The EHR is rather a unique document and a layered approach is necessary as old data must never be altered - may not necessarily be accessible but must never be altered. Errors can be corrected but the error must remain totally accessible in the manner it was presented to the clinician when it was relied upon - eg clinical results, medications. The concept of layering new information on old is important. There does have to be lock outs or transaction controls when new data is being entered in but there is no need for old material (old may be seconds of course)to be locked out cause it can't or shouldn't be changed. If two doctors are entering elements of say a discharge summary then one cannot edit while another is adding - it needs a message indicating someone else is working on the current document and wait. It is more complex than that but the basic principle applies old data never changes even old addresses must stay. Legally it is important to be able to reproduce exactly the circumstances that the computer presented to the clinician at any point in time for inquests, litigation etc. We are dealing with these issues today with our CIS and it is a challenge.
David Evans Brisbane Australia - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
