By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    physical health
    5 Ways Playing Games Can Improve Neural and Physical Health
    September 9, 2022
    Reasons For Hair Loss and Its Treatment
    Reasons For Hair Loss and Its Treatment
    February 16, 2022
    healthcare organization
    5 Actionable Strategies For Healthcare Organizations
    August 15, 2022
    Latest News
    7 Most Common Healthcare Accreditation Programs: Which Should You Use?
    August 20, 2025
    Hospital Pest Control and the Fight Against Superbugs
    August 20, 2025
    Hygiene Beyond The Clinic: Attention To Overlooked Non-Clinical Spaces
    August 13, 2025
    5 Steps to a Promising Career as a Healthcare Administrator
    August 3, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    4 Reasons Chris Cornell’s Death Raises Medical Ethics Questions
    December 19, 2018
    What If You Could Sell Your Vote?
    August 24, 2017
    The Sleepy American
    September 12, 2017
    Latest News
    How Social Security Disability Shapes Access to Care and Everyday Health
    August 22, 2025
    How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
    August 22, 2025
    How One Fall Can Lead to a Long Road of Medical Complications
    August 22, 2025
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: How to Design Next-Generation EHR Data Models
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > eHealth > Medical Records > How to Design Next-Generation EHR Data Models
eHealthMedical Records

How to Design Next-Generation EHR Data Models

ShahidShah
ShahidShah
Share
7 Min Read
SHARE

 

 

Today’s reality of patient management is “disjointed care” and most of the collaborators in a patient’s care team don’t know what each other is doing for the patient in real time. Knowing all the different participants in the patient’s care team (providers, payers, family members, etc.) and coordinating and integrating their electronic activities is what successful EHRs must handle with ease as they look to graduate from basic retrospective documentation systems to modern patient collaboration platforms. Current EHR apps are usually restricted to “legal entities” (e.g. a single hospital or a hospital system or single ambulatory practice). To manage integrated and coordinated care, successful EHR systems must open themselves up beyond legal boundaries but most of them have created their databases and data models to preclude that capability.

Most existing EHRs, even modern ones that were built for Meaningful Use, have traditionally done a poor job understanding and designing “multi-entity” or “multi-tenant” database models that would encourage secure, trusted, electronic collaboration between legal organizations (e.g. two hospitals or multiple clinics) and patients as they move across entities.

More Read

9 Great HealthCare Phone Apps
Three Ways a UCaaS System Can Improve Healthcare
Leading in Social at Cleveland Clinic
MHealth, Technology, and the Invisible Patients
How Social Media Can Help Address the Diabetes Pandemic

This is due not to the lack of availability of good design patterns but a lack of comprehension that tomorrow’s shared savings initiatives, capitated payment models, ACOs, and PCHMs require a level of coordination and amount of measurements of quality metrics that are tough to define, implement, and secure. Future EHRs cannot be seen as applications alone but as broad care coordination platforms that must allow dynamic business models that can accommodate a great deal of uncertainty and flexibility, especially with respect to legal boundaries. When you move from the certainty of supporting users inside a single organization to working with the uncertainty of multi-organization relationships and user communities, application architectures and data models must accommodate more fluid workflows that can change potentially daily or weekly based on the demands of new participants.

The healthcare IT applications development community needs to learn that data modeling is not just a technical exercise – that’s what leads to bad designs that don’t incorporate next generation business models. You can’t define a data model with a bunch of engineers and other geeks sitting around a table. Data modeling is about understanding all of the uses of the data, the relationships and attributes involved in the data, and, most importantly, how the data management approach will grow and change in the future. It’s the last part (extensibility of the database) that developers often forget when designing most systems. All this involves direct communication with end users, stakeholders, and other non-technical personnel. Too often, databases are treated as a file cabinet—just let your application toss whatever is necessary in there and then deal with organizing it later. But in the emerging world of ACOs and PCMH that won’t be possible.

Here are the kinds of attributes that next generation EHR data models must support:

  • Flexible patient-centric “person” models. Modern and extensible databases model patient (consumer), physician, nurse, staff member, administrator, contact, insurance policy holders, and related data as Person records. Instead of having a separate table for each type of person (for example, a different table for a patient versus a physician), you should try to model the different person types in a single inheritable and related table.
  • Flexible multi-facility “organization” models. The same goes for organizations. Facilities, tenants, hospitals, insurance providers, departments, clinics, administration, and related data should be grouped into something conceptually called an organization. Any entity that isn’t a Person type will likely fall into the Organization record type category—a single table with appropriate attributes should work fine.
  • Support for robust patient identification and de-duplication. When working in a multi-entity legal framework, there won’t be a single patient identifier to rule all the systems. Good data models allow an unlimited number of mappable identifiers for any entity—a primary key for internal consistency plus any number of external identifiers. Every Person record should allow an extensible set of identification values to use for both ID lookups and de-duplication requirements that crop up when integrating multiple systems.
  • Support for separation of PHI from clinical and transactional attributes. A good design is to put PHI data into one database (configured with proper security), and put the clinical, business, and other attributes into another database.
  • Support for multiple simultaneous entity roles. Each entity in the database, such as person or organization, should be able to support multiple entity roles. We have already described that a Person record should be created in a common table for patients, physicians, nurses, and so on, and why that makes sense. However, think about the scenario where a nurse at a hospital may also be a patient in the same hospital. Instead of duplicating records, the same record could take on dual roles; in this case as both a nurse and a patient.
  • Support for long-term storage and change management (revision control) of all entity attributes. When data lives for a long time, it can change. Extensible databases support long-term storage, change management of the database structures, and revision control of the data (records).
  • Support for multiple applications and devices within the same structures. When creating a database always assume that multiple applications will write to the same database. This means that for every record written you should trackwhich application wrote or changed the record and perhaps on which device.

TAGGED:EHRs
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

travel nurse in north carolina
Balancing Speed and Scope: Choosing the Nursing Degree That Fits Your Goals
Nursing
September 1, 2025
intimacy
How to Keep Intimacy Comfortable as You Age
Relationship and Lifestyle Senior Care
September 1, 2025
engineer fitting prosthetic arm
How Social Security Disability Shapes Access to Care and Everyday Health
Health care
August 20, 2025
a woman explaining the document
How a DUI Lawyer Can Help When Your Future Health Feels Uncertain
Public Health
August 20, 2025

You Might also Like

hwc linkedin
Social Media

Join Our LinkedIn Group!

October 22, 2013

Micro Apps for SMART

March 9, 2011
diabetes infogaphic
Social Media

Great Healthcare Infographics: 2 Things Your Data Visualization Needs

September 16, 2013

New Technology Improves Branding for Retail Health

July 5, 2013
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?