September/October 2021

Technology Trends: Moving Document Exchange Beyond Manual
By Chris Larkin
For The Record
Vol. 33 No. 5 P. 32

As any HIM professional knows, negotiating paper-based information exchange brings numerous challenges, including error-ridden data and delays in care. The COVID-19 pandemic—and the subsequent surge in telemedicine visits—has further highlighted the need for providers and insurers to exchange patient data digitally.

Despite this demand for more timely and accurate information transfer, only 6% of medical document attachments are processed using a fully electronic method. On the payer side, unreliable paper-based information exchange often threatens the efficacy of care transitions, delays treatment, and results in denials or payment reductions, ultimately affecting clinical outcomes due to the inability to quickly convey medical necessity when needed. This means health care providers continuously shoulder the administrative burdens of poor data exchange and processing workflows.

If all paperwork in health care were processed electronically, the industry per-transaction costs could be reduced by more than 60%, according to CAQH CORE. A streamlined, fast cloud-based service could also further industry goals toward interoperability, improve patient data security, enable cost savings, and help organizations house more accurate data that are being exchanged in a reliable and efficient way. HIM professionals safeguard that data integrity and help ensure the exchange process translates to smooth patient health care experiences.

Here’s how and why they’re saying “goodbye” to gaps in care and supporting value-based care models with improved data exchange.

Error-Prone Environments
The potential for miscommunication and faulty exchange of information in health care is substantial, and communication problems and inadequate information flow significantly contribute to medical errors. Consider how much patient information is dispersed among multiple providers and payers along the continuum of care. EHRs and other clinical information systems do not capture patient information or standardize medical documentation consistently.

In this environment of incompatible systems and compromised care, health care organizations default to traditional, paper-based document formats for records exchange. What providers fail to acknowledge is the weight of this decision: Fax hardware and equipment is typically characterized by unreliability, resulting in document delivery failures and delays.

As a result, inadequate information flow often causes problems that impact the availability of the essential knowledge needed for prescribing decisions, timely and reliable delivery of test results, and coordination of medical orders. The resultant administrative and medical errors of insufficient data exchange raise health care costs and may lead to poor health outcomes, including patient harm and readmissions.

Processes That Plague Health Care
Simply put, document-based information exchange processes are highly inefficient. Staff often print and copy documents, creating a risk of accidental exposure of protected health information and needless costs. Moreover, documents—whether printed or stored on a workstation or server—still require manual data entry into EHRs and practice management systems. The tasks are tedious, prone to error, and negatively impact workflow, staff efficiency, physicians, and patients, leading to potential problems, such as the following:

• patient record errors, including filing or documenting information in the wrong file, and data entry errors;

• poorly documented or misplaced test results; and

• gaps in communication during care transitions.

In addition to these areas of concern that threaten patient safety, inbound documents often contain a lot of information on clinical, administrative, and financial matters that aren’t necessarily relevant to an intended recipient. That means a recipient must review all pages of the document and separate needed information from extraneous data, which can further delay processing and care.

Document Processing With Artificial Intelligence
Aside from the logistical challenges paper documents present, analog setups are not rooted in a fruitful document exchange and processing strategy. Health care providers require a forward-thinking approach that enables fully digital, secure, and efficient communication among numerous highly customized EHRs, each with its own workflows and document processing preferences. This strategy begins with moving from paper to fully digital documents.

Health care organizations can accomplish this easily without having to overhaul their entire existing HIT infrastructure. The two main ways of transitioning from paper to digital are using digital fax instead of traditional fax and document imaging, a process in which documents are scanned into the system. In many cases, the resulting document format will be a TIFF image. While it’s not machine readable, this format enables paperless filing of clinical documents into the EHR.

On the other hand, converting the document into a readable format, such as a searchable PDF, allows an organization to add value to document processing at every subsequent step. Making the document readable enables automatic identification of the document type; data extraction, including patient name, medical record, date of birth, and physician name; and more effective management of the document’s overall lifecycle.

This final step of maturation requires utilization of artificial intelligence and natural language processing techniques. Automatic extraction of data replaces some of the human labor needed to manually index the information, which streamlines the triaging of documents to correct systems, teams, or recipients.

For example, if a digital document is clearly labeled as a discharge summary for John Doe, a staff member can process it more easily and faster than when they have to open and read it to understand the document type and the patient’s identity. By mostly automating the receiving, reading, classifying, and triaging of medical documentation, providers are able to save time and ensure information is received and processed quickly by the right person. By doing so, they better serve the patient.

The COVID-19 pandemic has driven home the need for seamless, 100% digital exchange of patient information. If HIM staff and other administrators depend on physical fax machines to get the jobs done, remote work becomes impossible. Most people don’t own fax machines—or have them routed to the hospital’s number—to print information and manually scan and enter it into the patient’s health record. A fully digital document processing approach enables the agility and flexibility necessary in the modern health care environment.

Moreover, recent ransomware attacks led to providers blocking inbound e-mail attachments altogether. The result was that providers could not access their own patient data, let alone data from other institutions. In many cases, emergency patients had difficulties being seen and experienced delays.

Cloud-based platforms that enable users to securely access patient information outside of the hospital’s network are a must in today’s climate.

Small Steps Lead to Big Results
It’s essential from both a patient safety perspective and provider efficiency outlook that the exchange and processing of medical documentation be digitized. After taking the first step of moving away from paper, organizations can build on that momentum by harnessing the power of artificial intelligence to fully support the daily work of clinicians and administrators. Outbound and inbound health care documents are then prioritized, addressed, processed, and delivered appropriately, facilitating timely information exchange for processing prescriptions, medical orders, billing, reporting, analytics, research, and much more.

— Chris Larkin, chief technology officer at Concord Technologies (concord.net), is a seasoned health care executive with vast experience leading technology and cognitive systems innovation. Larkin heads all of Concord’s strategic technology efforts, including product advancements, and the development of customer and partner educational initiatives.