The Electronic Health Record Part 1

The Electronic Health Record (EHR), is central to Health IT, but what is it exactly? It turns out that it depends on who you ask. Not only are there a number of commercial and open source products branded as electronic health records, but various standards organizations and professional organizations have offered their own definitions. At one level, this makes sense. For one thing, what could make more sense than to think of an electronic, or digital, health record as a digital version of the patient chart? This line of thinking leads us to think of the electronic health record as a combination of sections containing patient demographics, social history, known alleges, problem list, and so forth, coupled with an essentially episodic record of the patient’s treatment at a given facility (or practice). Records of this type are not typically very portable, and it is not uncommon for a patient to have to essentially “start over” when moving to a new location, or when changing primary care providers.

This is one of the problems that the introduction of electronic health records are generally thought to be intended to solve.Let’s consider another definition. This time, on offered by the Health Information and Management Systems Society (HIMSS 2011):

EHR is a  longitudinal electronic record of patient health information generated by one more encounters in any healthcare delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, vital signs, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate  complete record of a clinical patient encounter, as well as supporting other care-related activities directly or indirectly including evidenced-based decision support, quality management, and outcomes reporting.

Wow! That sounds more like a program than a definition.  Let’s take a closer look, anyway. First of all, we see here that the reference is described as longitudinal. This is a term taken from the social sciences. A longitudinal study is one that focuses on individual subjects over an extended period time, typically focusing on relatively few parameters. So, e have never concept here: a record that belongs to the patient, and is not tied to a particular place (e.g., a practice or facility), or time (e.g., a particular encounter). This is a significant desideratum of modern HIT systems.
But what of the remainder of the items listed here? There are no real surprises: progress notes, problems, orders and test results (for instance) are not essentially different from their paper counterparts. In other words, with the significant exception of the longitudinal record,  this proposed definition enumerates problems we already know how to solve. In that sense, it lacks depth, and we need to look further.