Thursday, January 6, 2011

Definitions Matter

In more than two decades of software development, I've become quite accustomed to having to deal with product builds where the final changes to a product were strictly replacing its name. This is usually because marketing either had a very late brainstorm, or someone higher up decided that we needed something catchier for a name. I'd long been accustomed to using code phrases to identify a release because we never knew what the name was going to be ... sometimes even on purpose.  I've also been very wary of believing I understood something just because someone used a name or three word phrase I recognized. I usually ask for definitions.

So, the latest ONC blog post providing definitions for EMR and an EHR shouldn't really bother me.  But it does, in part because this office already wasted $100K defining these terms.  It was Bush's ONC and not Obama's that wasted the money, but the current office could have at least had the courtesy to reference the previous report rather than ignore it and redefine the terms.  But the original report should have been buried anyway ... maybe I would have been happier if ONC had acknowledged the errors in that report and then redefined the terms.

The next part of the post that annoys me is the qualitative judgement applied to the names, that an "EMR" product has certain limits on features (e.g., equivalence to digital paper) and information exchange which an "EHR" solves.

I spent 10 years working on linguistic software.  One of the things that I learned during that period of time is how definitions change over time.  Today's Electronic Medical Record is a completely different thing that what we had 5 years or a decade ago.  Perhaps it is time to change the name, and call it an Electronic Health Record.  I guess I'll wind up leaving that issue up to marketing and politicians.  What I do know is that changing the name of a thing doesn't change what it IS, just the perceptions of it.  I'll just have to remember to use the latest HealthIT Buzz words, but if I happen to use EMR, please remember that I mean EHR.  I haven't ever worked on anything as limited as what ONC describes.

1 comment:

  1. Anything driven by a political process is likely to be ephemeral. HITSP, AHIC, HISPC, NHIN... are all fading memories from the Bush era.

    For this reason I am increasingly in favor of terminology that has persistent meaning for stakeholders. EMR, EHR, PHR, etc. are terms that did not arise from healthcare stakeholders. They are, instead, terms of art that I expect will eventually gain static definitions in case law rather than healthcare.

    I prefer technology-neutral terms like "health record" or "health data". These describe the knowledge domain and imply the stakeholders' value.