A Better Health Record Should Show What Changed, Not Just What Was Measured

The following is a guest article by Lisa Zahakos, PA-C, Founder of HEART RESERVE

Imagine a woman opening her patient portal before a midlife checkup. Her latest cholesterol results are there. So is yesterday’s blood pressure. Somewhere else is a pregnancy discharge summary from fifteen years ago. She remembers being treated for high blood pressure then, but she does not know whether that belongs in today’s conversation.

The information may be available. The connection is still hers to make.

I began my career in interventional cardiology in 2003. My question for health IT leaders comes from the clinical side of the screen: can a woman and her clinician see what changed over time without having to reconstruct her history at every visit?

Pregnancy complications such as preeclampsia and gestational diabetes are associated with higher long-term cardiovascular risk. The American Heart Association’s 2024 scientific statement emphasizes opportunities for prevention after these events. Its menopause statement describes changes in cholesterol and other cardiovascular measures during the transition. Neither history means a woman automatically has heart disease. Both deserve a visible place in the record.

Put the History Beside the Measurement

A useful starting point is a shared timeline that patients can read and clinicians can verify. It should bring relevant pregnancy events, dated blood pressure and laboratory results, medication changes, menopause history, symptoms, and cardiovascular tests into one view. Each entry should retain its source and the date the event happened, even if someone entered it years later.

Consider a second, hypothetical example: a woman’s LDL cholesterol rises across several tests around the time her periods become irregular. A chronological view would help her clinician examine those changes together. It should not automatically attribute the increase to menopause. Medication changes, other health conditions, and the wider history still matter.

Home readings need context too. Show the measurement dates, whether values came directly from a device or were entered manually, and the readings included in any average. Keep a clinic measurement distinguishable from a home series. A polished graph should not make unlike measurements look interchangeable.

Make Uncertainty Visible

An empty pregnancy-history field cannot tell us whether a woman never had a complication, does not remember, was never asked, or received care elsewhere. Those are different situations. The record should allow each to be represented without quietly turning missing information into a reassuring answer.

Patients should be able to contribute what they know. “I needed blood pressure medicine after delivery” is useful information even before the original records arrive. Label it as patient-reported, retain her wording, and provide a route for clinical review. Do not automatically convert it into a confirmed diagnosis of preeclampsia.

The same care applies to symptoms. “I stop halfway up the stairs now” describes a change that a checkbox for fatigue may lose. Preserve when it started, what brings it on, and whether it has been reviewed. A timeline entry also needs clear instructions about where to seek care; entering a symptom must not imply someone is monitoring it.

Explain What a Test Answered

A result marked “normal” can be reassuring and still leave other questions open. An echocardiogram, for example, evaluates heart structure and function. A report of normal pumping function should not become a summary saying that every possible heart problem has been excluded.

Alongside the original report, include a brief, clinician-reviewed explanation of why the test was ordered, what it found, and any documented next step. Preserve the test type and date. That gives the next clinician something more useful than a checkmark beside “cardiac testing completed.”

Give the Summary a Source and the Next Step an Owner

AI may help assemble this history, but a readable summary needs to be checkable. Each clinical statement should link to the record that supports it. Conflicting dates or diagnoses should remain visible until resolved. An inferred explanation should never appear as an established fact simply because the sentence reads smoothly.

Patients need an accessible way to flag errors, with a named team responsible for review and a visible correction status. Corrected information should carry through to later summaries. Otherwise, a patient may have to challenge the same mistake at every appointment.

For a health system, the first implementation could be a focused view within an existing preventive-care workflow. Agree on who reviews the history, when that happens, and where follow-up is documented. Offer a printable version and a staff-assisted route for people who cannot use the portal. Pregnancy history should be optional and relevant, never a prerequisite for a woman to receive cardiovascular prevention.

Evaluate whether patients understand the summary, whether clinicians can identify relevant history faster, and whether agreed follow-up happens. Measure errors and staff workload too. Better presentation alone does not establish better clinical outcomes.

A woman should be able to open her record and recognize her own story. Her clinician should be able to check it and use it. That is the standard I would ask health IT teams to build toward: a record that helps both people understand what has changed and decide what deserves attention next.

About Lisa Zahakos

Lisa Zahakos, PA-C, has been a physician assistant in clinical practice since 2003 and began her career in interventional cardiology. Her work has included preventive medicine, psychiatry, addiction medicine, and patient education. She founded HEART RESERVE, an independent women’s cardiovascular health education platform at heartreserve.blog.

The following is a guest article by Lisa Zahakos, PA-C, Founder of HEART RESERVE

Imagine a woman opening her patient portal before a midlife checkup. Her latest cholesterol results are there. So is yesterday’s blood pressure. Somewhere else is a pregnancy discharge summary from fifteen years ago. She remembers being treated for high blood pressure then, but she does not know whether that belongs in today’s conversation.

The information may be available. The connection is still hers to make.

I began my career in interventional cardiology in 2003. My question for health IT leaders comes from the clinical side of the screen: can a woman and her clinician see what changed over time without having to reconstruct her history at every visit?

Pregnancy complications such as preeclampsia and gestational diabetes are associated with higher long-term cardiovascular risk. The American Heart Association’s 2024 scientific statement emphasizes opportunities for prevention after these events. Its menopause statement describes changes in cholesterol and other cardiovascular measures during the transition. Neither history means a woman automatically has heart disease. Both deserve a visible place in the record.

Put the History Beside the Measurement

A useful starting point is a shared timeline that patients can read and clinicians can verify. It should bring relevant pregnancy events, dated blood pressure and laboratory results, medication changes, menopause history, symptoms, and cardiovascular tests into one view. Each entry should retain its source and the date the event happened, even if someone entered it years later.

Consider a second, hypothetical example: a woman’s LDL cholesterol rises across several tests around the time her periods become irregular. A chronological view would help her clinician examine those changes together. It should not automatically attribute the increase to menopause. Medication changes, other health conditions, and the wider history still matter.

Home readings need context too. Show the measurement dates, whether values came directly from a device or were entered manually, and the readings included in any average. Keep a clinic measurement distinguishable from a home series. A polished graph should not make unlike measurements look interchangeable.

Make Uncertainty Visible

An empty pregnancy-history field cannot tell us whether a woman never had a complication, does not remember, was never asked, or received care elsewhere. Those are different situations. The record should allow each to be represented without quietly turning missing information into a reassuring answer.

Patients should be able to contribute what they know. “I needed blood pressure medicine after delivery” is useful information even before the original records arrive. Label it as patient-reported, retain her wording, and provide a route for clinical review. Do not automatically convert it into a confirmed diagnosis of preeclampsia.

The same care applies to symptoms. “I stop halfway up the stairs now” describes a change that a checkbox for fatigue may lose. Preserve when it started, what brings it on, and whether it has been reviewed. A timeline entry also needs clear instructions about where to seek care; entering a symptom must not imply someone is monitoring it.

Explain What a Test Answered

A result marked “normal” can be reassuring and still leave other questions open. An echocardiogram, for example, evaluates heart structure and function. A report of normal pumping function should not become a summary saying that every possible heart problem has been excluded.

Alongside the original report, include a brief, clinician-reviewed explanation of why the test was ordered, what it found, and any documented next step. Preserve the test type and date. That gives the next clinician something more useful than a checkmark beside “cardiac testing completed.”

Give the Summary a Source and the Next Step an Owner

AI may help assemble this history, but a readable summary needs to be checkable. Each clinical statement should link to the record that supports it. Conflicting dates or diagnoses should remain visible until resolved. An inferred explanation should never appear as an established fact simply because the sentence reads smoothly.

Patients need an accessible way to flag errors, with a named team responsible for review and a visible correction status. Corrected information should carry through to later summaries. Otherwise, a patient may have to challenge the same mistake at every appointment.

For a health system, the first implementation could be a focused view within an existing preventive-care workflow. Agree on who reviews the history, when that happens, and where follow-up is documented. Offer a printable version and a staff-assisted route for people who cannot use the portal. Pregnancy history should be optional and relevant, never a prerequisite for a woman to receive cardiovascular prevention.

Evaluate whether patients understand the summary, whether clinicians can identify relevant history faster, and whether agreed follow-up happens. Measure errors and staff workload too. Better presentation alone does not establish better clinical outcomes.

A woman should be able to open her record and recognize her own story. Her clinician should be able to check it and use it. That is the standard I would ask health IT teams to build toward: a record that helps both people understand what has changed and decide what deserves attention next.

About Lisa Zahakos

Lisa Zahakos, PA-C, has been a physician assistant in clinical practice since 2003 and began her career in interventional cardiology. Her work has included preventive medicine, psychiatry, addiction medicine, and patient education. She founded HEART RESERVE, an independent women’s cardiovascular health education platform at heartreserve.blog.