A Shared Health Record (SHR) facilitates the sharing of clinical information between health information systems to enable better patient care thus improving health outcomes.
The SHR is a means of allowing different services to share health data stored in a centralized data repository. It contains a subset of normalized data for a patient from various systems such as Electronic Medical Record (EMR) or Laboratory Information Management System (LIMS). This record is queried and updated between the different institutions and systems that are authorized to do so. An SHR is distinct from a data warehouse; it is an operational, real-time transactional data source.
A point-of-care system (ie: LIMS, EMR) should be able to store a useful subset of a patient’s clinical information from that system such as a care plan, allergies, test results or a care summary. The SHR may store document-based data along with associated metadata e.g.an X-ray image with attached patient demographic metadata.
A client/POC system should be able to retrieve relevant portions of this shared clinical record as needed, for example: Retrieve a longitudinal list of observations relating to the patient, either by encounter or by observation type; or Retrieve one or more documents related to a patient by document type or date.
A client/POC system should be able to update existing clinical records in the SHR, for example: Update observations for specific encounters; Replace a specific document with an updated version
An data warehouse system should be able to retrieve copies of the clinical data for reporting and research purposes where authorised to do so.
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A Shared Health Record assessment is an analysis of a health system’s ‘current state.’ The assessment supports the identification of problems to be solved, stakeholders, goals/benefits, systems/data, applicable standards, and challenges/barriers. This process will lay the groundwork for the implementation of a Shared Health Record.
Stakeholder leadership is essential for supporting the successful implementation of a Shared Health Record. Effective leaders should be identified and join together to form an stakeholder leadership group for the development and implementation of an Shared Health Record. The group should have shared ownership of the Shared Health Record and be committed to the outcomes.
A Shared Health Record should be responsive to users’ needs and the local context. User stories and data specifications are two ways to describe: “What will the Shared Health Record achieve and How should it operate?” A primary objective of this guide is to promote and facilitate a country driven and user requirements based process. To complete Step 3 an in-country meeting of stakeholders is highly recommended and can expedite the process.
Using the draft specifications and user stories developed in Step 3 as a foundation to move forward, the next step is to determine resources and develop the project plan to support the implementation process of the Shared Health Record. This step will include selection of software, determining hardware needs, and software validation/testing.
After scaling the Shared Health Record and initiating the core integrations, it should be expected that requirements and requests for the registry will evolve over time. For this reason, ongoing support and continued iterative support strategies should remain in place. This can be organized by the roles of the technical support and implementation teams to triage requests for data, system enhancements, integrations, operations support or general troubleshooting among users.
During post production it is important to capture lessons learned. One helpful exercise is to have the team make two lists. The team should document what went well and should be done that way again as well as the things that can be done better next time. This exercise is important as this process is meant to be iterative.
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