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Comprehensive Health Record Vs. Connected Health Record

Posted on March 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The “comprehensive health record” model is quite in vogue these days. Epic, in particular, is championing this model, which supplants existing EHR verbiage and integrates social determinants of health. “Most health systems know they have to go beyond their walls,” Epic CEO Judy Faulkner told Healthcare IT News. A number of other EMR vendors have followed Epic’s lead.

To date, however, most clinicians have yet to embrace this model, perhaps because they’re out of patience with the requirements imposed by EHRs. What’s more, the broader healthcare industry hasn’t reached a consensus on the subject. For example, a team of experts from UCSF argues that healthcare needs a “connected health record,” a much different animal than vendors like Epic are proposing.

The authors see today’s EHR as an “electronic file cabinet” which is poorly equipped to handle health activities and use cases such as shared care planning, genomics and personalized medicine, population health and public health, remote monitoring and sensors.

They contend that to create an interoperable healthcare ecosystem, we will need to move far beyond point-to-point, EHR-to-EHR connections. Instead, they suggest adding connections with patients and family caregivers, non-clinical providers such as school clinics for youth and community health centers. (They do agree with Faulkner that incorporating data on social determinants of health is important.)

Their connected health record ties more professionals together and adapts to new models of care. It would foster connections between primary care physicians, multiple specialists, hospitals, clinics, pharmacies, laboratories, public health registries and new models of care such as ACOs. It would be adaptive rather than reactive.

For example, if the patient at home with cancer gets a fever, her temperature data would be transmitted to her primary care physician, her oncologist, her home care nurse and family caregiver. The care plan would evolve based on the recommendations of team members, and the revised vision would be accessible automatically to the entire care team. “A static, allegedly comprehensive health record misses the dynamics of an interactive, learning health system,” the authors say.

All that being said, this model still appears to be at the vision stage. Perhaps given its backing, the comprehensive health record seems to be getting far more attention. And arguably, attempting to integrate a good deal more data on patients into an EHR could be beneficial.

However, both models are largely untested, and both beg the question of whether building more content on an EHR skeleton can lead to transformation. On the other hand, while the concept of a connected health record is attractive, my sense is that the components needed to this happen have not matured yet.

Ultimately, it will be clinicians who decide which model actually works for them, not vendors or abstract thinkers. Let’s see which model makes the most sense to them.

A National Database on Advanced Directives? Great Idea.

Posted on December 5, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

An oldish post from the Healthcare Blog had me thinking about EMRs, advance directives and national patient IDs this week. John Maa, assistant professor of surgery at UCSF, writes about a case early in his career where:
– an 85 year old woman called 911, and was brought into the ER around noon with severe abdominal pain. She was delirious and could provide her medical history
– attempts to contact her family and friends were unsuccessful
– she had some serious problems that needed immediate attention, and two surgeons documented the need for her to be taken to the operating room for “life threatening emergency situation”. She underwent a six-hour surgery, was intubated, her kidneys were recovering.
– Her children arrived at about 10 pm, and asked for withdrawal of support. Amid all the back-and-forth, and threats of legal action etc, the hospital went with the family’s wishes and withdrew support. The woman died soon after.

For Maa, this was a formative experience of sorts, happening in his second month of internship. He says he still thinks about the case.

The ethics of the situation notwithstanding (and there’s more in Maa’s post that I’m not going into), from an EMR/EHR perspective – a unique patient ID that identifies each patient and an EMR that captured the woman’s advanced directive would have really helped. As commenter John Ballard states in the discussion following Maa’s post:

“One more illustration underscoring the importance of comprehensive advance directives, properly executed and easily accessible. Why such a document is not routinely a part of medical records is an ongoing mystery to me.

Advance directives — properly executed — should be required by all insurance plans as well as Medicare/Medicaid for beneficiaries. They should expire and be subject to renewal every five years to allow for changes in the person’s health, medical advances or discoveries and changes of opinion (not to mention the passing of designated agents)”

Another commenter says “What we need is a federal mandate for advance directives and a federally run advance directive database that can be accessed from any computer.” Indeed.