EHR, EPR, PS, PHR: Different Medical Records for Different Aims: Roles of Doctors, Patients, and Institutions

Abstract

Information and communications technology (ICT) in the health area is changing. In the past few years ICT innovation has flourished, producing innovative tools, applications, and devices. It seems that this new era, started by the web2.0 revolution, has also affected the health sector. Different cultural movements and scientific associations have arisen, with the aim of moving the paradigms fostered by web2.0 into the health sector, appropriating for themselves concepts such as sharing, collaboration, open source, social networks, user engagement, pervasive computing, distributed knowledge, pervasive and participative actions, and networks of communities. Innovative medical models have also been presented. Precision medicine, system medicine, pathology networks, and access to centers of medical excellence are focused on the massive use of clinical information and, in some cases, molecular data, using mathematical algorithms and sharing data, with professional collaboration overcoming the barriers created by the different agencies involved in the complex processes of care. We think, and the literature seems to agree, that traditional medical records are not able to support the meeting between new needs, new technologies, and new medical models. In this chapter we will explore how these changes affect the traditional concept of medical records and we will show that such changes must be incorporated in an overall environment that requires introducing the notion of a health ecosystem. This ecosystem is based on clear concepts such as the doctor-patient relationship, narrative conversations, federative architectures, big data, usage of algorithms, patient empowerment, and user-centered design.