There is a need to define a standard quickly for data interchange with regards to the Electronic Health Record (EHR) and the Electronic Medical Record (EMR).
As I noted in my previous blog, there are a number of standards bodies, organizations and open source communities – but they need to all come together to create and maintain a singular standard.  Remember, one dictionary breeds understanding, two or more breed confusion!
Let me start with a definition of the EMR from  “Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference”, HIMSS Analytics:
“The Electronic Medical Record [EMR] is the legal record created in hospitals and ambulatory environments that is the source of data for the Electronic Health Record [EHR]. The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.”
The EHR standardizes and holds information that all ‘interested parties’ or stakeholders utilize throughout the lifecycle of patient care.  This would include but not be limited to:

  • Patients / Consumers
  • Healthcare Providers: Doctors, Clinicians, Nurses
  • Employers
  • Payers / Insurers
  • Auditors (Patient Care Team)
  • Government

Since the EHR holds a much wider array of information entities and attributes and also is distributed to a much larger group of interested parties, each with their own information needs and security issues, the solution is not an easy one.
The EHR has to be segmented to contain the information on the patient as well as secured so that one interested party (say Employer) does not have access to information that is it not privy to view (Care givers notes on personal patient information).  In order to accomplish this, there should be a defined XML taxonomy of information built into sections that is defined in advance with each section having security keys surrounding this information.
There are also a number of standards types that need to be addressed:

  • Composite Industry Standards
    • IHE, ARTS, RosettaNet
  • Healthcare Specific Standards
    • HL7, HR-XML, MISMO, STARS, OTA, IUN, AMI, ICD-x, ICNP, DSN, HCFA, LOINC
  • Horizontal Industry Standards
    • XForms, ebXML, OAGIS, RFID, SODA, XBRL, WS2.0
  • IT Industry Specific Standards
    • Formats: XML, Web Services, WAI
    • Communication: TCP/IP, HTTP
    • Programming: Java, .NET, SQL

This throws a wrench into the process, but we as architects of solutions need to adopt those that are the industry best practices and move forward – rather than get bogged down in the woods but forgetting about the forest.
With all of the issues, this is not an easy task, but it both accomplishable and required in order for healthcare to enter the information age!
There should be a government mandate that requires this to be completed within foreseeable future (not next year but now).