EHR Information Lifecycle Model

For those of us familiar with information architecture, records management, enterprise content management, archival, retrieval, and search, the notion of an Information Life cycle is central to the concept of managing information.

This is not a new concept, but it's one that the Electronic Health Care industry seems to still be figuring out. It's also one that organizations need to start figuring out as they tranisition from a paper model to an electronic model. And I'm going to warn you -- if you are in the process of an organizational transition to electronic medical records, and haven't yet considered ILM, this post is going to hurt a little.

At present, the majority of EHR systems that are Commercial Off The Shelf (COTS) have internal mechanisms for user signing, time and date stamping, and then finalizing information. Often times when a clinician is working on a record, that feature is represented by a "file" button within the EHR system that changes the "state" of that document from draft to final. But what did that really do? Obviously, it depends on the system you are using, but here are some generalities.

On one hand, yes, it "saved" the data and created a final version, and then essentially stored all that data back in the database. But is it really a document? What if you want to retrieve that document? Where is that document located? Is it in multiple tables within the backend SQL database, and then reconstructed through a report viewer? How is the "state" of that document preserved?

And how and when does one migrate that document to the next phase of the information lifecycle -- the archival and long term storage phase? And where is that place? What is organizational policy and HIPAA regulation around document retention for the type of document that you have just created? How do you remove that document from your active environment, to an inactive environment in order to conserve space and performance? Where does it ultimately end up?

Any organization familiar with the overflowing chart room, a basement filled with boxes, and the clumsy attempt to scrounge up a specific piece of information in a cluttered room has experienced information lifecycle management in its most basic form.

Now, take the analogy and apply it to an electronic environment and one can quickly see that you've not necessarily solved your document management challenges simply by implementing an EHR - you've just created a different context in which those same challenges exist. Instead of a basement filled with boxes, you've got an old Maxtor 100 GB drive stuck in an outdated server somewhere in the basement.

And this is why, as a part of considering the implementation of an EHR, organizations also need to consider ILM. Do your electronic charts migrate outside of the EHR into a longer term storage solution? How does your EHR actually re-construct an electronic chart? How easy is it to print? How proprietary is the information stored within the system? Physically, where is the data stored? Does your organization understand and have policies dealing with geographically diverse data storage for catastrophic events? Does your organization understand access and performance curves related to frequency of accessing electronic information and how that relates to the cost of storing that information in an active utilization environment vs. migrating that data to a slow disk, low power consumption, stable media environment?

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