Use Your Words: The Importance of Structured Data

May 14, 2010 at 3:09 pm 1 comment

One of the uphill battles that mTuitive has faced over the years has been convincing people the value of structured data. Actually, to step back, the uphill battle has been defining structured data and then explaining its import to various medical facilities. Luckily, that battle is progressively easier as more studies are published on the strengths of synoptic reporting and as the term grows in popularity and familiarity. What was once a part of a sales pitch is quickly becoming unnecessary as people are getting much more comfortable with the idea of structured data and interested in how it can immediately help their organizations. A recent piece in California HealthCare Foundation’s Issue Brief does a great job of illuminating the various levels of data and why there’s not only a growing need but also a growing desire for employing these techniques in health facilities.

Author SA Kushinka expertly lays out the case for electronic reporting, but has to first define each type of data capture and dissemination (as we at mTuitive have done for many years in our sales pitch). Kushinska points out that most data is currently unstructured – either because it is merely on paper or because it’s entered as free text into the electronic record. Free text by itself isn’t necessarily a bad thing – but it leads to many problems for later investigators. For example, if one wishes to search all the free text reports for use of the word “heart attack,” the results may not include reports using the term “myocardial infarction.” Unless everyone is using a shared lexicon – what Kushinka calls a “structured vocabulary” – then word searches in free text can be incredibly tedious and unfortunately incomplete. By enabling and enhancing the ability to search medical records, researchers are able to discern patterns in behavior of diseases and the efficacy of medicine and treatment on patients.

Kushinka’s piece contains a helpful chart displaying all of the strengths and weaknesses of the various levels of structured data. One disadvantage of synoptic reports that was of particular interest to me is that some users have complained that “notes from structured templates are difficult to read as a narrative of the patient’s condition, as they appear more as lists than as prose.” In showing our reports to various prospective users and surgeons, we’ve had some people push back on the “list” approach and presentation. But it doesn’t take long to realize that the list didn’t come at the price of information. In fact, if anything, it allows for clarity and objectivity. For a physician to remark that something was done “clearly” or “easily” or any other adverb is actually a product of subjectivity – what is easy for one is difficult for another, etc. By simply stating what happened and in what order, without any need for superfluous language, it makes it easier for patients and other physicians to understand what happened.

It’s preposterous to think that people can’t extrapolate a process based on a sequential list. We derive narratives from unique elements all of the time. Instructions for assembling furniture, recipes for a delicious meal or baked good, following prompts on an ATM screen. Individually, it’s just a collection of segmented aspects of a longer process; but when they are gathered together, they form a cohesive narrative that one can easily follow and understand.

That’s not to say there won’t be items that don’t fit into a category or section; there will always be anomalies or something worth noting that doesn’t fit into any pre-designed field. That’s why it’s important to cover as much as possible with structured vocabulary and to allow for an evolution of your report that’s achieved by working with many consultants and testers. And, lastly, to include a space for free text. Because even if there’s 99% covered by the report, one has to allow for that 1%. That doesn’t mean that synoptic reporting is inherently flawed, or that structured data is severely limited; it just means that there are always freak incidents, isolated events, odd anomalies that cannot be precisely catalogued or indexed the first time they appear. However, as the reporting progresses, it should be able to adapt to these outlying pieces of information and the report designers will continue to work on incorporating as much of the information in a structured format as possible.


Entry filed under: Synoptic Reporting. Tags: , , , , , , , , , , , , , .

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