Longitudinal Patient Records: A Re-Examination of the Possibility

Abstract

It has long been recognized that the Longitudinal Patient Record (LPR) has been defined as “A life-long incremental process where each clinical encounter is merely an updating of the file” (Gabrieli, 1997) Understanding the health condition of patient longitudinally is very important to the care of the patient. However, it is not clear to what extent a longitudinal patient record is in fact possible, since a true longitudinal patient record would need to include all information for a patient, from cradle to grave, across all healthcare providers and systems, across all corporate or geographic or national boundaries. Compiling or maintaining such a record is a problem of staggering practical difficulties. Yet, there is no doubt of the potential benefit to the patient of the availability of such a record to the patient’s caregivers and providers. In this thesis, we re-examine the possibility of a longitudinal patient record, both in its pure logical sense, and in a practical sense. One point of view that we stress is to model the longitudinal patient record not so much as a static thing, but rather as a functional entity. That is, the longitudinal patient record is understood as a set of processes that provide the physician or other clinician decision maker (or for that matter the patient himself) with whatever longitudinal view of the patient information is available and practical to serve the current context of decision making. That is, the model we suggest is one of making the most out of whatever patient information is available to the decision maker.