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The question I want to pose: what functions should be included in an EMR? And, what functions should not be included?

One of the 100 universal principles of design presented by Lidwell, Holden, and Butler (2003) ,must have book, is the flexibility-usability tradeoff. This principle states as flexibility increases usability decreases. Flexibility is increased by adding functions to an EMR. As functions increase there is much higher chance of this software being harder to develop and harder to maintain. (37signals 2006)

If we agree that medical records must be computerized, then we must agree on a common goal that EMRs will serve. A good definition for an electronic medical record: a computer-based system that captures, stores, or communicates clinical data to enhance medical decision-making. (Wyatt and Crispin 1994) The following three points describe how can this definition be deducted:

1. EMRs are not personal health records nor are public health records. The 2001 US National Committee on  Vital and Health Statistics (NCVHS) strategy for building the national health information infrastructure presented three dimensions to health information: health care provider dimension, personal health dimension and population health dimension. There is overlap between these dimensions but the one EMR is concerned with is the health care dimension. I must reiterate that there is overlap between the three dimensions. It will be fruitless to try and draw a line dividing these three dimensions. For example, documenting that a clinician reported on a communicable disease should be part of the healthcare provider and population health dimensions. A consent form should be part of the health care provider and personal health dimensions.

2. NCVHS includes information needed by clinicians and their organizations or hospitals in the health care provider dimension.  EMR should only include information needed by clinicians. Wyatt and Wright (1998) sees medical records as one source of evidence used by clinicians to make evidence based decisions. (The other two are the patient and medical literature.)

3. I do realize that this definition of what should be included in an EMR is restrictive. But, if we serious about improving usability and reducing complexity then we must be as restrictive. There will be other systems as personal health records, population health records, imaging storage systems, and laboratory systems that share information with EMR. But, in a service oriented architecture era, these will form different categories of services.

The following post will describe in a much more practical sense what information are stored in EMRs.

37signals, 2006, Getting Real,the smarter, faster easier way to build a successful web application. https://gettingreal.37signals.com/

Lidwell, W., Holden, K. & Butler, J., 2003. Universal Principles of Design, Rockport Publishers.

Wyatt, J.C. & Wright, P., 1998. Design should help use of patients’ data. Lancet, 352(9137), 1375-8.