The population health record: concepts, definition, design, and implementation.

In 1997, the American Medical Informatics Association proposed a US information strategy that included a population health record (PopHR). Despite subsequent progress on the conceptualization, development, and implementation of electronic health records and personal health records, minimal progress has occurred on the PopHR. Adapting International Organization for Standarization electronic health records standards, we define the PopHR as a repository of statistics, measures, and indicators regarding the state of and influences on the health of a defined population, in computer processable form, stored and transmitted securely, and accessible by multiple authorized users. The PopHR is based upon an explicit population health framework and a standardized logical information model. PopHR purpose and uses, content and content sources, functionalities, business objectives, information architecture, and system architecture are described. Barriers to implementation and enabling factors and a three-stage implementation strategy are delineated.