I read the April 2009 article about the Health Story Project. If I understood it correctly, Health Story is attempting to provide more information. What I am confused about is how. The article said the provider continues to point-and-click as well as can use dictation.

After re-reading the article, it seems what they are doing is just trying to standardize EHR information. While that is not a bad thing, it doesn't seem to meet the needs of the providers. We still have point-and-click and have to spend several minutes clicking to accomplish something that would traditionally take seconds.

It seems that the providers must be educated to adapt to the EHR. That is particularly hard to understand-I thought programmers should make programs intuitive and user-friendly. I have used what is labeled "the best" of EHRs for 3 years and, unfortunately, with every "improvement" it becomes more work-intensive. I would love to use a program that meets providers' needs rather than those of the data collectors and programmers.

Your article was informative and very interesting. Thanks.

S. Elise Ledbetter, FNP-BC
Via e-mail

RESPONSE: You are correct that the Health Story Project aims to enrich EHRs with important information created through dictation/transcription-offering a patient's complete health story.

You wanted to know how Health Story will accomplish this in a way that meets the needs of providers. As with what appears to be your experience, many EHR systems seek to eliminate narrative notes in favor of template patient notes that consist of data elements supplemented by free text fields, replacing dictation and transcription with direct data entry. This works well in some contexts and less well in others.

Health Story offers an alternative-the use of structured narrative data, which is discrete data within a clinical narrative that can be tagged using XML and easily exported to data fields within an EHR. Structured narrative notes can be created several ways. For example, dictated voice files are processed through a back-end speech recognition engine and a natural language processing system, and then edited for accuracy. Or, dictated voice files are transcribed by MTs using template notes with pre-defined XML fields. In either case, specific data fields within the notes, such as lab values and quality measure information required for meaningful use of EHR systems, can be tagged, extracted and stored to the appropriate EHR fields. 

A major barrier to implementation is that many EHR systems are not designed to accept discrete data from tagged documents, unless undertaken as a special custom project. To eliminate this barrier, Health Story develops standard technical implementation guides for common types of clinical documents through the HL7 data standards organization (www.hl7.org). Five guides are available, with more in development. Suggested technical requirements for transcription and EHR system vendors are posted at www.healthstory.com to aid providers in talking with their vendors about the Health Story option. Many of the Health Story Project vendor members offer this capability today, and we anticipate significant uptake in use of the Health Story-supported HL7 standards in the coming year. 

In the article you read, there was a reference to physician training in the use of the Health Story specifications. The training does not require a new application interface, but it does take some small steps toward standardizing the content of the notes. The Health Story-sponsored implementation guides follow Joint Commission guidelines and industry best-practice established through an open, HL7 ballot process to define required and optional sections within the notes. The exact text of the section name and content is not tightly constrained, and the guidelines conform to a broad statistical analysis done of current practice.

We hope this was helpful and it encourages your practice to consider the Health Story pathway.

The Health Story Project