Structured and Unstructured Data, I Adore You Both

Calling all electronic patient record systems (EPRS) structured data! Yes, all you electronic health / medical, administrative, and financial systems’ data elements that are binary, discrete, computer-readable, and, typically, are stored in relational databases with predefined fields … you tidy, typically core, transactional and mined elements. Hello? I’m talking about all you digital, patient demographic, financial, and clinical health data that are sitting in master patient indices, insurance claims, clinical histories, problem lists, orders, test results, care plans, and business intelligence reports — to mention just a few.

Meet unstructured data! Yes, all you EPRS data that are non-binary, non-discrete, sometimes only human-readable, and sometimes not stored in relational databases. This means all you digital, bit-mapped images, text, videos, audios, and vector graphics that are harnessed in word-processed summary reports, electronic forms, diagnostic radiology images, scanned document images, electrocardiograms, medical devices, and web pages – again, to mention just a few.

I know this might be an awkward introduction. However, I’m really happy to finally get you two data formats together. And, while this might be jumping the gun a bit, I really hope one day you two will get married! I know, I know. That is, after you’ve carefully sorted out all your differences and learned how to live together in peace and harmony for the betterment of patient care.

After all, I’m certain you heard the rumor that the “adoption” and “Meaningful Use” of “certified” diagnostic image-generation and management systems, such as a PACS for one or more of the “ologies”, might be included in Stage 2. In addition, heaven help if, given the revised Federal Rules of Civil Procedure Governing Electronic Discovery that became effective December 1, 2006, a patient’s electronic health/medical, administrative and financial episode-of-care records (I mean x-rays, bills, ECGs, orders, progress notes – the works!) are subpoenaed for that Weird News Andy case we recently read on Mr.HIStalk! So, don’t you think it’s time at least to begin acknowledging one another in public?

Who am I, you ask, to be so bold to introduce you to the other? I’m just one, frustrated HIT professional who specializes in most of the EPRS unstructured data and who observes that these data are rarely considered in EPRS strategies and purchases … until after the fact. Once considered, they divide provider organization departments right down the middle; those working with you, structured data, vs. those working with you, unstructured data. Don’t even get me started about integration and usability issues!

Come close, structured data, so I can tell you that I do adore you – especially when I search a database for one or more of you, and, quickly and easily, the search engine finds, retrieves, and even manipulates parts or all of you. On the other hand, what often makes me want to delete you is when you insist on snubbing unstructured data. I’ve even watched you try to convert some unstructured data, such as rich-text or video data, to your popular religion, using pretty-good-but-not-perfect artificial intelligence and recognition tools … just so that you can brag about how you were able to generate the complete health story with your qualities.

Unstructured data? After so many years working with you, you know that I love being able to retrieve your gorgeous, bit-mapped, raster images generated by that digital chest x-ray or computed tomography (CT) scan stored in a diagnostic image management system; or, listen over and over to your brilliant sound bytes generated by that digital stethoscope; or, fast forward your streaming videos / frames generated by that important cardiac catheterization study; or, admire the perfect lines connecting the series of points plotted by that fetal trace recording. On the other hand, what I can’t tolerate is when I am required to search, for example, a valuable narrative text for one or more of you, and after hours I still can’t find you!

Today there is no complete electronic patient health / medical, administrative or financial record system without both of you. Let me see a hand shake.

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