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| Clinical document architecture (CDA) has rich content and is easily viewed on an iPhone. |
(Editor's Note: This article is a complement to "What's the Story?" in the April print edition.)
 EHR use is expected to explode in the next few years, if all goes according to the stimulus plan. Health care stakeholders are eager to reap the benefits of EHRs, but hurried adoption runs the risk of overwhelming physicians and overlooking critical operations issues. The Health Story Project, a collaborative that values the full patient story, is caught somewhere in the middle; the group's success depends on increased EHR use, but the wrong approach to implementation can also close the book on narrative text--the very thing Health Story is trying to save.
The Turning Point
The American Reinvestment and Recovery Act of 2009 (ARRA) has directed $19 billion to move health care into the digital age, including $17 billion in incentive payments to hospitals and physicians who adopt "meaningful use" of EHRs by 2011. In 2015, the sweet reward will turn into a harsh kick in the rear from the Centers for Medicare and Medicaid Services, as providers who fail to adopt EHRs will see reductions in payments.
Debate ensues over whether incentives are worth the costly investment in an EHR system, but members of the Health Story Project are more concerned about how implementation proceeds.
Led by the Association for Healthcare Documentation Integrity (AHDI), American Health Information Management Association (AHIMA), M*Modal and Alschuler Associates, among other organizations and vendors, the Health Story Project defines standards that ensure EHRs include narrative details, not just coded data. They recognize the potential EHRs have to improve patient care, but caution against systems that cut valuable details.
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| CDA XML may look foreign to non-IT staff, but it makes data easily shareable. |
"All the good things EHR brings to U.S. health care become even more pronounced if we have quality standards in place, if we have the full story so relevant details are not left out," said Susan Lucci, RHIT, CMT, AHDI-F, who represents AHIMA in the project.
Mixed Reviews
Health Story leaders are excited about the promise stimulus funds hold for EHR adoption. The group has already outlined standards for more comprehensive digital records, so they're hoping the ARRA will help providers play catch-up and start building the definitions into their systems.
Dr. van Terheyden, chief medical officer of Pittsburgh-based M*Modal and co-founder of Health Story, called the stimulus funds "icing on the cake." He also hopes to include government standards in Health Story's implementation guides to advance the odds of achieving interoperability of detailed records, but noted any standards imposed on EHRs are only as good as their usefulness. "Just having the government say you should use it doesn't necessarily make it work," he said.
Similar concerns quell the enthusiasm of other Health Story leaders. The group cautioned against putting IT at the heart of hasty implementations, which would neglect input from those immediately involved in patient care. "We have to stop hanging our hats on technology alone and go back to considering what these kinds of decisions mean to physicians," Lucci said.
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| The Health Story Project is working to keep narrative text and the data together in the medical record. |
The Health Story Project involves a variety of health care stakeholders when writing and developing standards. Before being approved by Health Level Seven, the project's implementation guides are also open to public comment; suggestions are incorporated into the guides to make sure they meet provider needs.
Liora Alschuler, principal of Alschuler Associates, LLC, East Thetford, VT, and co-founder of Health Story, called for a shift in perspective to accompany the shift to digital. She said it's important for those on the HIT end to recognize there's more to health care than coded data entry. "It's amazing to me that planning at very high levels continues with the assumption that EHR adoption means the end of narrative notes," she said.
Those leading EHR adoption should also be attuned to changes in physician workflow; too many changes at once could be off-putting to medical staff. According to Alschuler, this is one case where slow and steady wins the race.
Cheryl McEvoy is an editorial assistant with ADVANCE.
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