shared care

1. Unit: IV
Subject: HEALTH/NURSING INFORMATICS
AND TECHNOLOGY

2. Challenges of capturing rich patient
histories in a computable form
1. Data Standardization & Interoperability
Patient histories are documented in diverse
formats (structured and unstructured).
Different healthcare systems and providers use
varying terminologies and coding standards (e.g.,
ICD, SNOMED CT (Systematized Nomenclature of
Medicine- Clinical Terms), LOINC(Logical
Observation Identifiers Names & Codes).
Lack of interoperability between electronic health
record (EHR) systems leads to fragmented data.

3. Challenges of capturing rich patient
histories in a computable form
2. Complexity & Variability of Patient
Histories
Medical histories include symptoms, past
illnesses, family history, medications, allergies,
social determinants, and lifestyle factors,
making structured capture difficult.
Patient-reported information is often
subjective and varies in detail.

4. Challenges of capturing rich patient
histories in a computable form
3. Natural Language Processing
(NLP) Challenges
•Much of the history is captured as
free-text notes, requiring NLP to
extract meaningful data.
•Clinical jargon (vocabulary),
abbreviations, and context-specific
meanings add complexity.

5. Challenges of capturing rich patient
histories in a computable form
4. Data Entry Burden & Clinician
Workflow
Physicians may find structured data
entry time-consuming and prefer free-
text notes.
Poorly designed interfaces can lead
to missing or inaccurate data entry.

6. Challenges of capturing rich patient
histories in a computable form
5. Longitudinal Data Tracking &
Evolution
Patient conditions change over time,
requiring ongoing updates and version
control.
Integrating data from multiple visits
and sources without redundancy is
difficult.

7. Challenges of capturing rich patient
histories in a computable form
6. Privacy, Security & Ethical
Concerns
Sensitive patient data must comply
with regulations (HIPAA, GDPR).
Balancing data accessibility with
patient confidentiality is a challenge.

8. Challenges of capturing rich patient
histories in a computable form
7. Integrating Social & Behavioral
Determinants of Health (SDoH)
Social and environmental factors
influencing health are hard to quantify and
encode in structured formats.
Capturing lifestyle habits (e.g., diet,
exercise, substance use) often requires
patient self-reporting, which may be
inaccurate.

9. Challenges of capturing rich patient
histories in a computable form
8. Incomplete or Inconsistent
Data
Patients may forget or misreport
medical history details.
Gaps in records due to care
received at different institutions.

10. Challenges of capturing rich patient
histories in a computable form
9. Technological Limitations
Legacy systems may lack
advanced AI/NLP capabilities for
structured data extraction.
High implementation costs for
intelligent, interoperable systems.

11. Latest global developments and
standards to enable lifelong electronic
health records to be integrated from
disparate systems.
​
Integrating lifelong electronic health
records (EHRs) from disparate systems is
a complex endeavor that has seen
significant advancements in global
standards and collaborative efforts. Key
developments include:​

12. Latest global developments and
standards to enable lifelong electronic
health records to be integrated from
disparate systems.
1. Adoption of HL7 FHIR Standard : The Fast
Healthcare Interoperability Resources
(FHIR) standard, developed by Health Level
Seven International (HL7), has become pivotal
in facilitating seamless electronic health data
exchange. FHIR employs modern web
technologies and standardized data formats,
enabling interoperability across various
healthcare systems and devices.

13. Latest global developments and
standards to enable lifelong electronic
health records to be integrated from
disparate systems.
2. Collaboration Between SNOMED International
and open EHR : In March 2025, SNOMED
International and open EHR entered a five-year
collaboration to enhance health data
interoperability. This partnership aims to combine
SNOMED CT's comprehensive clinical
terminology with open EHR's standardized EHR
specifications, promoting consistent and
interoperable health data management globally

14. Latest global developments and
standards to enable lifelong electronic
health records to be integrated from
disparate systems.
3. Emphasis on Semantic
Interoperability : Achieving semantic
interoperability ensures that
exchanged data is not only shared
but also meaningfully interpreted
across systems.

15. Latest global developments and
standards to enable lifelong electronic
health records to be integrated from
disparate systems.
4. Implementation of Data Privacy and
Security Standards:
Protecting patient data is crucial when
integrating electronic health records.
Compliance with regulations such as the
Health Insurance Portability and Accountability
Act (HIPAA) ensures that patient information is
kept confidential and secure.

16. Latest global developments and
standards to enable lifelong electronic
health records to be integrated from
disparate systems.
5. National Initiatives and Standards:
Countries are developing and adopting
national standards to guide EHR integration.
For instance, India's Ministry of Health &
Family Welfare released the Electronic Health
Record Standards for India, outlining protocols
for data privacy, security, and interoperability
to ensure consistent EHR implementation
nationwide.