I've read Andis Robeznieks' article "
Using EHRs to extract data on adverse drug events." It is all true. But why isn't it a common practice? Why don't we have an EHR that all healthcare providers use? Why don't we use standards that make all this possible?
For almost eight years I was chairman of CEN/tc251/wg1. CEN is the European standardization organization. While I was chairman, CEN/tc251 worked on three European standards—one is becoming an Australian standard; two are on their way to becoming International Organization for Standardization standards.
One standard defines the concepts and terms clinicians need to cooperate. The second standard makes possible plug-and-play exchange of documented information gathered while providing care to the patient and while collaborating with colleagues. Plug-and-play is defined as systems capable of recieving, storing, retrieving, presenting and exchanging information without any programming. This is based on a new exciting paradigm—a paradigm that is used for messaging. It is called the archetype paradigm or two-model-level paradigm. The third one makes it possible that EHR systems are capable of cooperation.
This set of three standards makes it possible for EHR systems to provide the things discussed in the article, and it can provide much more.
The question is, "Why are we not using these standards?" My answer is:
- The "not invented here" syndrome.
- The belief by many that Health Level 7 and its message paradigm will solve the problems, while it never can because all messages take a lot of resources to produce them and even more to implement them in all systems in a patient-safe way.
- The fact that information technology vendors and consultants make a lot of money out of the mess the message paradigm is associated with.
- HL7—the industry and consultants do a good job promoting the message paradigm as the only solution.
For more information I refer to
openehr.org, an open-source community that provides a lot of background technical information and implementable specifications, plus some software.
Gerard Freriks, MD
member of EuroRec
European Institute for Health Records
the Netherlands
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