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EPR Models: checklists or constraints?

I was reminded of the good old six level Electronic Patient Record (EPR) model that originally appeared in Information for Health back in 1999 through a posting on the E-Health Insider group on LinkedIn. For those of you who haven't seen it or have maybe forgotten it, here it is...

  1. Level 6 Advanced multi-media and telematics Level 5 plus: telemedicine, other multi-media applications (e.g. picture archiving and communications systems)
  2. Level 5 Speciality specific support Level 4 plus: special clinical modules, document imaging
  3. Level 4 Clinical knowledge and decision support Level 3 plus: interactive care pathway support, electronic access to knowledge bases, embedded guidelines, rules, electronic alerts, expert system support
  4. Level 3 Clinical activity support Level 2 plus: electronic clinical ordering, results reporting, prescribing, passive multi professional care pathways
  5. Level 2 Integrated clinical diagnosis and treatment support Level 1 plus: integrated master patient index, departmental systems
  6. Level 1 Clinical administrative data Patient administration and independent departmental systems

Unfortunately, it never really influenced NHS thinking outside of the IT department. Most Chief Executives hadn't heard of it and---dare I say--neither had some IT directors. To some extent this ignorance paved the way for the NHS National Programme for IT. Now the HIMMS EMR adoption model gains in popularity.

But I am not sure that these models are any good at all, other than as a communication tool. At a time when healthcare should be looking sideways to its partners and forwards to its customers, these models encourage introspection. Good IT Directors will implement a strategic plan appropriate to their organisation's starting point and to look outwards. At best these models are useful ticklists, at worst misleading anachronisms.


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This is what the current EMRs and EHRs currently offer...maybe in a couple of years we would able to see the next generation of emrs being more expansive. We certainly have seen some transition already. Some EMR vendors have extensively worked on their Patient Portals and they have started looking more of what you would expect from a complete practice management solution. Companies like curemd have been working extensively on this aspect, the change may come sooner than we'd expect :)

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