International Journal of Medical Informatics 58 – 59 (2000) 101 – 110 Power of expression in the electronic patient record: structured data or narrative text? Christian Lovis a , Robert H. Baud b, *, Pierre Planche b a Health Serices Research and Deelopment Veterans Affairs, Puget Sound Health Care System, Seattle, WA, USA b Medical Informatics Diision, Uniersity Hospital of Genea, Genea, Switzerland Received 27 January 2000; accepted 14 April 2000 Abstract This paper presents the authors’ experience with the development and use of a document-centered electronic patient record (EPR) in a large teaching hospital. The development of the document-centered EPR began with the formulation 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 alternate and more conventional approach — the data-centered EPR — is compared with the document-centered EPR. Various benefits and pitfalls are discussed. Finally, the choice was to offer both solutions in a tightly linked system. The need for an EPR which combines the document and data centered approaches is a reflection of the more general discussion of what the medical record will be in the future. All too often, the need for structured data conflicts with the need for free texts and the power of expression. It is not easy to evaluate the consequences of this initial decision. However, changing the foundations of the EPR after its implementation is difficult and expensive. Therefore, the selection of the correct orientation in a given hospital requires a broad-based discussion. © 2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Document centered electronic patient record; Structured data www.elsevier.com/locate/ijmedinf 1. Introduction The development of a new electronic pa- tient record (EPR) can occur in two pre-exist- ing and extreme contexts. First, a legacy system may already be in place, possibly with existing departmental applications. The pre- existing system can act as a feeding source for the EPR. Second, if in place, the existing systems are not expected to interact with the new developments and everything has to be built from scratch. The specific situation of any given hospital is always somewhere be- tween these two extreme prototypical situations. In the presence of an existing information system (IS) — the so-called legacy system — the EPR benefits from a pre-existing source of information. For the benefit of the EPR, it * Corresponding author. E-mail address: robert.baud@dim.hcuge.ch (R.H. Baud). 1386-5056/00/$ - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved. PII:S1386-5056(00)00079-4