How to Create Structured Narrative Notes

Structured narrative notes can be created in several ways, depending on the balance of technology versus human intelligence desired by each user.

In a high tech, low touch system, dictated voice files are processed through a back-end speech recognition engine and a natural language processing system, and then edited for accuracy.  In a high touch, low tech system, dictated voice files are transcribed by medical language specialists using strucutred narrative notes with pre-defined XML fields.

In either case, specific data fields within the notes, such as lab values and quality measures required for Meaningful Use, can be tagged, extracted and stored to the appropriate EMR fields.

The major barrier to implementation is that many EMRs are not currently designed to accept discrete data from tagged documents, unless undertaken as a special (and usually expensive) custom project.  To eliminate this barrier, standard interfaces have been developed by the Health Story Project (www.healthstory.com).  Technical implementation guides for four common document types have already been published, with more in development.