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Light at the End of the Tunnel in the Free-Text-Structured Documentation Controversy?

November 14, 2012
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Physician informaticists help move the discussion—and the solutions—forward in the physician documentation arena


One thing seemed clear, even amid the complexity of the physician documentation session held Nov. 6 during the AMIA 2012 Symposium, held last week at the Chicago Hilton & Towers in downtown Chicago, and sponsored by the American Medical Informatics Association.

And that is that we are beginning to see a decisive shift in resolving the tension between free-text narrative and structured documentation within physician notes in the electronic setting, with new technologies, experimentation in patient care organizations nationwide, and above all, the leadership of physician informaticists, all pushing the healthcare system towards a resolution of this enduring, thorny problem.

As Kenric Hammond, M.D., clinical associate professor at the VA Puget Sound Health Center in Tacoma, Washington, told attendees, “The strength of CPD”—he and the other presenters in the session used the term “computerized provider documentation” to describe the phenomenon—“is that it improves communication; the vulnerability is that CPD takes over. I’ve heard estimates of up to 25 percent of physicians’ time going to documentation,” Hammond said. “But a balance needs to be struck between the administrative uses, which are essential—otherwise, the organization dies—and the clinical uses—otherwise the patient dies. So my plea is, ecosystem members unite! Clinicians, administrators, and information scientists need to work together to characterize and understand the ecosystem and understand everyone’s needs.”

And that is just what is happening now in pioneering patient care organizations across the U.S., and it is a very heartening development. Just in time, too, as physicians are becoming exhausted by the conflicting demands on their time, thought processes, and workflow. Are we anywhere near yet to resolving all the problems involved? Of course not. But, Christopher Longhurst, M.D., CMIO at Lucile Packard Children’s Hospital at Stanford University, told me afterwards, “In the tug-of-war over free text versus drop-down menu-based structured documentation, free-text narrative has already won,” because of physicians’ insistence that the patient story be retained as a key element in physician diagnosing and treatment.

Fortunately, Dr. Longhurst told me, the leading edge of strategies, going beyond the natural language processing tools current now, and being referred to by many as “text analytics,” is moving forward rapidly, both technologically and in terms of the kinds of innovations that physician informaticists are helping to lead the industry forward on, in terms of advising vendors and IT experts, as they embed such capabilities into the newest generation of software.

So keep an eye out in this absolutely critical area, because things are changing very quickly right now—and we at Healthcare Informatics will most assuredly bring you the latest in this very exciting, rapidly evolving arena.