The government has doled out nearly $20 billion in incentive payments since 2010 for its meaningful use program in order to nudge physicians towards adopting electronic health records (EHR). U.S. hospital systems and physician practices pay billions annually to EHR vendors in order to qualify for those meaningful use incentive dollars and prevent penalty payments in the future.
EHR adoption has modernized the practice of medicine in innumerable ways. However, documentation into EHRs has proven quite cumbersome for physicians. Physicians who rely heavily on transcription services to document into the EHR, for example, fail to get “structured data” into the EHR. Structured data refers to having information that is contained within a specific field (e.g., “Last Name”) or data that can be assigned a code. Therefore, structured data can be “processed” by a computer. “Unstructured data” generally refers to information stored as free text, which cannot be easily processed by a computer.
Why should we care about structured health data? Globally speaking, EHR interoperability and health data analytics require “structured” data. You simply cannot share, aggregate, and analyze health data from EHRs if the data is not captured in a structured format.
For years, physicians have relied on recording patient chart information in the form of a clinical narrative. This narrative captures the essence of the patient visit. It is very difficult to capture the essence of this narrative using structured data. Now boxes must be clicked, drop down menus selected from, coding systems sorted through. In order to accurately capture structured data, physicians have and will continue to see reductions in productivity. But structured data is critically important to modernizing medicine as recognized by the College of Healthcare Information Management Executives (CHIME) which has called for the use of structured data in health care reporting so that quality data can be extracted from all health records and be better utilized to examine trends.
Physicians, hospital administrators, and patients should all care about structured data. First, structured data will invariably result in better-coordinated care for patients. It is the only way that physicians can truly “speak a common language” from physician to physician, between hospital departments, and even between health systems. It is truly the backbone to a world where a patient’s complete health record can be shared and coordinated. Second, structured data will set the stage for big data and predictive health analytics. EHRs have the power to capture incredible amounts of data. So much data, in fact, which if structured properly, we can begin to track, monitor, and even predict health outcomes. Data projects have been sponsored to extract information from unstructured data, and have found remarkable trends hidden within the clinical narrative written by physicians.
While the benefits of structured data are evident, the roadblock to clear, accurate, structured data is the time and energy it takes for a physician to complete the EHR. No one can create more hours in a day; however, there are new technologies available that give physicians their time back and create strong EHR’s complete with structured data. Expert scribes, for instance, can input structured data in the EHR and create more robust information that analysts can use to predict health care trends and monitor a patient’s health.
The push for structured data is important. As a physician, I can understand first hand the resistance to requiring doctors to complete additional administrative work. That is why I got into the business of scribes, and continue to push for innovative ways in which new technologies can lessen the burden on physicians and optimize the use of EHRs. EHRs are one of the most valuable tools available to physicians when structured data is used, that is why it is important to offer solutions to acquiring this data as opposed to another item on a physician’s to do list.
Brian Clare is an emergency physician and founder and CEO, eScribe Management Services.
