Use of electronic health record structured text and its payoffs. The approach and barriers to using structured text in EHR to document care encounters.

The Military Health System (MHS) deployed its electronic health record (EHR), AHLTA to Military Treatment Facilities (MTFs) around the world. This paper focuses on the approach and barriers to using structured text in AHLTA to document care encounters and illustrates the direct correlation between the use of structured text and achievement of expected benefits. AHLTA uses commercially available products, a health data dictionary and standardized medical terminology, enabling the capture of structured computable data. With structured text stored in the AHLTA Clinical Data Repository (CDR), the MHS has seen a return on its EHR investment with improvements in the accuracy and completeness of coding and the documentation of care provided. Determining the aspects of documentation where structured text is most beneficial, as well as the degree of structured text needed has been a significant challenge. This paper describes how the economic value framework aligns the enterprise strategic objectives with the EHR investment features, performance metrics and expected benefits. The framework analyses focus on return on investment calculations, baseline assessment and post-implementation benefits validation. Cost avoidance, revenue enhancements and operational improvements, such as evidence-based medicine and medical surveillance can be directly attributed to use structured text.