What do we have? You can have all the messages, connect-a-thons and profiles that you like - certainly you will achieve short- to medium-term connectivity wins but it is not enough. It is not sustainable and clinicians want and need to share relevant data when it is needed. Predetermined messages and documents will be a great start, but it's not enough.
You can invest huge resources in terminology - we definitely need it - but terminology in isolation is also not enough.
You can demand all the 'damn data' that you want, but non-standardised data will still largely not be computable - largely limited to read-only access.
What do we want?
We hear talk about:
- shared electronic health records;
- semantic interoperability; and
- health data liquidity.
Essentially these phrases describe different aspects of the same 'elephant in the room'; just using different jargon...
We expect our healthcare professionals to be able to safely exchange important health information. To have the right health information available at the right place at the right time. To prevent us repeating our health histories ad nauseum. In fact a huge percentage of patients assume that we can already do this! But we can't... yet. Shared health records are not easy.
What do we need?
A single data-driven "universal health record", an uhr! And please note the deliberate lack of capitals.
What on earth is an uhr, I hear you quite reasonably ask...? A uhr is simply a non-proprietary pool of standardised health data which can be used for any purpose we want - PHR, EHR, EMR, SEHR, IEHR, research, epidemiology, reporting & stats, shared care, clinical decision support & more. There is no particular EHR application associated with it; in fact it works with any and every software program, vendor and healthcare provider.
The key (and I say it yet again)... it's. all. about. the. data.
In addition, and supported by:
- Collaboration at international, national, jurisdictional or organisation level to share and re-use the clinical data definitions, so that our health information can similarly be shared.
- Clinicians driving the clinical content definitions - reflecting the information they need for recording health care for themselves and their patients, ensuring that EHRs are 'fit for purpose'. Terminology integrated with these structured clinical content definitions to unambiguously define the building blocks of the health record.
As a result:
- Message structures required for data exchange become more about the wrapper and less about content - much easier to negotiate and maintain.
- Vendors no longer have clinicians locked-in to proprietary data silos
- Tools used to do 'clever stuff' with our data need only to be built once to conform to these agreed clinical data definitions - think decision support, reporting, data repositories, and integration. Now that takes away a lot of the barriers we strive to overcome!
- Data in a common format can be exchanged between systems - data liquidity becomes a reality, flowing to where it is needed and according to authorisation and access permissions.
Gimme a universal health record. Gimme my damn, um,... uhr, and let my data flow...
And so, I archetype;-)