Research & White Papers
The record is not the event.
A medical record is a representation of clinical events, not the events themselves. These papers follow that principle from the review of a single chart to the design of the systems that produce it.
White Paper · The Original
The Record Is Not the Event
Why Medical Record Review Is Not Medical Event Reconstruction
Summarizing a chart is not the same as establishing what happened to a patient. This paper introduces Clinical Evidence Investigation, a framework that tests each chart entry against timestamps, EHR audit trails, and metadata.
For: attorneys, legal nurse consultants, and medical record reviewers
Read the paper (PDF)White Paper · 2026
The Record Is Not the Event
Why the Next Generation of Electronic Health Records Must Be Designed for Provenance, Reconstruction, and Forensic Readiness
EHRs show what the record says but rarely how it came to say it. This paper offers five design principles, a layered model for displaying provenance, and the Clinical Record Forensic Readiness Score (CRFRS) for assessing any EHR or clinical AI tool.
For: health system leaders, EHR vendors, clinical informaticists, and AI developers
Read the paper (PDF)White Paper · 2026
Data Interoperability Is Not Epistemic Interoperability
Preserving Meaning Across Clinical Information Exchange
Health information exchange can succeed technically while losing what the information means. This paper separates moving data from preserving its source, certainty, and history, and describes what must travel with clinical information for the receiving clinician to trust it.
For: interoperability and HIE teams, clinical informaticists, and health IT policy professionals
Read the paper (PDF)Discussion Draft · Japan
Provenance-Aware Clinical Information Systems for Japan's Healthcare DX
Japan is standardizing and connecting its healthcare information systems now, which is when provenance is easiest to build in. This discussion draft applies The Record Is Not the Event framework to Japan's healthcare digital transformation.
For: Japanese healthcare organizations, health IT vendors, and policymakers
Read the discussion draft (PDF)White Paper · 2026
The EHR as an Evidentiary System
Provenance, Layered Chronology, and the Next Generation of Digital Health
The medical record is routinely asked to do evidentiary work it was not designed for. This paper proposes the Layered Clinical Record, a model in which chronology, provenance, and transformation history are built into the record and its reporting output, with Japan's Healthcare DX as a case study.
For: EHR developers, clinical informaticists, healthcare risk and quality leaders, and health IT policymakers
Read the paper (PDF)