1.
AMIA Annu Symp Proc
; : 1153, 2007 Oct 11.
Artigo
em Inglês
| MEDLINE
| ID: mdl-18694249
RESUMO
Clinical Documentation in the ambulatory care setting must support each clinician's unique workflow and data collection requirements. In addition the documentation system must also be the foundation for interoperability both within and external to the organization. Linking documentation to controlled medical terminologies (CMT) provides data sharing capability and centralized management and quality reporting. Separating codified content from its presentation allows clinicians to create templates and forms that meet these requirements while still ensuring data integrity.