Narrative Text and Changing Workflows
In “Balancing Act: Can CMIOs and CIOs Make Physician Documentation Work for Everyone?” author Mark Hagland addresses the tension between structured fields and narrative text, pointing out that these tensions result in workflow issues. The article explains the various uses for narrative text in the EMR.
The NEJM column “Off the record—avoiding the pitfalls of going electronic” draws attention to the loss of narrative text: drop-down menus and discrete fields lead physicians “to ask restrictive questions rather than engaging in a narrative-based, open-ended dialogue,” which can be “key to making the correct diagnosis and to understanding which treatment best fits a patient’s beliefs and needs.”
An eWEEK article, “Doctors Say Narrative Missing from Proposed EHR Regulations,” highlights the importance of narrative text: “No matter how good [EHR records] are, you’ll never get the flavored nuance of the patient’s [situation] if you don’t have an unstructured note,” said Dr. Steven Schiff, the medical director and service chief of cardiology at Orange Coast Memorial Medical Center, in Fountain Valley, Calif. The article cites a study by Nuance Communications in which 96% of physicians said they feared losing important patient information without narrative text in EHRs.
From Henk A.M.J ten Have, M.D., Ph.D., Professor & Director, Center for Healthcare Ethics, Duquesne University in “Narrative-Based Medicine: Potential, Pitfalls, and Practice”: “Narrative provides meaning, context, perspective for the patient’s predicament. It defines how, why, and what way he or she is ill. It offers, in short, a possibility of understanding which cannot be arrived at by any other means.”
Further Reports & Articles: