by Bethany Schroeder, MFA, MS, RN
June 29, 1998

Every nurse I’ve ever known has wondered why we don’t have a standardized way of documenting services in health care. Our patients and their families grow impatient with us when we ask—again—for a date of birth or a diagnosis, and we’re powerless to do more than sympathize. What we need is a single tool that everyone in health care can use to document, monitor, evaluate, archive, and bill for information and services.

Sharing patient information among facilities, disciplines, or departments is difficult at best. We can share information by using similar paper chart materials. But paper is easily lost, and labor-intensive searches are required for quality improvement efforts. Also, even if you can get a paper chart from one place to another, you can’t reuse the information in it without filling in a new form.

The problems with software are equally forbidding. My computer may have a different operating system than yours, so we may be unable to exchange documents and read them from our respective computers. The best we can do is print copies for one another or exchange copies on disk and hope that our translation programs will let us read the information. In either case, we have to re-enter most if not all of the data to use it.

Efficient communication

Today we may have a solution to the problem: extensible markup language (XML). It’s easy to implement, and it allows you to enter information once and use it as much as you want with anyone and for as many reasons as you can identify.

Initially developed to manage data on the Internet, XML can be applied to any electronic, audio, or video technology. This year it was formally recognized as an international standard, and industries and governments throughout the world plan to use XML to make communication more efficient. Information groups in health care have also begun to recognize XML’s usefulness, especially in light of the prospect of the electronic medical record and the pervasive call for a paperless healthcare system.

With XML and its associated technologies, healthcare providers will be able to share information, regardless of whether senders and receivers have the same hardware or software. This technology can work with any system, is relatively easy to learn, and takes less time to implement than the programs we’ve installed so far. Even though XML is a new standard, it’s a subset of one of the oldest standards in the publishing industry, which means that established developers, educators, and producers of the product already exist. And because the technology is an open standard, no one can own it, and anyone can use it and develop products.

Why introduce a new standard in an industry that’s already crowded with different ways to manage information? Because this one can meet the demands of payers, regulators, patients, clinicians, and even the federal government. Despite the need to retool and retrain all levels of workers in industries that opt to use XML, experts agree that the effort appears to be worth it. That’s because we will at long last have control of an information management mechanism, rather than working at the mercy of a vendor who owns the code.

Your contribution counts

This is a good time to get involved. We need nurses to analyze the documents needed to use XML. Right now, physicians and data managers are making most of the decisions about the way XML will be applied to the patient record. But nurses could make valuable contributions to the effort.

I believe this technology will ultimately help the healthcare system save money while increasing the quality of care. At a time when more of us are interested in data management, I’d like to see nurses participate in building our information system rather than have it imposed on us by people who don’t always know enough about our practice to make informed decisions.

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Related Sites

The W3C's XML site.

The HL7 SGML/XML Special Interest Group. HL7 is a healthcare standards body that is developing methods to share patient data.

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