The need to know the history of the use of digital patient data, in particular the EHR

The purpose of this article is to explore the need for the possibility to reconstruct electronic medical data, in particular the electronic health record (EHR) as they have been or could have been presented to a specified health care professional at a specified moment in the past. The approach taken is that first the need for such functionality is discussed with attention to the differences between electronic records and paper records in this respect. Next the architectural and technical consequences of the implementation of the functionality are considered. The article concludes that such functionality is needed for medical audit, self assessment and handling of complaints. It further concludes that it is far from easy to implement the functionality. If the health care community underwrites the need for such functionality this will have a significant impact on the architecture of medical information systems and the (distributed) EHR. It is recommended that the professional associations and the governments, in collaboration with WHO, take a position on the need to be able to reconstruct the contents of the EHR. IMIA could take the lead in that process.