UCSF researchers take issue with Epic's 'CHR' definition, offer alternate meaning
First, it was called an EMR – an electronic medical record, meant to document the patient encounter at the point of care. Then, of course, the nomenclature began to change, with more and more experts preferring a broader term: electronic health record.
As the Office of the National Coordinator for Health IT saw it, EHRs did everything EMRs did, and more: "EHRs focus on the total health of the patient — going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient's care," ONC officials said back in 2011.
But this past year a new term entered the conversation: CHR. As defined by Epic CEO Judy Faulkner, the "E" in EHR is superfluous: It's "all electronic" now, she said at the company’s user group in September, proposing that what's needed instead is a "comprehensive" record that folds in social determinant data and incorporates other wellness factors that impact that 99 percent of patient time spent outside of clinical settings.
"If you want to keep patients well and you want to get paid, you’re going to have to have a comprehensive health record," Faulkner said. "You’ll need to use software as your central nervous system, and that’s how you standardize and manage your organization."
Immediately, Epic's rivals pointed out that they too are in the CHR game.
"We’ve been discussing longitudinal health records that include social determinants and other relevant data for at least two years now, and there are more than 100 clients today using Cerner’s population health management platform," said Cerner President Zane Burke.
This past week at HIMSS18, in an interview with Healthcare IT News Editor-at-Large Bernie Monegain, Judy Faulkner doubled down on Epic's plans to broaden the capabilities of its CHR, folding in ways to depict an array of socioeconomic factors via the Epic platform.
But in a March 13 blog post from UCSF's Center for Digital Health Innovation, three experts took a closer look at the capabilities said to be inherent in a so-called CHR – taking issue with the term "comprehensive" and offering a different word for that first letter instead.
"The controversy is over much more than just a name," said Aaron Neinstein, MD, director, clinical informatics at UCSF; Mark Savage, director of health policy, and Ed Martin, director of technology.
"It reflects a debate over the goals of health information technology. Life, health and healthcare are neither static nor siloed but are constantly in motion, and one's health data must be in motion, too. We need a connected health record."
Nearly a decade since HITECH rocketed EHRs into common usage, a lot has evolved in healthcare and technology. The rise of "shared care planning and coordination, genomics and personalized medicine, population health and public health, remote monitoring and sensors" mean that the idea of an EHR as an "electronic filing cabinet" leaves much to be desired, the UCSF researchers said.
Policymakers, providers and patients increasingly recognize this, and know that an "interoperable healthcare ecosystem requires far more than point-to-point, EHR-to-EHR connections," they added.
But while vendors such as Epic and Cerner are now recasting their products as comprehensive health records, able to manage new data types and use cases, they're missing the point, the researchers said.
"Interoperability is a national priority precisely because no single vendor EHR system is comprehensive, and there must be interoperability across myriad data types, sources, authorized users, and use cases," they write. "Given this, we say 'connected health record,' not comprehensive health record, and we are not alone."
That definition of a CHR doesn't define relevance by what data is "locked in – and out – of the record," they explain. Instead, its "completeness" comes from "focusing on the dynamic conversation, teamwork, interconnections, and diverse data sources inherent in managing health and healthcare today."
Physicians and other clinical end-users are have been complaining for years that EHRs are bulky, burdensome and unwieldy. Further populating them with more design elements to accommodate ever-increasing types of data will only exacerbate the problem.
On the flip side, the provisions for open APIs and other innovative connection points included in 2015 certified EHRs, Stage 3 meaningful use and the 21st Century Cures Act means it's easier than ever to link existing systems to an array of myriad other data sources.
"A static, allegedly comprehensive health record misses the dynamics of an interactive, learning health system," said the UCSF researchers. "Rather, patients, providers, population health agencies, registries, payers, researchers, social service agencies, community centers and accountable care organizations all need interconnected systems and records."