What's in a name?


It may look like a duck and quack like a duck, but does that mean we absolutely have to call it a duck?

Pondered by philosophers throughout the ages, that question comes to mind again in the wake of the news that, contrary to impressions given recently by the secretaries of the Department of Defense (DoD) and the Veterans Administration (VA), efforts to develop a single EHR for the two mammoth agencies are not dead.

Maybe.  Well, it depends on how you define EHR. And therein lies the rub.

This article has some follow-up questions for high-level officials following the recent announcement by Secretaries Panetta and Shinseki, and these officials maintain that rumors of the demise of the so-called iEHR “have been greatly exaggerated.”

According to Elizabeth McGrath, deputy chief management officer at DoD, “future plans for iEHR include using common data standards, pulling together authoritative data sources, taking a service-oriented approach, the utilization of an enterprise services bus that enables us to move data to the place it needs to be in a standard way.”

The last part of that sentence –“to move data to the place it needs to be in a standard way” – is to us the most intriguing part, as it points to what seems increasingly challenging about the language used to describe the goals of the health IT transition in general, and the quest for ubiquitous EHRs specifically.

Is an EHR primarily a storage mechanism? On one level, obviously.  But, ideally, it will be accessible to so many people over the course of a lifetime -- people from different backgrounds with different specialties looking for different bits of data -- that it will be a storage mechanism with the mother of all open-door policies.

It’s not our intention to get caught up in games of semantics.  It’s just that language means something, or perhaps more relevantly, language signals goals that, in this case, have implications when it comes to things like effectively using public resources.

So every once in a while it seems worth simply asking the question, What are we talking about?

Perhaps it’s best to give an example.  Here’s the final quote from VA CIO Roger Baker: “Our goal is to make certain that we are creating a single medical record for all patients.”

Now, let’s edit it a bit: “Our goal is to make certain that we are creating the capacity for all patients to have access to their medical information any time, any place.”

Given the pace of technological change, and given the resulting constant increase in the malleability of data, what’s that going to be called?