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Paper Trails

September 28, 2009
by Kate Huvane Gamble
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Document management is no silver bullet, but it can patch holes as hospitals transition to paperless

Mike Davis

Mike Davis

As the HITECH Act slowly begins to move the market, a large number of hospitals are expected to adopt electronic records as part of the drive toward a paperless environment. But, as many CIOs can attest, the process of going digital can be complicated. As a result, organizations are turning to content management solutions to help ease the transition by incorporating paper documents into the patient record and creating a centralized data source.

And while some view document management as a temporary fix that offers little in the way of data analysis, Mike Davis, executive vice president at Chicago-based HIMSS Analytics, believes it serves a key purpose for organizations in limbo, and may continue to have a market presence for some time. “I think that everyone will need document management capabilities to some degree,” he says. “You just can't get to a paperless environment unless you have that.”

Suresh Gunasekaran

Suresh Gunasekaran

Davis cites three primary functions for document management and imaging in the hospital setting: revenue cycle management, human resources, and information management. For many organizations, the starting point is in the administrative and billing departments.

At the University of Texas Southwestern Medical Center in Dallas, Hyland Software's (Westlake, Ohio) OnBase content management is used to scan insurance cards, patient consent forms, and explanation of benefit forms from insurance providers (to attach to patient records). According to Suresh Gunasekaran, assistant vice president and CIO, University Hospitals and Clinics, it can help provide a sense balance in an environment that is very much in flux. “I think the industry's made a lot of progress with making many billing functions electronic, but we still get 500-page documents from our payers, and parsing all of that electronically and posting it is difficult,” he says. “Document management is a stop-gap for that.”

While CMS has implemented e-billing, and a number of payers are starting to adopt an electronic standard, Gunasekaran says he believes it will still take several years for the change to take effect. So until there is an industry-standard insurance card, he says his organization will continue to leverage document and image management.

At BryanLGH Health System, a 583-bed medical center based in Lincoln, Neb., Mason, Ohio-based MedPlus' ChartMaxx electronic file cabinet functionality is being used to manage claims and billing information generated by third parties. “Instead of producing it back on paper, we just send the forms through ChartMaxx,” says CIO Rich Marreel. “That way, the billing department is able to just bring up the patient record online as opposed to fumbling through papers.”

Denni McColm

Denni McColm

After it was deployed in the billing department, the solution was extended to other areas including human resources, where workers scan and store employee files. Marreel says it's also used across two BryanLGH campuses as the electronic patient record solution. “The idea is anything that's needed for reference that has a substantial impact on the operations of the organization is information we want to get in electronically.”

The patchwork EMR

While document management plays a key role in linking administrative files, perhaps its most significant function - particularly in the current environment - is to integrate data into the hospital's electronic record, says Davis. “As hospitals move toward an EMR, what they're trying to do is gather as much discrete data as they can. With discreet data, you can analyze it more effectively, and you can use it with clinical decision support systems, which will become increasingly important.”

For many hospitals, most of the data that needs to be scanned and indexed into the patient record comes in the form of laboratory results and referral information. This is particularly true at academic medical centers such as UT Southwestern, where patients often go seeking second opinions - and bringing with them data from outside providers.

“For us, document imaging bridges our gap with the outside world,” says Gunasekaran, adding that many insurance companies require labs to be done through companies like Quest Diagnostics (Madison, N.J.) or LabCorp (Burlington, N.C.), which don't always have adequate interfaces with providers. “As long as we have outside labs and outside providers of ancillary services, we're always going to need some way to scan things in. Because it's unacceptable for us to have 85 percent of the information in the EMR and 15 percent of it somewhere else,” he says.

What some organizations are finding is that even if they are fully integrated, content management still needs to be part of the strategy. Citizens Memorial Healthcare, a Bolivar, Mo.-based system that includes a 74-bed hospital along with more than 500 long-term care beds and 20 physician practices, is about as close to paperless as an organization can get, according to CIO Denni McColm. But as she says, that doesn't stop paper from coming in - particularly in the outpatient setting. “Every referral out to a subspecialist generates paper back to the practice.”


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