by Nicole Sowers
For public health agencies that serve individuals, families, and communities, it is essential to choose a documentation approach that not only captures care but also supports analytics, outcomes measurement, and interoperability. This article compares the major documentation systems and highlights why a standardized language—especially the Omaha System—strengthens electronic health records (EHRs) and population health reporting.
Healthcare documentation has evolved from free-text notes to sophisticated standardized terminologies. Each format—SOAP, Narrative, NANDA, NIC, NOC, ICD, and the Omaha System—supports specific aspects of clinical care, yet they differ in structure, consistency, and ability to produce meaningful reports.
Comparison of Documentation & Classification Systems
| System | Type | Inter-disciplinary? | Tracks Interventions? | Measures Outcomes? | Best Fit For |
| SOAP | Narrative structure | Yes | Partially | No | Clinical visits, therapy, general medicine |
| Narrative Notes | Free text | Yes | Variable | No | Home visits, behavioral health, outreach |
| NANDA | Nursing diagnoses | No | No | No (needs NOC) | Nursing education, hospitals |
| NIC | Nursing interventions | No | Yes | No | Nursing-focused care plans |
| NOC | Nursing outcomes | No | No | Yes | Measuring nursing-sensitive outcomes |
| ICD | Global disease classification | Yes | No | No | Billing, epidemiology, surveillance |
| Omaha System | Problems, interventions, outcomes | Yes | Yes | Yes | Public health, community care, home visits |
SOAP Notes
Developed by Dr. Lawrence Weed in the 1960s as part of the Problem-Oriented Medical Record, SOAP notes structure narrative information into Subjective, Objective, Assessment, and Plan.
SOAP Notes are often used in physician practices, behavioral health, therapy disciplines, and some public health programs. It may be the most widely adopted standardized language, which is an advantage. The more people that use it, the more recognizable it is. An article in Physiopedia provides detailed examples of SOAP notes for those unfamiliar with the documentation format.
EHR Implications Using SOAP Notes
Because SOAP notes are narrative-driven, they provide little structured data for population-level reporting or outcome measurement unless coded with standardized classifications. The mostly unstructured format of SOAP notes means that many clinicians may be saying the same thing but in very different ways. Aggregating the notes in a way that ensures accuracy and measurable data becomes difficult. AI will help with this but based on 2025 studies, it still falls short.
Narrative Notes
Narrative notes pre-date EHRs and remain common because they allow detailed storytelling and context. Practitioners use them in settings where context-rich descriptions are needed, such as home health, hospice, behavioral health, and mental health.
EHR Implications Using Narrative Notes
- Hard for EHRs to analyze and aggregate
- Highly variable across providers
- Poor inter-rater reliability
- Limited ability to generate population-level insights
NANDA International (Nursing Diagnoses)
Established in 1973, NANDA-I standardizes nursing diagnoses. NANDA is used in academic nursing, hospitals, long-term care and some home health settings.
EHR Implications Using NANDA
NANDA provides structured problem language, a diagnosis and is used in individual, family and community care. It does not specify interventions or outcomes—limiting its reporting usefulness unless paired with NIC and NOC.
NIC (Nursing Interventions Classification)
Standardizes nursing interventions and developed at the University of Iowa. Acute and long-term care, nursing education and nursing settings use NIC.
EHR Implications Using NIC
NIC adds structured intervention data, essential for tracking what care was provided, but still requires pairing with NANDA and NOC for full care-cycle measurement.
NOC (Nursing Outcomes Classification)
NOC defines measurable outcomes sensitive to nursing care.
EHR Implications of NOC
NOC provides structured outcomes, but limited to nursing-specific scenarios—not ideal for interdisciplinary EHR environments such as public health.
ICD (International Classification of Diseases)
Created by the WHO, ICD is a global standard for diseases, injuries, and public health reporting.
EHR Implications of ICD
ICD excels at:
- Billing
- Global surveillance
- Epidemiology
However, ICD does not link interventions to outcomes at the clinical level, nor does it reflect holistic public health practice.
The Omaha System
Created for community health practice, the Omaha System is a holistic, interdisciplinary, and outcomes-based taxonomy.
EHR Implications of Omaha System
The Omaha System contains three interdependent components:
- Problem Classification Scheme (Diagnoses)
- Intervention Scheme (What was done)
- Problem Rating Scale for Outcomes (Knowledge, Behavior, Status)
There are Four Domains in the Omaha System
These domains support documentation across individuals, families, and communities—ideal for public health agencies.
- Environmental
- Psychosocial
- Physiological
- Health-related behaviors
The Omaha System includes problem identification, applies across healthcare settings for interdisciplinary use, and measures outcomes. It is mapped to the Social Behavioral Determinants of Health (SDOH) and is recognized by the American Nurses Association.
Uniquely suited for documentation and outcome measurement within an EHR, the Omaha System should be implemented in conjunction with ICD codes for billing purposes.
Standardized Language Comparison on Measurable Outcomes
| System | Outcomes Built In? | Notes |
| SOAP | ❌ | Narrative, variable |
| Narrative | ❌ | No structured measurement |
| NANDA | ❌ | Diagnoses only |
| NIC | ❌ | Interventions only |
| NOC | ✔ | Nursing outcomes |
| ICD | ❌ | Diagnosis-centric |
| Omaha System | ✔ Comprehensive outcomes integrated (KBS ratings) | Interdisciplinary, measurable, EHR-friendly |
Only NOC and the Omaha System measure outcomes—but only the Omaha System links those outcomes directly to interventions, making it uniquely valuable for interdisciplinary practice.
The Omaha System’s Knowledge, Behavior, and Status ratings integrate exceptionally well with EHRs at individual, family, and community levels. This EHR integration is especially important in public health, where funding and accountability tie closely to demonstrable outcomes.
Takeaways
The Omaha System stands apart. Created for community and public health practice, it provides a holistic, interdisciplinary structure covering environmental, psychosocial, physiological, and health-related behavior domains. It includes diagnoses, interventions, and a built-in Problem Rating Scale to measure outcomes over time.
- SOAP and Narrative Notes are flexible but lack standardized tracking of interventions and formal outcome measurements, making large-scale data analysis difficult.
- NANDA, NIC, and NOC each address only one part of the documentation cycle (diagnoses, interventions, or outcomes) and are nursing-specific, not inter-disciplinary.
- ICD codes are global standards for classification and billing but do not track interventions or measure patient-specific outcomes.
- The Omaha System offers a complete, integrated, and inter-disciplinary framework for problems, interventions, and outcomes, which is why it is uniquely suited for settings like public health and community care.
When an EHR incorporates the Omaha System’s intervention schema, users can connect each intervention to its corresponding outcome ratings. This creates a powerful feedback loop: researchers and practitioners can analyze the resulting data to identify which interventions most effectively improve outcomes for a given patient or population.
That is powerful data. An EHR should not be a cemetery for documentation. It should be a dynamic, analytical tool that, when combined with a standardized taxonomy, returns valuable, actionable insights to the staff who use it every day.
References
Bulechek GM, McCloskey JC. Nursing Interventions Classification (NIC). Medinfo. 1995;8 Pt 2:1368. PMID: 8591448.
International Statistical Classification of Diseases and Related Health Problems (ICD) World Health Organization (WHO).
Jones, Dorothy; Lunny, Margaret; Keenan, Gail and Moorhead, Sue. (2021). Standardized Nursing Languages: Essential for the Nursing Workforce, National Library of Medicine: National Center for Biotechnology Information.
Our Story, Nanda International, Accessed Dec. 2025.
SOAP Notes, Physiopedia, Accessed Dec. 2025.
The Omaha System, https://omahasystem.com, Accessed Dec. 2025.
Wisconsin Association of Local Health Departments and Boards.(28 Feb 2022). Standardized Terminology in EHRs for the Future of Public Health.