Question

This case involves a healthcare system consisting of five clinics serving nearly 2 million residents in a large metropolitan area and treating over 500,000 patients annually. In preparation for the implementation of an EHR system for the five clinics, the healthcare system implemented an electronic document/content management (ED/CM) system to handle the imaging, indexing, and storage of selected hard copy documents from active patient paper medical records so that in the future, to support continuity of care needs, key documents would be retrievable through the EHR system. However, the healthcare system lacked the level of internal IT and health information services staff resources required to manage the implementation of hardware/software and to handle the actual paper conversion process, so these aspects of the project were outsourced. The outsourced company installed hardware and software, redesigned workflow in the health information services department, collaborated with the health information management professionals to redesign standardized patient record forms and worked with IT staff to develop interfaces that would allow for scanned images to be fed into the EHR system. The outsourced company also managed the preparation, scanning, indexing and quality control activities associated with the actual paper conversion process.

Questions
1. As the healthcare system prepares to select an outsource company as its vendor for this project, what types of information should it give to and gather from each vendor under consideration?
2. What are the potential benefits a healthcare system could gain from implementing a document imaging and management project prior to implementing an EHR system?

Answer 1

Ans) 1) When weighing EHR options from a number of different vendors, practices should take into account the reputation of each company. One of the best ways to do this is to get first-hand experiences from other practices.

- Physicians can ask other professionals about their software to gauge whether the company is stable, reliable and available.

- EHR Intelligence explained that practices need to get assurance from the vendor that the software will be continually updated according to EHR incentive program requirements and federal regulations.

- Physicians and administrative staff should also be confident that the vendor will be available to resolve any technical problems during and after implementation.

2) 10 reasons why it’s a good idea to switch out paper-based processes to electronic form.

a. Easy to implement and manage

The process of a DMS is simple: Paper documents are generated or come into the office, clinic or hospital, and are scanned into the system. Each scanned document is indexed and attached to either an existing electronic patient record or a new one can be created.

b. Increased productivity

With a DMS, you can reduce the time to access patient files by simply keying in a search term. Each document that is converted to electronic form is given a unique identifier (usually an index number) and can be searched for through various search terms. Physicians and administrators can search a patient’s name and retrieve their medical record in mere seconds, leaving them more time to spend on value-added activities.

c. Eliminates human error

Mistakes are unavoidable when dealing with vast amounts of paper documents. Too much paper causes clutter, and clutter increases the occurrence of lost or misplaced files and pertinent documents. Therefore, a Document Management System aids in reducing adverse drug events, such as improper dosage of medications. If files or documents are misplaced, physicians are not able to know what medications a patient may have adverse reactions to. This increases patient safety and protects physicians from potential regulatory and legal sanctions.

d. Reduces costs

There are many cost-saving benefits of a DMS:

Reduce the cost of physical storage space – A hospital, multi-physician, or high volume clinic can spend large amounts of money each year on storage for patient files. In addition to the cost of the physical storage, most medical storage facilities charge a fee every time an employee handles a document. This means there is a charge for retrieval of the required document, delivery of the document and yet another charge for the document’s return to the storage facility. This process can often take several days to complete and physicians may be forced to see patients without their full medical record on hand (this is where the earlier point of human error comes in).
Reduce the cost of paper – photocopying, faxing, printing, etc.
Reduce the need for additional staff – Extremely busy offices, like those of high-demand specialists in particular, staff more office administrators in order to deal with the large amounts of paper work coming into and generated by the office. A DMS can reduce the needs for extra staff, in turn, reducing operation costs.
Document management systems are relatively inexpensive compared to that of more sophisticated EMR systems. A document management system can be used as a transitional or alternative system to an EMR for physicians who are not ready to dive into an expensive, more sophisticated system, or for those who don’t feel they need the level of sophistication an EMR provides.

e. Improves patient care and satisfaction

Converting paper documents to electronic forms gives physicians and administrators more time to devote to patient care and value-added activities. Less search and faster retrieval times results in more time tending to patient needs. This, in turn, increases patient satisfaction.

f. Increases security through audit trails

An audit trail shows the date, time and username for each activity that takes place within a record. This allows administrators to monitor record activity and ensure security and compliance. A DMS can also be equipped with “rights management” which allows administrators to input who can do what with each document. This ensures that the proper business practices are followed and that content is properly captured, stored, managed, and disposed of at the appropriate and legal time in its lifecycle.

g. Maintains regulatory compliance

Security control is a critical regulatory requirement. PIPEDA and HIPA mandate privacy and security of protected health information. A Document Management System offers seamless conversion of paper documents into electronic files to control information access and increase confidentiality. Security features, disaster recovery and enhanced auditing ensure regulatory compliance.

h. Easily integrates with existing systems

A DMS can be easily integrated into most office systems. This means that doctors and administrators don’t need to spend valuable time on training for a new system.

i. Reduces the risk of damage

Storing paper documents and patient medical records on-site can be risky business. Documents can be destroyed by fire, flood, and natural disasters such as severe storms.

j. Enhances collaboration

Documents can be retrieved and modified by a user while access is denied to others while that particular document is being used. This reduces duplicates and old versions of content to be kept in the system. Collaboration features can also allow multiple users to view and alter a document at the same time. Whether or not a document is available to only one user or many users at the same time will be specified by the administrator, depending on office needs.