HISTalk: Defining Our Terms: Does Anyone Know What an “Open EHR” Really Is?


A JAMIA article by Dean Sittig and Adam Wright proposes use cases of exactly what determines whether a given EHR is “open” or “interoperable,” which hopefully will squelch the bleating of robotic vendor CEOs who insist on abusing the term to mean “whatever we’re selling at the moment.” The authors also question whether a system is open if its vendor requires those who need access to its system to be certified, to sign a non-disclosure agreement, to pay a license fee, to pay the vendor for custom programming, or to buy documentation. The EXTREME (Extract, Transmit, Exchange, Move, Embed) use cases require the EHR to:

  1. Export patient records in a format that can be discretely imported into another system that includes enough metadata to make the information usable, with a published dictionary describing how the information is stored and what it means.
  2. Support the ability for users to send some or all of a patient’s information to another EHR or PHR system via a standard format, allowing the user to choose which information to send and maintaining a usable data structure.
  3. Respond to data queries 24×7, use a record locator service, send information in a structured format, and send its data dictionary to the receiving EHR.
  4. Allow a customer to move all of their patient information to a new EHR, preserving metadata and maintaining the existing transaction history.
  5. Provide read and write API access to clinical and administrative information, such as by using SMART or FHIR services, and store new values provided by the external application.

For more information, see the summary Dean and Adam wrote as a HIStalk Readers Write article.

Here’s a challenge to EHR vendors: is your system open and interoperable based on the definition above?

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