Problem: no current status

The entries in our electronic health care records as they are currently built, only give us a chronological list of measurements and changes of the patient’s condition and investigations and treatments applied to him. A number of these steps naturally result in a change in the status of the patient, such as becoming less ill (if cured), having one leg less (after an amputation), having cardiac insufficiency (after a myocardial infarction) and so on. It would be only natural to always have a current picture of how the patient is and apply those changes to him, but that is not the case. There is no such current picture available in the medical record. To know how many legs the patient has, we have to assume he started out with two, then try to find any note in the EHR that indicates he lost one or more legs, to finally arrive at the current count. If we miss a record, we reach the wrong conclusion. You would be excused if you found it much more rational to check the actual patient and count his legs, in this situation.

When we paint our red house green, it is a green house from that point forward. However, if we reasoned according to medical records, it would still be a red house, albeit painted green on a certain date by a certain person who works in a certain department. If all I need to know is that the house is in fact green, that is a very circuitous description of a green house, but that is how we work. Actually, this example may seem contrived, but it’s over simplified. In real medical life, we would probably find records of the house being painted both blue, black, and all shades of pink, but unless we caught all these records and got them in the right order, it would be very difficult to be certain of the current color of that red house.

It’s painfully obvious that we absolutely must have a record of the current state of the patient in the EHR, but so far, I’ve not seen a single EHR system that even attempts to implement that. A curious state of affairs, indeed.