According to Becker’s Hospital Review, several experts from UCSF’s Center for Digital Health Innovation have outlined their vision for a Connected Health Record. Aaron Neinstein, MD, Mark Savage, and Ed Martin proposed that “we need a connected health record” and defined it as follows: “the connected health record achieves true completeness by focusing on the dynamic conversation, teamwork, interconnections, and diverse data sources inherent in managing health and healthcare today.”

As a concrete example, they discussed the shared plan of care that “all care team members can update [...] electronically in real time with inputs and outputs to and from a multitude of systems.” Communication is also a critical aspect of the Connected Health Record. “Recommendations and changes in care plan from any one of those providers will be communicated to and accessible automatically for the entire care team.”

This all sounds great! But where should it live? Not, the authors rightly argue, within the existing electronic filing cabinets: “the construct of electronic health record as electronic filing cabinet remains deficient” and “a chorus of physicians and patients is crying out that EHR systems are already cumbersome and inefficient. Imagine how much worse this might become if EHR systems grow and grow to accommodate new use cases.”

Perhaps it should be some other piece of software that connects to the filing cabinets via APIs. That would allow you to view all of your information that is in different EHRs, without needing to copy it all into a single institutional health record. In fact, this software already exists today. It is an app called Health Records, and it was created by Apple.

Of course, the patient controls this app, not any institution. But isn’t that how it should be? Isn’t that necessary to achieve the goal of a connected health record that stands apart from all the institutional records and the various electronic filing cabinets? Why should an institution be able to view another institution’s data? This violates basic business principles - the incentives are aligned against it. Only the patient and their health care proxies should control the complete, connected record of their health.

So far so good, but what about the shared plan of care and the communication between the patient, their family members, care navigator, and all of their health care providers at different institutions? We’re still missing a critical piece of the Connected Health Record.

But wait, are those things actually a health record at all? A shared plan of care that lives with the patient and is visible to everyone in that patient’s care team… the ability for any providers from different institutions to communicate with each other, as well as with the patient… that’s not a health record at all. It’s a Clinical Communication app! And this, too, already exists today.

Connect the health records and create a single view of all the data that the patient controls. Then, empower the patient to selectively share that information with anyone on their care team. Finally, give all those health care providers a living, shared plan of care that they can update in real time. Now that is connected health care!

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