I’m new to openEHR and have a question regarding its structure. In openEHR, is it necessary to create one EHR per patient, with each EHR including all different compositions (such as observations, encounters, and other clinical data) related to that patient?
Or is it possible to use a single EHR to manage multiple patients and their compositions?
I’m looking for guidance on whether the standard practice is to maintain separate EHRs for each patient, or if there are alternative approaches that might allow for a different structure.
A single EHR is meant to be used as the root/container of clinical data for a single subject. That subject is a patient in almost all the cases. I’m being careful just in case there is a theoretically possible but practically not observed situation where the subject is not a patient but another actor, but I cannot remember an example of that.
So in response to your question, I’d say there are not alternative approaches. One patient may end up with more than one EHR due to clinical info being kept in multiple systems, then ending up in the same system, or mistakes due to misspelling patient name etc, but even in those cases the EHR itself has one subject. Take a look at EHR Information Model (openehr.org) and openEHR Architecture Overview You’ll see " patient-centric, longitudinal health record" mentioned in the architecture document. The patient-centric is the key when thinking about an EHR.
This is a good question by the way, we should clarify this in the specifications. Thanks for asking.
Some examples mentioned in the past (that I know of):
when you need to cover the case of a mother-fetus problems from child perspective → is that really to be saved in the mother’s EHR?!
organ donors issues which need to to record aspects referring two individuals
group treatment in mental care - although that might debatable if you really need to record something in the context of the group (I guess most of care entries are always in a relation with a person, not with the group - but you might need admin_entry for the group)
In any case, openEHR is still “pacient centric …” as mentioned above. Workarounds are possible, but it will defeat the purpose.