Patient X was contacted by his personal physician yesterday, he reports that his potassium is high. Patient Y is on three medications: the diabetes one, the blood pressure one and the cholesterol one. Patient Z has been vomiting and urinating blood for months and has had several tests performed with unknown results. These are common problems in healthcare. Common, because information is missing at the point of service (”POS). And common, because the information resides in some physical form at some physical location (”silo”).
Some view that the move from paper to “electronic” (actually digital) records will solve this displacement of POS from silo. But changing paper to digital silos doesn’t address the proliferating number of silos. As healthcare moves to the electronic health record (”EHR”)1, every entity will be creating their own EHR that may or may not exchange information in either a compatible or timely manner. Hardware, software, adherence to standards, and a willingness to participate form the walls of these new silos. It is envisioned that the EHRs, residing in these silos, will exchange information through health information exchanges (”HIE”)2.
Patients may change enrollment with health insurers on an annual basis. A change in insurer may change the entities involved in providing the health services. Many patients have no form of third–party payment and may be exposed to a large array of different entities. Here entities3 may be: providers, facilities, payers, regulators, researchers and patients.4
Problem 1. A patient may have health services provided by numerous entities.
Problem 2. Every entity will create an EHR.
Problem 3. Information exchange between entities must be facilitated.
Problem 4. Problems 1–3 multiply the complexity.
EHRs are presently defined in content and scope by the entities creating them. This also creates an ownership interest. The total health record for the individual patient is a composite of all the individual EHRs created by all the entities providing services to the patient. The completeness and timeliness of the total health record is dependent upon the ability of the individual EHRs to be exchanged and integrated.
If the EHRs are defined as subsets of a patient’s PHR and moved from the entites’ silos to a standardized “health cloud,” then the many EHRs are reduced to a singular PHR and there is no need for HIEs.” The patient becomes the owner of the PHR and the entities become “tenants” for the duration of the service relationship.
Footnotes:
- EHR as a general category that includes the electronic medical record (”EMR”), computer physician order entry (”CPOE”), etc.
- Here HIE is used broadly for any exchange from faxes and email to quasi–utility models.
- Here entities are broadly construed to include all that would access EHR or contribute to the EHR.
- Patients will want access to different EHRs and will want to create their own health record—the personal health record (”PHR”)
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I really hate to have this insight.
my favorite line has to be :
” The patient becomes the owner of the PHR and the entities become “tenants”
alright my head is spinning now