Writing in the Journal of the American Medical Informatics Association this past week, two health IT researchers put forth five use cases that help define what an "open" electronic health record should really look like.

Dean F. Sittig, professor of biomedical informatics at the University of Texas Health Science Center at Houston, and Adam Wright, medical informatics researcher in the Department of General Internal Medicine, Brigham & Women’s Hospital, use the term EXTREME – it stands for EXtract, TRansmit, Exchange, Move, Embed – to shape a definition of useful interoperability.

• An organization should be able to securely extract patient records while maintaining granularity of structured data.
• An authorized user can transmit all or a portion of a patient record to another clinician who uses a different EHR or to a personal health record of the patient’s choosing without losing the existing structured data.
• An organization in a distributed/decentralized health information exchange can accept programmatic requests for copies of a patient record from an external EHR and return records in a standard format.
• An organization can move all its patient records to a new EHR.
• An organization can embed encapsulated functionality within their EHR using an application programming interface. Goals: access specific data items, manipulate them, and then store a new value.

The five EHR use cases are similarly meant to help five distinct types of people: clinicians (enabling the delivery of safe and effective health care); researchers (helping advance understanding of disease and healthcare processes); administrators (reducing the need to rely on specific EHR vendors); software developers (so they can develop innovative applications); and patients (so they can access their personal health information anywhere).

Widespread access to EHRs that conform to the five EXTREME use cases "is necessary if we are to realize the enormous potential of an EHR-enabled health care system," Sittig and Wright contend.

"Health care delivery organizations should require these capabilities in their EHRs. EHR developers should commit to providing them," they write. "Health care organizations should commit to implementing and using them. In addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers to widespread health information exchange that is required to transform the modern EHR-enabled health care delivery system."

Read their full study here.