EMR Should be Human Readable and not Machine Readable

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We all agree that formatted text and text within forms cannot convey the subtleties conveyed by freely written natural language. Yet, informaticians push for standardized text entries. Using today’s technology, codifiable and formatted text allow for easy extraction of data. The extracted data can be flexibly used in foreseen and unforeseen uses. Two foreseen uses are conducting studies and designing smart decision support systems.

On the other hand, extracting data from naturally written text (non-codifiable and non-formatted) is hard, and with today’s technology unreliable.

Is there a compromised? That is having data within EMR that can convey the subtleties of language and at the same time be flexible enough for utilizing this data for things as research, QI and designing smarter decisions support systems.

I do believe that writing naturally and conveying the full meaning of text comes first. We should wait for technology to change and improve instead of forcing people to change their writing style to a less effective style. Yet, if I am to compromise I would present the following rule:

use codifiable and formatted text entry only when the writer and reader have similar background knowledge

Follows is the rational for this rule:

The goal of text is to transmit meaning through time and space. Whatever ‘meaning’ is enclosed in written text will need to be read for this meaning to be transmitted. In my post titled ‘understanding reading’, I illustrated how readers use their previously held knowledge to fill in the gaps present in text. I illustrated how McNamara and Kintsch (1996) showed that broken text can be comprehended by knowledgeable readers. Therefore, readers with the appropriate background knowledge may be able to understand codifiable/formatted text. For such readers, the use of the full range of language may not be necessary.

The only possibility for the writer and the reader to have the same knowledge is for them to be the same person. A close enough proposition in healthcare is when the reader and writer have similar: specialty and/or experience.

Here are three examples that apply this rule:

Progress notes in an outpatient office will have limited number of writers and readers. These will have similar background knowledge. Therefore, we may be able to use codifiable and formatted text in outpatient progress notes. However, progress notes in in-patient settings have diverse writers and readers. Likewise, discharge summaries have diverse writers and readers. In these two situations, allowing for natural language will assure better transmitting of meaning.

McNamara, D.S. & Kintsch, W., 1996. Learning from Texts: Effects of Prior Knowledge and Text Coherence. Discourse Processes, 22(3), 247-88.

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