Are we telling the real [Health] Story?

Are we missing the boat when we talk about structured data, meaningful use and the Health Story Project?

The Health Story Project is an initiative founded originally by Alschuler Associates, LLC, M*Modal, AHIMA, AHDI, MTIA, and supported now by many other members of the healthcare community. Its purpose is to translate clinical information provided through dictation and narrative reports into a language that can be accepted by, shared between, and used in electronic health records.

The Health Story (formerly CDA4CDT) does this in two ways:

  1. By creating and promoting a standard for the exchange of structured data through HL7 CDA (Clinical Document Architecture).  Adoption of this HL7 data standard supports interoperability – the ability to access and share the valuable information that was previously locked deep inside the narrative. It also supports meaningful use guidelines by providing the ability for healthcare providers to structure data provided in a narrative report such that it can be understood by an EMR.
  2. Creating the content standards for the most common document types – so far for consultation reports, history and physical reports, operative notes, procedure notes, discharge summaries, and DICOM.

We are all abuzz these days about item number 1 – everyone wants to talk about meaningful use and the EMR/EHR.

The Health Story Project solves the problem of getting information out of the narrative and into the EMR, doesn’t it?

Well, not quite….regardless of how the CDA document is created, through Speech Understanding or by the application of a more traditional NLP followed by human validation, there is still a big gap that we aren’t talking about.

Let’s say we’ve got this beautifully structured report – all ready to go. Now what? How does it get into the EMR? Osmosis? Telekinesis? Vulcan mind meld?

How many EMRs are accepting the Health Story standards?  How many healthcare providers know about the Health Story?

I work for M*Modal.  We’ve been creating CDA documents as our native format through our Conversational Documentation Services (CDS) since day 1. For documents that are typed from scratch, or created with the help of our Speech Understanding process, we’ve been there, done that, have the T-shirt. It’s not a big deal for us – everyone who knows us, knows we used the term “Meaningful Clinical Document” to describe documents created in our native CDA format long before the term “meaningful use” was coined.

And do you know what happens? Many (not all!) of our partners strip all the structure OUT of the document – and deliver straight text back to their healthcare provider customers.  GASP! You mean they HAVE structured documents, already in CDA format, and they are WASTING them?

Well sure they are. Why? The easy answer is because the healthcare provider customer has no way to consume the CDA. The EMR doesn’t accept it.

But I think there is another answer to this question. Many of our partners aren’t using the Health Story standards to drive content because we are by and large in this industry still providing content based on preference, not on usefulness.

Here is my take.  We are MISSING a big part of what the Health Story project is about.  Sure, it is about creating the HL7 CDA data standard for exchange of structured clinical data, blah, blah, blah.

But look up above at item number 2!  We forget that a big part of the Health Story discussion is deciding what CONTENT is useful, and should be a part of, the common document types.

Healthcare providers NEED to see a chief complaint in an H&P. They need to see allergies, medications, and past medical history. They should have a hospital course section in a discharge summary in order for it to be useful.

The content, the information, is what is important about that document! That is the core truth that we forget during all this talk about structured data.

But do your healthcare provider customers KNOW about this? Do they know that you can help them to define standards for useful content requirements for their work types?

Even if the EMR is not accepting the Health Story HL7 CDA data standard, the sheer availability of the standard content is in and of itself of tremendous value.

So why are we scrambling around trying desperately to accommodate requests for hanging indents and worrying about widowed and orphaned lines on a printed page when we know these things don’t matter for healthcare and that paper is going away?

Why are hospitals succumbing to the traditional speech rec vendor mantra “you get what you say – type what you hear” in pursuit of the cheapest line, when standards for meaningful documentation are more cost effective for the facility in the long run?

We should be telling the healthcare providers that we can help them achieve the CONTENT they need to provide high quality patient care, to support coding and billing and revenue cycle management, to add value to analytics and abstraction – to support the entire spectrum of healthcare’s use of documentation.

If your healthcare provider customers knew you had the ability to provide these content standards for meaningful, truly useful documentation WITHOUT forcing their doctors to adopt a process they DON’T want – don’t you think they’d put pressure on the EMR vendors to accept the Health Story’s HL7 data standard?

But if they don’t understand the value of what you can do for them – why would they care about anything beyond the cheapest line they can find?

We all agree that the narrative is important. We all know doctors don’t like having to enter their own data into a structured template in an EMR. We’ve all seen the torn-up hundred dollar bill. Old news folks.

If we want this initiative to work, we must do a better job of promoting the Health Story Project to the healthcare provider.

The content of the documentation – the valuable information provided – THAT is the REAL Health Story.

Let’s start telling it.

-Lynn

2 Responses

  1. Perhaps we could truly go where no one has gone before and actually teach doctors how to dictate from the minute they enter medical school. They spend a good amount of time learning how to extract the information from patients or do the procedure but, as far as I can tell in over 30 years as an MT, next to no time in learning how to take what they’ve extracted or the steps they’ve performed and make a coherent, cohesive document out of it. No, they don’t like dictating (or any other kind of data entry); it’s not as sexy as saving lives, but it is, always has been and always will be a necessary evil. Maybe they’d hate it less if they were actually taught how to do it instead of being left to flounder. After all, we don’t turn a surgeon loose without teaching him how to cut.

    Having standard document templates from hospital to hospital for only the needs to have information would certainly help. Does it make any sense to have templates made up of headers where half of which are never used? And yet, I see that every day. If’s not capturing that supposedly “important” information and it’s not teaching the doctors that they need to dictate it, either. So maybe we also ought to look at what’s nice to have and what’s needs to have. Maybe we ought to look at why we collect the information we do and not settle for a “because I’m the mommy, that’s why” or “because we always have” rationale.

    Some formal training in the fine art of dictation could be a win-win all around as it could save time (and time is money) for both the doctor and the MT while still getting the necessary information, the key word being “necessary.” Well, at least until we get Dr. McCoy’s tricorder to do it for us!

    • Hi Karen: I completely and emphatically agree with you that we need to be talking about WHY certain content is required rather than, as you said, doing it “because we always have.”

      One sad truth is that the balance of power in the healthcare world is shifting from the doctor to the CFO. Right now physician adoption of dictation eliminating technologies is low largely because doctors won’t use them.

      However, many facilities now are forcing the doctors to adapt – like it or not. So the same doctor who wouldn’t take the time to dictate that valuable content will be forced to enter the data in the EMR some way.

      Will the quality of the information entered by the doctors be high? Will the information be accurate and comprehensive? Time will tell…

      Which make it all the more important that MTSOs promote their ability to help healthcare provider clients with quality and compliance and show their knowledge of clinical documentation.

      Thanks for writing!

      -Lynn

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