The transition to an EMR can be a complex and lengthy process, and most hospitals (even those that have deployed an EMR) have found themselves handling a mix of paper and electronic documents.
The Cleveland Clinic has an even larger document management challenge than most hospitals — the nationally known non-profit organization manages records on more than 5 million patients across 20 facilities (including nine community hospitals). In July 2006, the Clinic selected Westlake, Ohio-based Hyland Software's OnBase document management system to get a better handle on its records as it deployed Epic Systems’ (Verona, Wis.) EMR. Although the system is still not fully deployed, the Clinic is already seeing results.
“When a patient comes in and you have those documents readily available, that provides a significant improvement in quality,” says Robert Juhasz, D.O., associate medical director at Cleveland Clinic. “Instead of searching for documents, the information is available right there on your computer, in a timely fashion.”
Document management and imaging (DMI) systems are considered a crucial part of the migration to an EMR, and can help a hospital better manage both its paper and electronic documents. “Many healthcare providers are looking to document and records management systems both to improve patient care and to improve their billing operations,” says Rebecca Wettemann, vice president of research at Wellesley, Mass.-based Nucleus Research.
DMI solutions vendors have responded by providing a wide range of capabilities, from basic document imaging and workflow management to electronic forms creation and electronic charting — blurring the lines between DMI and EMR. In some cases, hospitals are using electronic document management as a stepping stone to a full-blown EMR, while for smaller facilities the document management system essentially functions as the full electronic record.
ProMedica Health Systems, a nine-hospital organization in Toledo, Ohio, has deployed Cincinnati-based Streamline Health Solutions’ document management application across its facilities in combination with 3M Health Information System's (Murray, Utah) clinical data repository and a fully integrated PACS. “The combination of those three technologies satisfies a large portion of our physicians’ needs,” says ProMedica CIO David Selman. “The Streamline system is one of the key components of our overall technology strategy.”
Selman is not alone in banking on the application. “The vendors have this vision of what document management can become, which is a key piece of the overall EMR,” says Jared Peterson, vice president of operations at KLAS, Orem, Utah. “They are becoming a key part of what the physician sees, and how the business office views the overall medical record.”
Analyzing and resolving the spend
A DMI system can be cost justified using a variety of factors, but the primary benefit is increased productivity for clinicians and HIM staff. “Physicians and hospital staff spend less time looking for information,” Wettemann says. “Patient care is improved, because you're able to route patients more quickly to the next appropriate step in their care.”
A robust DMI can speed the billing cycle, prevent loss of paperwork, improve the admissions process, increase the availability of documents, and reduce the cost of storing paper documents. A DMI can automatically route and process documents, saving time and labor in the HIM department, and speed fulfillment of release of information requests. By scanning and compiling documents electronically, hospitals are able to provide simultaneous access to patient records, so charts don't have be shuttled between departments.
“We actually had to adjust our productivity targets because the staff is so much more efficient now,” says Barbara Knight, director of health information at Sun Health in Sun City, Ariz. “Our analysis staff has doubled their expected productivity goals because of how quickly they can process a record.”
Sun, which operates two acute care facilities and a rehab center, is using the ChartMaxx solution from MedPlus (Mason, Ohio) to automate its document management processes. The solution, which went live in October 2007, is integrated with the hospital's Affinity billing and registration system from QuadraMed (Reston, Va.).
Deploying a DMI system requires a hospital to examine both its internal processes and over arching document strategy. Providers should evaluate all paper-based processes, and develop a plan to ensure clinical staff will support the solution. “When a health system commits to doing this, it's committing to operational change,” Selman says.
Selman, as well as Dan Slates, director of IT at the Cleveland Clinic, both emphasize the importance of categorizing and standardizing document types across the enterprise, and properly indexing those documents within the DMI solution.
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