Where should electronic records for patients be stored?

Vijay Lapsia, Kenneth Lamb, William A. Yasnoff

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Introduction: The importance of a nationwide health information infrastructure (NHII) is widely recognized. Patient data may be stored where it happens to be created (the distributed or institution-centric model) or in one place for a given patient (the centralized or patient-centric model). Minimal data is available regarding the performance implications of these alternative architectural choices. Objective: To help identify the architecture best suited for efficient and complete nationwide health information exchange based on the large-scale operational characteristics of these architectures. Design: We used simulation to study the impact of health care record (data) fragmentation and probability of encounter on transaction volume and data retrieval failure rate as markers of performance for each of the above architectures. Results: Data fragmentation and the probability of encounter directly correlate with transaction volume and are significantly higher for the distributed model when the number of data nodes >4 (p

Original languageEnglish (US)
Pages (from-to)821-827
Number of pages7
JournalInternational Journal of Medical Informatics
Issue number12
StatePublished - Dec 2012


  • Electronic Medical Record
  • Health Information Exchange
  • Health Record Bank
  • National Health Information Infrastructure
  • Patient-Centered Medical Home
  • Personal Health Record

ASJC Scopus subject areas

  • Health Informatics


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