It is interesting that the Booze reference on issues around data liquidity assume that the EHR is an application, and that data is something separate. In view of my involvement with openEHR (the basis for the ISO 13606 standard for EHR extracts) I take a slightly different view – that the EHR is actually the health data itself, not an application. This enables us to view the problems slightly differently.

One of the main reason why there is so much chaos at the moment is that we all use different ways of defining the same clinical content, so trying to align all of these is very difficult, maybe near impossible. We are turning ourselves inside out trying to devise sustainable ways of connecting ‘apples with pears’, not only now, but as a vehicle to take us into the future.

However if we adopt an approach in which we mandate a consistency of data definitions then exchange of data becomes simpler by orders of magnitude. These standardised content definitions become a foundation for eHealth, a logical record architecture. It is an approach that is gathering momentum in Europe. In openEHR these content specifications are known as archetypes. Archetyped data can be aggregated and combined to build and generate the documents, messages and shared applications that we need, whether CCR, CCD, software applications, integrated research databases, clinical decision support systems etc – a lingua franca of healthIT. The data will stand a better chance of becoming ‘liquid’ and ‘flowing’ if we have a very tight understanding of what each piece of data means and use it consistently.

The concept of archetypes or archetype-like standardised definitions seems to be largely missing in the eHealth discussion emanating from the US at present. Trying to achieve a single common language at the messaging or document level without common data definitions/specifications is fraught with problems as you so rightly point out in your post.