A term used to describe the collection information generated to record the clinical care and health status of an individual or group. Health records are also known as medical records, paper-based health records, clinical records, healthcare records, digitized health records, electronic health records, electronic medical records, and personal health records.
Published in Chapter:
Evolution of the Health Record as a Communication Tool to Support Patient Safety
Trixie Elizabeth Kemp (University of Tasmania, Australia), Kerryn Butler-Henderson (University of Tasmania, Australia), Penny Allen (University of Tasmania, Australia), and Jennifer Ayton (University of Tasmania, Australia)
Copyright: © 2021
|Pages: 29
DOI: 10.4018/978-1-7998-6618-3.ch008
Abstract
This chapter provides a brief history of health records development through the ages, from ancient Mesopotamian clay tablets through to today's electronic health record. An understanding of where we have come from informs future direction and enhances knowledge. While the content and method has evolved, the need to document health information has been consistent for over 4000 years. The central premise has always been to support quality health care through quality information. This chapter will explore the link between health records and patient safety.