The 'Core Data Set' - How much Information is Really Needed?  |  October 10, 2008  

I am writing this posting en-route from Singapore back to Vancouver. I have spent the past 10 days working with the Singapore Ministry of Health Holdings (the group designated to develop and implement Singapore's Electronic Health Record).

Over this time, I have had an opportunity to meet a wide range of individuals in Singapore, participate in a GP IT Forum and visit a number of clinic settings as well as see some Singapore developed EMR systems in action - a very interesting experience.

As an external consultant, what struck me most markedly about the Singapore environment is the pragmatic nature of the people when it comes to developing solutions. And this got me thinking about a very important question that all healthcare systems face in terms of the type and amount of information that needs to be shared between a physician's EMR system and the broader healthcare community through the Electronic Health Record.

There are two opposing forces at play in Canada in terms of information sharing between the physician's medical practice EMR system and the regional or provincial EHR's that are either being used or are in the process of being developed. Physicians in private practice settings are extremely sensitive about issues relating to patient privacy, particularly with respect to sensitive information e.g. sexually transmitted disease history, history of termination etc. Physician are answerable to there provincial licensing body (College of Physicians and Surgeons) in terms of performance (or lack thereof) and the College establishes the rules and guidelines by which physicians are measured. Ask any physician what it feels like to receive a personally addressed letter from the College and they will tell you it is generally associated with angst. At the same time, Electronic Health Record strategies are in development across Canada, initially providing view access to physicians and other healthcare providers who have received the appropriate authority to access those records, but with a later expectation that certain information will be shared from private practice physicians EMR systems to the EHR.

In British Columbia there has been a great deal of debate and negotiation between the BC Medical Association and the Ministry of Health which resulted in the definition of a core set of data that would be shared from (primarily GP EMR systems) back to the EHR. This has not been without controversy.

My question though revolves around how much information is really needed to provide good quality care and essentially get the job done? This is a rhetorical question. I do not know the answer. If you ask private practice physicians, they will likely tell you 'as little as possible' and if you ask EHR system developers they will answer ' as much as possible'. So, where is the middle ground?

Alan Brookstone
Canadian EMR