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Tuesday, July 19, 2016

Do you have the vision to use HealthIT standards?

One of the challenges of meaningful use is in how it has diverted attention from other uses of standards that could have value.  Use of the Unstructured Document template provides one such example.  Use of unstructured document specifications, either from IHE Scanned Documents (XDS-SD), or CCD-A Unstructured Document supports exchange of electronic text that is accessible to the human reader (CDA Level 1), but not in structured form (CDA Level 3).  A common use case for this kind of text is in dictated notes, something we still see an awful lot of, even in this nearly post-Meaningful Use era.

Some even incorrectly believe that one cannot uses these specifications because they are "forbidden" by meaningful use.  While users of these specifications cannot claim that use towards qualification for meaningful use, that program is NOT specifying what they can or cannot do elsewhere to improve care.  And again, while use of these specifications do not count towards Certification of EHR systems under the 2015 Certification Edition criteria, again, certification is the lower bar.  You can always do more.

There are a number of benefits for using unstructured documents in exchanges where structured detail is not present.  One of these is simply to make the text available to systems that can apply Natural Language Processing technology to the text to produce structured information.  I've worked on two different systems that were capable of doing that with high reliability, and there are commercial systems available to do this today.  This sort of use can be applied to clinical care, or to so-called secondary uses (often related to population-based care or research).

Provider organizations won't ask for this specification by name, rather, they will ask for the capabilities that it supports.  This has always been the problem of standards.  Meaningful Use, MIPS and MACRA eliminate that problem by making systems directly responsible for implementing standards, and making providers care about that by affecting their pocket book when they use systems that do not.

The challenge for good systems developers and product managers is in applying standards like these to system design, without having their customers asking for it directly.  That takes vision.  Do you have the vision to use standards that you aren't required to?  


  1. In talking with a number of vendors, it seems to me that the use of "prohibited" in Meaningful Use regarding unstructured documents was generally interpreted as do not implement it rather than you do not get MU credit. Clinical notes are invaluable to our work. In retrospect, ONC should have made these mandatory from the start and grow the data collection later. Guess they forget the major tenet of CDA, human readable first, machinable second.


    1. I agree on your description of the general interpretation, but because meaningful use and certification are "Voluntary Programs", we are not bound by their constraints in what we deliver in our products, only in what we can certify, nor in what is used to deliver care, only in what qualifies as "meaningful use". On the human readable side, most countries start simple, and then move to the more complex. In the US, we did it differently -- as usual.