Structured Narrative Notes - Best of Both Worlds

A colleague of mine recently attended an IT conference to hear the latest and greatest on EMR implementations by hospitals and large medical groups.  During one panel presentation, a physician panelist said, “My ideal world is one in which I dictate my patient encounters, and all necessary information is magically imported and saved in the EMR.”  (Click here to see an example of a chart note generated by an EMR)

This physician hoped his idea might be available in three to five years.  In fact, the good news is that “the magic” is available today through “structured narrative notes” combined with a robust interface between dictation/transcription platform and EMR.
 
What are structured narrative notes?  Simply, they are traditional narrative notes in which selected data has been tagged.  The data tags are visible within a word processing application such as Microsoft Word, but invisible when the document is printed.  Click here for a example of a document with the tags turned off and on.  These data tags allow discrete data to be exported from the narrative note to an EMR database. 
 
Structured narrative notes offer the best of both worlds:  the efficiency and clinical utility of traditional dictation combined with the discrete data capture of electronic medical records. They can help eliminate barriers and increase physician adoption of electronic medical records.

So why aren’t they being more widely used?  The barrier is not technology, but cost.  Most EMR vendors would prefer not to import structured narrative notes or save discrete data to their databases.  So they put up either financial or technical barriers to this simple solution.  Fortunately, as more and more hospitals and practices implement EMRs, we are beginning to hear customers request structured narrative notes from their EMR vendors.  And the smart vendors are listening.