Comprehensive Health Record Vs. Connected Health Record

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.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

1 Comment

  • What they need is a systems analyst to sit down and work out the system with them. I don’t consider what EPIC and CERNER, etc. have done to be in line with systems analysis. This is just going to be another follow the $$$ and CMS and the good ol’ boys network will ship a package on one hand and take it all back the next. Do we ever learn?

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