Power of expression in the electronic patient record: structured data or narrative text?

This paper presents the authors' experience with the development and use of a document-centered electronic patient record (EPR) in a large teaching ho spital. The development of the document-centered EPR began with the formula tion of a set of critical hypotheses to facilitate both the continuation of the best medical practice and the implementation and use of the EPR. An al ternate and more conventional approach - the data-centered EPR - is compare d with the document-centered EPR. Various benefits and pitfalls are discuss ed. Finally, the choice was to offer both solutions in a tightly linked sys tem. The need for an EPR which combines the document and data centered appr oaches is a reflection of the more general discussion of what the medical r ecord will be in the future. All too often, the need for structured data co nflicts with the need for free texts and the power of expression. It is not easy to evaluate the consequences of this initial decision. However, chang ing the foundations of the EPR after its implementation is difficult and ex pensive. Therefore, the selection of the correct orientation in a given hos pital requires a broad-based discussion. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.