Early into his second term, President George W. Bush called for the nationwide adoption of universal EMRs by 2015. Most healthcare organizations seem to be on board with this mission and agree that widespread use of EMRs will reduce storage and recordkeeping costs, protect patient confidentiality, and improve research and patient care. While the potential benefits are evident, most healthcare practitioners are slow to implement EMR practices and platforms. The aversions to EMR adoption are well documented. First off, there’s the cost. Transitioning to an EMR not only involves an investment in new technology components, but also a cost associated with the implementation resources (e.g. technical consultants) to ensure a successful rollout. Second, and more importantly, is the change in workflow that is required on the part of the healthcare facility and the physicians. Shifting from a manual paper to an automated electronic platform is a complex process that takes time. Many healthcare organizations feel that the time it takes to implement the technology, redefine the workflow processes, and get the entire staff up to speed on the new system has the potential to negatively affect patient care in the near term. Healthcare facilities that have put their EMR initiatives on hold due to these or other aversions may find hope in many of today’s EDM (electronic document management) and ECM (enterprise content management) systems.
ECM Features, Integration Facilitate EMR Transitions
More and more, ECM offerings are being used by healthcare organizations as a bridge technology to EMR implementations. Though an organization may be a couple years from implementing an EMR, or may be in the early stages of a multiyear EMR rollout, it is possible to begin the digitization of medical records much earlier and make those digitized records available to providers in a patient care setting by installing an ECM system first. At this point, you’re probably thinking, “Won’t an ECM system potentially duplicate some of the features present in the EMR system I eventually deploy?” The answer is yes, but those duplicated features will likely be more robust and universally user-friendly as part of the ECM system.
“While some EMR packages offer a scanning component, these scans are typically processed as attachments to a patient record, indexing is limited, and it is difficult or impossible to search across patient records for text fields,” says Mauricio Pinto, director of healthcare solutions for Laserfiche. “Furthermore, an EMR document imaging module cannot easily be used by HR, accounting, legal, or credentialing departments due to the proprietary nature of the EMR application.”
Furthermore, an ECM system will enhance an EMR initiative with contentspecific features that aren’t part of most EMR products. These features include, but aren’t limited to, automatic data capture and extraction, file format conversion, search capabilities, automated workflow, and audit trail reporting.
“The key to making an ECM investment in preparation for a future EMR initiative worthwhile is the ECM system’s breadth of integration tools,” says Ed McQuiston, director of healthcare solutions for Hyland Software. “The ECM platform needs to be able to later integrate the already digitized content with the selected EMR system to give providers a seamless user experience for viewing both discrete data/structure content through an EMR, as well as the unstructured content typically managed by an ECM system, all through the EMR interface.”
Additionally, healthcare providers are beginning to identify ancillary benefits in working with ECM systems that go beyond the standard scan and retrieve functionality. “When an ECM system is capable of handling disparate content types, and makes that content available through integrations with core applications such as an EMR, the benefits that can be realized are multiplied,” adds McQuiston. For example, content from diagnostic devices (e.g. EKGs) can be stored in an ECM repository and made available through an EMR. Healthcare providers are thereby able to connect disparate line-of-business applications that are often incapable of communicating with one another.
Further illustration of how an ECM system facilitates the transition to an EMR is provided by the following theoretical example from Laserfiche’s Pinto. “An EMR platform implemented on a patient-by-patient basis typically requires the paper chart to be pulled, a new EMR file to be created, and the information from the paper chart to be manually entered into the new application,” he says. “Document information that cannot be easily input, such as lab tests, must either be left in paper format or scanned with an ECM solution. This approach to implementation involves a hybrid solution consisting of both paper and EMR for as long as it takes to cycle through all active patient charts. If you start with an ECM solution instead, then you can convert all existing paper charts into electronic images immediately. An icon in the EMR patient record can bring up the historical chart image, while dayforward information can be entered into the new EMR application.”
Workflow, Centralized Capture Accelerate EMR Adoption
Alone, the fundamental characteristics of an ECM system make it an attractive first step toward an EMR implementation. However, a few emerging ECM trends in particular are helping to accelerate the healthcare industry’s transition toward EMRs. The first of these trends is the increased leveraging of the workflow capabilities of ECM products by healthcare organizations. “ECM workflow is the next big step for healthcare providers,” says Hyland’s McQuiston. “Workflow in healthcare is often synonymous with a particular business process as opposed to a technology. However, the business process management tools associated with an ECM system can be used to automate numerous manual workflows in a healthcare organization, such as deficiency management, physician signoff, and release of information.”
Integrating these ECM features for scanned content and enabling business processes through the eventual EMR application will enhance the overall compliance and retention objectives of the healthcare facility. For example, document images can be automatically routed to physicians, nurses, or lab technicians. By eliminating the routing of physical charts, the chance of a chart being lost or misplaced is greatly reduced.
Another ECM trend leading to EMR adoption is an increased investment in the centralized capture of patient records. In an effort to cut costs, many hospital groups have already consolidated business operations. These groups are now executing similar approaches to implementing EMR platforms. For example, hospital groups are now investing in highvolume, centralized document capture centers in major metropolitan areas that can meet daily SLAs (servicelevel agreements) while servicing the chart capture requirements for multiple facilities.
While many hospital groups are investing in their own capture centers, others are looking to outside sources to manage this process for them. “Onsite facilities management for medical record capture is one of the fastest growing trends when it comes to EMR initiatives,” says Jay Keough, business development manager for Imaging Business Machines, LLC. “Healthcare providers are experts at delivering highquality medical care, but when it comes to document capture and getting high volumes of complex information into their back end systems, they often fail to meet internal SLAs. A growing number of focused vendors have developed systems and processes to deliver document processing without the PHI (protected health information) ever leaving the hospital.”
While an ECM system can help streamline your transition to an EMR platform, understanding theindividual needs of your organization is key to selecting an ECM system of the proper size and scope. “An organization moving to a new facility where it doesn’t plan to build storage space in anticipation of EMR adoption will require significant backfile conversion prior to the move in order to have quick access to historical information,” says Hyland’s McQuiston. “Conversely, organizations that consistently have three years of historical information in paper form onsite may choose not to perform a backfile conversion all at once, but rather scan historical information the first time a patient comes in for a visit after the ECM solution is implemented. Understanding these environmental considerations will ultimately dictate the best transition strategy for a healthcare organization.”