Anyone who knows the work of William Shakeaspeare in Romeo and Juliet recognizes these famous lines: “What’s in a name? That which we call a rose by any other name would smell as sweet!”
In @BIDgente we have been asking a similar question regarding Electronic Health Record systems. What happens when we give different names to the same thing? In health systems, it can be problematic that hospitals do not speak the same language. On a larger scale, it is confusing that Latin American and Caribbean countries do not use the same terms. According to Weathers and Esper, the purchase, implementation, and maintenance of an electronic health record (EHR) are among the most significant financial investments a practice will make. Globally, the electronic health record market value is expected to grow to over US$ 30 billion by 2026. While penetration rates vary between LAC countries, they are expected to rise. With the COVID-19 pandemic, their importance is clear. However, upon reviewing research and definitions of various countries, various terms are used, and we might not all be talking about the same thing.
In our recent learning material, Electronic Health Record Systems: Definitions, Evidence, and Practical Recommendations for Latin America and the Caribbean we take a deep dive into how the definitions of Electronic Health Record Systems (EHR-S) and related terms have evolved, how they are defined, and the terms used in official definitions by the countries in Latin America.
Many times, when we hear a term we assume that we all share the same definition. For example, “working with models” is going to have a very different meaning for an economist or an airplane manufacturer. Both are correct, but the meaning depends on the audience and context.
Definitions are also critical to help us categorize. If I showed you a set of photos, some of cars and others of bicycles, surely, you’d be able to categorize them based on the core set of characteristics they share. It’s probably just as easy to tell apart a medical record on paper from an electronic medical record – one is on paper, the other is on a computer. What if I then ask you next organized the same photos of cars into specific groups – luxury cars, sports cars, and coupes. The definitions needed to tell them apart need to be much more precise – here we might need to know more information and have a trained eye to know the type of horsepower, the number of cylinders, the car’s weight, if it has a heated steering wheel, the material the seats are made of, and the safety features included.
Upon analyzing definitions of terms related to EHRs used in the Americas, we found that both Spanish and English-speaking countries use different terms and definitions, making it hard to know if we are all talking about the same thing. For example, some specifically talk about shared health records, data exchange, and interoperability; others mention certain things that providers should be able to do with the systems and the information they should contain. Some countries distinguish between records that are used within a health center, information that is shared between various health centers, and information that is directly managed by the patient, and use different terms to define them. There is high variability between terms and acronyms used in both languages.
This isn’t just an issue of semantics or translation. Just as certain safety features of cars are more important than others, research shows that being able to perform certain tasks in an EHR System makes a difference in terms of quality, efficiency, and safety. For example, we found that most evidence from systemic reviews of the literature is linked to specific tasks performed by an EHR system, such as providing clinicians with alerts for drug interactions, possible diagnosis, or preventative care reminders; helping them adhere to clinical guidelines; allowing them to spend more time with patients; and reducing the cost of redundant diagnosis by providing access to patients’ clinical information stored by other providers. It is important to note that evidence varies across settings, and success is also determined by factors outside of the software itself, such as change management.
Therefore, we must ask, what’s in a name? Can we still call a system an EHR-S if it does not perform these tasks? What standards must it meet? Which ones matter the most for LAC? Who should determine this?
Luckily, for Electronic Health Records, many people and organizations have thought long and hard about these questions for many years. For example, the International Organization for Standardization (ISO) has issued guidance on Electronic Health Records and related terms in English, including very detailed guidance on what a system must be able to do to be considered to meet various standards, such as ISO/HL7 Electronic Health Records-System Functional Model. Other ISO definitions around EHR systems, EHRs, EMRs, and EHR architecture are more general but do point out key differences. However, the adoption of international standards, among other key regulatory issues related to digital health, highly varies in countries in Latin America and the Caribbean, making detailed comparisons difficult. The American Cooperation Network for Electronic Health, RACSEL reviewed experiences in 5 Latin American countries and created recommendations for some of these issues. During 2019, the WHO convened a technical working group and survey to help define the minimum functions that digital client records, results are still in progress.
The decision to install an EHR system is an important investment, and the last thing we want is to pay for a luxury vehicle that is missing seatbelts because we weren’t sure which features were the most important. Hopefully, our story in LAC does not end as tragically as poor Juliet’s, and we can quickly conclude that indeed, what truly matters is what something is, not what it is called, or in the case of electronic record systems, what they can do to, to have a common understanding.
Do you know if the hospitals in your country have Electronic Medical Records? Did you download our publication “Electronic Health Records Systems“? Tell us your opinions in the comments section and learn more by visiting our Social Digital platform.