The Document/Data Continuum
The Document/Data Continuum By Michael R. Cohen, Margret Amatayakul and Deborah Kohn
Our January 2005 EHR Corner (“To Scan or Not to Scan?”) inadvertently left some people with the impression that in developing your EHR strategy you need to choose between a document imaging/scanning strategy or a “more robust” systems approach using structured data. While that was not our intent, and certainly not our point of view, we felt it appropriate to elaborate on this strategic issue. Deborah Kohn, principal of Dak Systems Consulting and a well-known authority in document management circles, joins EHR Corner this month to help clarify the wide array of options that make it less of a “black-and-white” issue and more of a continuum.
The conundrum used to be, Is structured data better than unstructured data? On one hand, structured data easily support clinical decision making, data comparability and data mining. On the other hand, structured data require carefully constructed templates, a controlled vocabulary and a significant degree of change to which users must adapt. Alternatively, unstructured data are more familiar and “richer” in context. Unstructured data in an electronic environment sometimes involve only scanned documents, as may have been suggested in “To Scan, or Not to Scan.” However, many other forms of unstructured data must be managed and are highly valuable as part of the electronic health record.
Some digital documents incorporate the strengths of structured data, especially where they utilize customizable and/or pre-populated templates or enable smart text, embedded codes, macros, etc. Digital documents containing such retrievable data become more searchable, allow for retrieval of specific data and afford considerable support for managing the flow of work associated with the documents. Some digital documents incorporate text, bit-mapped or audio/video data, but such unstructured data cannot easily be searched or manipulated.
Beyond scanning We’re now faced with the following question: How do we get all the unstructured data contained in documents and all the structured data contained in databases to join hands? Electronic document/content management (ED/CM) systems help manage both analog and digital documents. And while ED/CM systems do not mine, compare and analyze data as does a system built solely around structured data, they certainly have much more utility than simply scanning handwritten documents or managing keyboarded unstructured data.
ED/CM systems encompass a broad array of technologies. One is document imaging and another is document management, which helps control versions of all digital documents. Document content management technology helps manage digital document creation, distribution and customization. Records management technology helps manage electronic document storage, retention, archiving and destruction. Computer output to laser disk/enterprise report management (COLD/ERM) technology takes the digital data (such as from a laboratory information system) that is outputted in report format and easily distributes it in report format with e-mail, Web or traditional hard-copy print or fax processes. Workflow management technology helps organize, automate and improve processes.
So, while many health care organizations are considering whether to use “bridge” technologies, such as document imaging technology or a more comprehensive ED/CM system, it should not be implied that the only options are to scan or not to scan. The decision should focus instead on finding the right balance of both structured and unstructured data and the documents containing those data.
For more information link … http://health-information.advanceweb.com/editorial/content/editorial.aspx?CC=59346
Compliments of FileMan Research
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