The answer to the question, of course, is a lot. I sat in on a Definitions Forum held today in Washington, DC, to review work in progress around defining and characterizing key HIT terms. These include ones we use and see a lot: EHR, EMR, PHR, RHIO and HIE.
I sensed from the experience that there is potentially (potentially) much at stake in the definition of these terms, because definitions reflect culture. Indeed, Dr. Karen Bell, who opened the session stated that “culture eats technology for lunch.” In my own work, I have learned something similar – “culture eats strategy for lunch.”
Even though the acronym “PHR” is discussed at the beginning of the presentation, the discussion centered mostly on RHIO, HIE, and EHR, and I focused my attention mostly on the last acronym. What I appreciated about the emerging definition of EHR (see page 20 of the presentation) is that it is more aspirational than I have seen in the past. Still, there was some interesting discussion on two specific topics. One, the role of health plan as an actor in collecting and accessing data from an electronic health record. I stated in the discussion that this connection requires further discussion, in my opinion. At the current time, the definition says “collected from and accessible by all providers.”
I think a bigger issue is the role of the patient in the definition. It’s not there. This was brought up, and our moderator, Dr. David Longnecker from the Association of American Medical Colleges, posed an interesting question about this. He wondered if adding patient input to the EHR was similar to listserv’s he has operated where the moderated variety have been more successful than the unmoderated variety. This was a great time to add the experience of Group Health Cooperative, which has shown that patients are very respectful of their care team and of their health record, even now that they are allowed to write to it via the online health appraisal.
Comments (rather than definitions) are still being accepted through the Web site, at this link. The definitions are set to be completed on March 28, 2008.