indonesia Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

14. South Korea Personal Health Record Software Market

14.1. South Korea Personal Health Record Software Market Overview
14.2. South Korea Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
14.3. South Korea Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
14.4. South Korea Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

15. Western Europe Personal Health Record Software Market

15.1. Western Europe Personal Health Record Software Market Overview
15.2. Western Europe Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
15.3. Western Europe Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
15.4. Western Europe Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

16. UK Personal Health Record Software Market

16.1. UK Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
16.2. UK Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
16.3. UK Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

17. Germany Personal Health Record Software Market

17.1. Germany Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
17.2. Germany Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
17.3. Germany Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

18. France Personal Health Record Software Market

18.1. France Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
18.2. France Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
18.3. France Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

19. Italy Personal Health Record Software Market

19.1. Italy Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
19.2. Italy Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
19.3. Italy Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

20. Spain Personal Health Record Software Market

20.1. Spain Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
20.2. Spain Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
20.3. Spain Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

21. Eastern Europe Personal Health Record Software Market

21.1. Eastern Europe Personal Health Record Software Market Overview
21.2. Eastern Europe Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
21.3. Eastern Europe Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
21.4. Eastern Europe Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

22. Russia Personal Health Record Software Market

22.1. Russia Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
22.2. Russia Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
22.3. Russia Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

23. North America Personal Health Record Software Market

23.1. North America Personal Health Record Software Market Overview
23.2. North America Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
23.3. North America Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
23.4. North America Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

24. USA Personal Health Record Software Market

24.1. USA Personal Health Record Software Market Overview
24.2. USA Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
24.3. USA Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
24.4. USA Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

25. Canada Personal Health Record Software Market

25.1. Canada Personal Health Record Software Market Overview
25.2. Canada Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
25.3. Canada Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
25.4. Canada Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

26. South America Personal Health Record Software Market

26.1. South America Personal Health Record Software Market Overview
26.2. South America Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
26.3. South America Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
26.4. South America Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

27. Brazil Personal Health Record Software Market

27.1. Brazil Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
27.2. Brazil Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
27.3. Brazil Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

28. Middle East Personal Health Record Software Market

28.1. Middle East Personal Health Record Software Market Overview
28.2. Middle East Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
28.3. Middle East Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
28.4. Middle East Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

29. Africa Personal Health Record Software Market

29.1. Africa Personal Health Record Software Market Overview
29.2. Africa Personal Health Record Software Market, Segmentation By Component, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
29.3. Africa Personal Health Record Software Market, Segmentation By Deployment, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion
29.4. Africa Personal Health Record Software Market, Segmentation By Architecture, Historic and Forecast, 2019-2024, 2024-2029F, 2034F, $ Billion

30. Personal Health Record Software Market Competitive Landscape And Company Profiles

30.1. Personal Health Record Software Market Competitive Landscape
30.2. Personal Health Record Software Market Company Profiles
- 30.2.1. GE Healthcare Overview, Products and Services, Strategy and Financial Analysis
- 30.2.2. Cerner Corporation Overview, Products and Services, Strategy and Financial Analysis
- 30.2.3. Allscripts Overview, Products and Services, Strategy and Financial Analysis
- 30.2.4. eClinicalWorks Overview, Products and Services, Strategy and Financial Analysis
- 30.2.5. Athenahealth Overview, Products and Services, Strategy and Financial Analysis

31. Personal Health Record Software Market Other Major And Innovative Companies

31.1. NextGen Healthcare
31.2. Meditech
31.3. Greenway Health
31.4. CareCloud Inc.
31.5. Kareo
31.6. Zapbuild
31.7. E-MDs Inc.
31.8. SoftClinic Software
31.9. Practice Fusion Inc.
31.10. AdvancedMD
31.11. Practice Fusion
31.12. HealthFusion
31.13. CureMD
31.14. Epic Systems Corporation
31.15. NoMoreClipboard

32. Global Personal Health Record Software Market Competitive Benchmarking And Dashboard

33. Key Mergers And Acquisitions In The Personal Health Record Software Market

34. Recent Developments In The Personal Health Record Software Market

35. Personal Health Record Software Market High Potential Countries, Segments and Strategies

35.1 Personal Health Record Software Market In 2029 - Countries Offering Most New Opportunities
35.2 Personal Health Record Software Market In 2029 - Segments Offering Most New Opportunities
35.3 Personal Health Record Software Market In 2029 - Growth Strategies
- 35.3.1 Market Trend Based Strategies
- 35.3.2 Competitor Strategies

36. Appendix

36.1. Abbreviations
36.2. Currencies
36.3. Historic And Forecast Inflation Rates
36.4. Research Inquiries
36.5. The Business Research Company
36.6. Copyright And Disclaimer