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For other articles and previous issues click here. July 4, 2005 File-busters Healthcare organizations can opt for document management systems to expedite the transformation to a more efficient workflow. Healthcare facilities set themselves apart from the competition by employing the latest technologies to diagnose and treat patients. But behind the front lines, many of those same organizations continue to utilize archaic paper filing systems for patient charts. Additionally, millions of pieces of paper are shuffled within the hospital environment on an annual basis—from manually completed forms to faxes and copies of insurance reimbursements. Not only is the shuffling of paper documents inefficient, it’s expensive. “When you have a facility that only has paper, they are less efficient in both cost structure and revenue capital than a facility that puts documents on an imaging system,” says Chris Boue’, vice president of operations at Smart Document Solutions. The price of dealing with the paperwork processing burden is significant—the annual cost of processing 30 billion healthcare transactions is nearly $250 billion. To break those costs down even further, the average ratio of staff to handle paperwork to doctors can sometimes be as high as 1:1. Jeffrey Green, director of compliance for financial solutions at LaserFiche, says studies show that if you try to manage content in a hospital with paper files and electronic records, you will spend 500% more than a facility utilizing a digital records management system. “The change involves a culture switch, but there is such a huge return on investment with a digital records system [that] the pros far outweigh the cons,” he says. Green explains that a doctor could spend approximately
$30,000 annually on 14 file cabinets but the installation of a digital
records management system costs roughly $3,200. John Quinn, partner with Accenture's Health & Life Sciences practice, says there are two different options to consider when looking at electronic health records (EHRs). One is scanning current paper images, and the second involves sourcing the information in electronic form. “Clearly, the vision for electronic health records requires sourcing information into electronic form and that option has been available for quite some time,” he explains. “But for some organizations, scanning paper information into a document management system may be the first step or it may be their preferred method.” When a facility scans information, the computer is “blind” to the information contained in the scanned documents, Quinn says. “For example, sourcing information not only allows the physician to see items like cholesterol or lipid values but the computer can also react to these values by actions such as flagging values that are out of range.” Scanned documents are great for the human eye but almost impossible for computers to act on, Quinn explains. “If a document is scanned, you can pop it up on the screen but you can’t have the computer reliably read or interpret the information—it’s only for human consumption,” he says. “There are alerts that computers can add from electronically sourced data that physicians are looking for, such as potential drug interactions or a diagnostic test was performed yesterday that the physician is not aware of, and has mistakenly ordered again today.” Clearly, Quinn says, it’s more expensive to go the all-digital route in a strict dollars-and-cents aspect. The downside is that type of EHR via a document management system gets a healthcare facility only part of the way toward its goal of portability. Scanning documents usually requires human involvement to identify the patient to get the scanned images filed under a correct set of indices that will allow the end user to retrieve the information. “You also have to have someone trained to find the salient pieces of the information in the scanned document and then correctly key them in,” Quinn cautions. “Recent breakthroughs have solved the problems
of static documents, now allowing for data extraction to turn these
documents into active information,” Green says. Although the benefits are obvious, the steps to get there are not as crystal clear. Boue’ says the move to a document management system is not one taken lightly. “You really need to assess your main needs and figure out your long-term objectives as well as short-term ‘pain points,’” he says. “Knowing your real objectives are more important than looking for a quick fix. Administrators need to determine the problems they are facing and choose solutions that address them.” To remain viable, healthcare entities are going to have to become clinically sound, financially viable, and more competitive, Boue’ explains. Implementing the proper document management system can go a long way toward remaining viable. “Because discreet data gets entered into a system by the clinician, the record carries with the patient. If you have a cardiac patient who has adverse reactions to certain medications, that would pop up on a screen to alert the physician,” he states. “Patient care has to be the first priority and if records are maintained electronically, the foundation for better care is stronger.” In addition to better care, a strong document management system could reduce the losses a healthcare organization incurs in lost reimbursements every single hour because of inaccurate coding. Efficiency is the third advantage, Boue’ says. “There would be better documentation of the types of encounters physicians have with patients,” he says. “The more patient information is transferred electronically, the more potential efficiency a facility realizes.” The savings realized by storage costs could be drastic as well, Green explains, saying the hard drives where records are stored can be purchased for a few thousand dollars and hold millions of documents. Staff time is also reduced because typically one person is responsible for organizing 12 to 15 filing cabinets. Those costs, he says, would disappear. “The healthcare industry has spent billions of dollars to improve patient care but very little has been spent on technology to improve the business practices of the hospital,” Green says. Getting Clinicians to Participate Not involving the correct people in the decision-making process can cause problems down the road. “You need to involve the health information management specialists from the facility to talk about the advantages of changing to a document management system,” he says. “A facility needs to know which problems it wants to solve before it goes out and starts looking at systems.” Boue’ says today’s medical schools are generally doing a better job of introducing their physicians to the electronic world. “Most graduating doctors expect to be greeted with digital,” he says. Clinicians, such as nurses, “are very approachable to the new technologies because tasks like filling out forms don’t help them offer better care for their patients,” he says. Obviously, the longer someone has been around, the more difficult it is to effect a change to the newer technologies. Installing a document management system, Quinn says, need not involve wholesale, sweeping changes. “You need to try to mirror the way clinicians access their information,” he explains. “The way the doctors do their work has to be configured into the system and the process workflows of the system.” The worst thing that can happen, Green agrees, is to spend a lot of time, money, and effort implementing a system that no one will use. “The usual reason for reluctance to participate in the change is because of the ‘this isn’t the way we work’ philosophy,” Green says. “Any system has to support existing processes but the reality of any new system involves training and a process for adoption.” Matt Rohs, vice president of operations at Smart Document Solutions, says physicians are becoming more receptive to new processes. “I think this change causes more of a shake-up for the staff because they have to convert from doing something they’ve done for years and a conversion to a document management system, from a paper one, creates a drastic change in their work responsibilities,” he says. “The conversion from a manual system gives the staff more of a market value in the workplace because they’ve been exposed to the latest technologies.” Green says he has seen a remarkable enthusiasm from healthcare workers who have experienced the implementation of a document management system. “From items as simple as not having to worry about paper cuts to being able to instantly put your hands on a patient’s ‘chart’ in the computer, the feedback we’ve seen at LaserFiche has been remarkable,” he says. With the proper document management system, all items that would be in a patient’s chart are captured locally but managed centrally. The HIPAA Factor Many document management systems are equipped with “strong” passwords—those that consist of uppercase and lowercase letters as well as numbers. “We have a system in place that uses private encryption passwords that not only tell which computer a user was logged into but tells where and how you were looking to access information,” Boue’ explains. “Transmitting and storing documents electronically allows for the greatest compliance with HIPAA privacy regulations.” Green explains that installing a document management system makes reaching HIPAA privacy levels more achievable at a much lower cost. “You can eliminate the problems of possibly having a patient chart lying around an emergency room rather than being secured in a file drawer—if everything is digital, only those with clearance are authorized to access the information,” he says. Bottom Line Because the old paper file system was efficient doesn’t mean efficiency will transfer to an electronic set-up. Each facility must come up with a system for chart retrieval. Involving employees in the planning and implementation phase is crucial to their being able to search for, access, and retrieve information when required. — Robbi Hess, a journalist for more than 20 years, is a writer/editor for a weekly newspaper and a monthly business magazine in western New York. |
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