The Ontological Status of
Electronic Patient Records
The delivery of health care is as old as civilization itself. Archeological findings give incontrovertible evidence of this fact, and already Babylonian records attest to the provision of health care as a socially validated undertaking. Indian, Chinese and Egyptian records bear similar testimony.
In the beginning, contact between health care providers and health care consumers was limited in scope. It encompassed the physician 1 and the patient in a direct and immediate personal interaction. In sociological terms, therefore, the scale of interaction was small.
Of course there were exceptions to this. For instance, physicians sometimes inquired about their patients' symptoms from other persons who stood in direct contact with the patients and who knew them. Further, in China and medieval Europe physicians were often not in direct contact with socially exalted patients but communicated with them only through intermediaries. However, these were noteworthy precisely because they were exceptions. In principle, direct contact with the patient through personal interaction and direct examination was the rule. Consequently, from an information- and decision-theoretical point of view, the touchstone of traditional medical diagnosis and treatment decision-making was the direct interaction between the physician and the patient, where patient- relative data were gathered in this inter-personal encounter between the physician and the patient her- or himself.
This traditional physician-patient encounter, being immediate, was a temporally limited and evanescent affair. At the same time, however, then as now, health care decisions frequently had to take into account data that were no longer available to direct medical inspection on a given occasion