I. Community Health Record Data-Collection and Reporting Limitations

1. There is a lack of standardization for the naming of data elements that would compose a CHR, and for the types of data that should be collected.

2. Consensus is absent around which data sets and indicators are using valid data-collection methods. Consensus would improve reliability of the data and allow for comparison of data sets across different regions. State health departments may be charged with collecting and populating the broad data for CHRs and making them available in their states, but these efforts should not limit local flexibility to add additional indicators and evolve the CHR data standard.

3. CHR data should be reported at the most granular level available; often, data collected today is at state and county levels and lacks zip code– or census tract–level granularity. There should be a concerted effort to collect and report data at the most granular level that is reasonably possible, subject to arriving at validated metrics. Consistency of reported data needs to be established.

4. There is a lack of methods for the interoperability of CHR data, which contributes to the difficulties of comparing data across regions.

5. Data comparisons across communities are not always time-consistent; there is no standardized method for accurate time-stamping of data (such as a date [month–day–year] standard with clear guidelines for when data are collected and reported). For example, two data sources may list a “publish date” of 2014, but the data were collected from different years, which makes data comparability not only difficult but potentially misleading.

6. CHR-level data sources are limited today, but as EHR and PHR data become more prevalent and reach critical mass coverage in certain geographic areas, CHR data may include aggregation of certain EMR–EHR-level and PHR-level data. Therefore, it would be efficient during CHR standard-creation efforts to map to existing clinical data standards when relevant and appropriate.

7. As individuals move from community to community, data may show up in more than one region. Methods are lacking for deduplication of individual data when real-time aggregation of record-level data becomes more viable.

II. Community Health Record Application Limitations

1. There is a lack of standardized summary scores and indexes that allow for rapid and efficient data consumption and use of (what is sometimes voluminous) community health data.

2. Community health data are rarely used today to inform health care delivery strategies, such as clinical quality initiatives. Data are available, but not easily found and not commonly used.

3. Community-level data historically have not been made available to the community in easy-to-use formats, nor are there standard data APIs for application and service developers who could leverage these data to add value and improve community health.

III. Community Health Record Financial Constraints

1. Many communities feel that they lack the financial resources to collect and report community-level health data.

2. States and communities are left to their own discretion as to level of investment in collecting and reporting data; some states charge fees to access the data that have been collected.

3. There are few incentives for community stakeholders to consume and act on community health data (such as community health bonds and other potential methods of providing incentives for mid- and long-range community health planning).

IV. Community Health Record Privacy Limitations

1. Although guidelines exist for HIPAA-compliant de-identification for aggregated data sets, there is the potential risk of identifying individuals through triangulation of aggregated data when data are reported in small numbers and rural areas. Specifically, in the future, when we aggregate EMR and PHR data, this raises concerns of privacy and shows the need for ongoing guidelines for this issue.

Note. API = applied program interface; CHR = community health record; EHR = electronic health record; EMR = electronic medical record; HIPAA = Health Insurance Portability and Accountability Act; PHR = personal health record.