Posted by: notdeaddinosaur | May 2, 2012

One Simple Idea: Standardized Form for all Medical Reporting

My response to the unoffered invitation to address, well, anyone about what I would do if I were Health Care King (h/t to Kevin): 

One single, deceptively simple idea that would vastly improve medical care in this country by immediately streamlining all medical communication:

Design a standardized form for all medical reporting.

Scope of the problem: Despite my exclusive use of an electronic medical record, I still receive dozens of medical communications on paper every day. So be it. Until we get to the utopian ideal of a nationally interactive medical record system, we’re stuck with dead trees. I get that. I handle it by scanning each report or letter and incorporating it electronically into my record.

Here’s my issue: basic data such as the patient’s name, date of birth, and date of service appear in different places on every form. X-ray reports from one hospital have the name at the top, DOB under that, service date right above the report. Another hospital’s reports have the date of service at the end of the report narrative. Lab reports look completely different. As for letters from consultants, Gd help me! Some only mention the patient in the first paragraph of the letter, with no birth date to be found. Some aren’t dated. Letters generated by one EMR have all the information I need in the upper right; another company’s letters have it on the left. Lord only knows where the date of service can be found.

Banking has long used standardized forms for things like checks. Despite always having the same essential information in the same basic places, they can still be personalized infinitely. A couple of decades ago, all the medical insurers (including Uncle Dr. Sam) got together and agreed on a uniform claim form. (Granted their Explanation of Benefits forms are still all over the map, meaning my office manager has the same hassles trying to post payments as I do finding the data I need in the documents I upload; but I digress.)

All I ask is that every medical report have a uniform heading, with spaces for the patient’s name, birthdate, and a date for the document which should default to the date of service. Other useful pieces of information (for which space could be allocated, even if left blank when unnecessary — like an insurance claim form) could include the physician, the medical record number (used mainly for institutions), location, procedure, etc. It would be nice if the body of the reports followed suit, but I have no problem leaving it with one large content field. Tables for lab results would be nice. Once you design it for paper, frankly it becomes child’s play to adapt it for electronic use, which would be a giant step towards a universal EMR.

Just think: if every single lab report (from every lab), every x-ray report, every procedure report, every referral letter and consultant’s report, every medical document had exactly the same identifying information presented in exactly the same format every time, how much easier it would be to keep it all straight.

I wouldn’t even have a problem with this as a government mandate. After all, you have to use specific government forms to file your taxes, apply for a drivers license, register to vote, etc.

Best of all, it wouldn’t even be terribly expensive. The main issue would be re-programming all the electronics to present the data in the new, agree-upon uniform format. Of course that’s probably why it will never get done: everyone think’s their way works just fine for them, and besides, since there’s so little money to be made, no one will be able to make a killing off of it. Then again, streamlining and simplifying medical communication could prevent other kinds of killing as well. And that would be a good thing.




  1. It’s always the simplest ideas that make the most sense. The only problem is who to contact to make this a reality. Hm.

  2. hmmmm, maybe someone could design such a form as a template and make it available for free, pass it around, start a grassroots demand for it.

    Nah. That’ll never work. Your solution is elegantly simple. Makes entirely too much sense. Alas, it would confuse people, violate their expectations of complexity. Everyone would have to retool and retrain….

    Wait…wait…retool? Retrain? Maybe there is a buck to be made. Your idea just might work!

  3. Ha! I just got back from a conference that skirted around some of those benefits that you’ve mentioned, but got nowhere close to the elegant approach to next steps that you’ve got here!

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  4. You are preaching to the choir. I deal with medical records all day long and go practically crazy trying to find the date of service. It is always in a different place and all I can find is the DOB. It’s a pain.

  5. Hey! I’m a writer for the blog I wanted to do a little interview on you, your blog, and your issues/views on urgent care.
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  6. I can certainly understand your frustration but I think it gives inadequate weight to personal preference. Preference is the external manifestation of things that we subconsciously understand out ourselves. Some people (physicians) process words better than sounds, for some its the other way around. Some prefer information laid out one way, some another. This is because the habits patterns they have developed and the way their minds work do better with one format than the other – and they know it subconsciously – hence the preference. Can they retrain themselves? Of course – in time. But this is not necesary.

    The “form” you talk about is really made of of three components:
    – Information, e.g. 12/12/11997
    – Meta-information, e.g. the label “Birthdate”
    – Formatting information, what we call “layout” or “style”

    What you and I and everyone else want is to receive reports in which these three elements are kept separate. A properly structured XML document can easily be used to accomplish this. The information is tagged (delimited) in such a way that each element can be accessed individually. Each element can have its own meta-information (one of several ways) and a Style Sheet can accompany the report that specifies the Layour – how the report will appear to you.

    If you don’t happen to like the default style and if you can interpret the meta-information (like getting everyone to call birthdate birthdate rather than BD, or Date of Birth, etc.) then you can have your own personalized style sheets that will display each report the way you want it, rather than the way the sender imagined it.

    What needs to be standardized are the names of the common elements and the approach, i.e., people must stop exporting nicely formatted reports, dolled-up with their own little artistic touches, and instead concentrate on exporting the information in a consistent structured format that anyone else can consume and format as they desire.

  7. @danessin: I agree completely, and I understand how easy it is from a technical perspective. What I’m pointing out is that there’s still a lot of paper around, and that standardizing the layout will make it easier for everyone to find the info they need. I’m just taking the bull by the horns and saying, “Let’s do this”, then start using it from the ground up. It seems to be a more direct route towards a universal record format than anything tried so far.

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  8. Regarding standardization of printed reports: I probably should have mentions that I see a couple of problems although I agree that it is the “obvious” solution
    1) I a bit skeptical about getting general agreement and a general change in behavior. When given a chance people tend to refuse to agree with anyone about anything.
    2) Organizations like the hospital where I practice bind their paper charts at the top and MUST have the ID at the bottom. Organizations that bind their charts on the side have the option to choose either the top or the bottom. So if I was going to suggest a “standard” it would be to put the ID at the bottom, but then you wouldn’t like that. And so on and so forth…

    I think the only pragmatic thing to do is to consider any existing print format that cannot be reprogrammed to be like any other sunk cost and write it off. Get everyone (ha!) to agree to start today to export the information and the style separately and before long, the legacy stuff will be such a small percentage that it will no longer bother you.


  9. p.s. I apologize for typing on a micro-size keyboard and ending up with so many dropped characters.


  10. I consent completely, and I understand how effortless it is from a technical perspective. What I’m pointing out would be that there’s still a significant paper around, and also that standardizing the design makes it much less difficult for everyone to find the information they require. I’m simply taking the bull of the horns and additionally saying, “Let s do this”, then start using it from the ground up. It seems to generally be a more direct path towards a universal record structure than anything tried so far.

  11. Great idea.

    The worst reports are the reports I get from an unnamed large radiology practice that lists the ordering MD’s name larger than the patient’s name. And hides the patient;s name in the midst of a bunch of irrelevant info

  12. Hey Lucy,

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    Client Services Director
    Hippocratic Web Studio

  13. i thought this would be a docs form but it isnt

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