April 30, 2007

EDMS Technology — Rising Above Paper
By Selena Chavis
For The Record
Vol. 19 No. 9 P. 20

Choosing the proper document management system can streamline operations and increase efficiencies.

Which comes first—the EDMS or the EMR? Or are they one in the same? Ask vendors of electronic document management systems (EDMS) and HIM professionals these questions, and the answers will vary based on organizational needs and objectives.

What they can all agree on is the fact that EDMS technology is providing a much-sought-after solution for more efficient and streamlined paper management. As healthcare environments move further into the realm of hybrid medical records, where data is recorded in both paper and electronic forms, virtually every healthcare organization will wrestle with the challenges of managing paper-based health information alongside more efficient, streamlined, and secure electronic data processes.

“You can go into a hospital that claims to be paperless, and you’ll find thousands of papers in patient charts,” says Brian Patsy, president of Ohio-based EDMS vendor Streamline Health. “I don’t know of any hospital that isn’t a hybrid medical record. Everybody’s a hybrid, and that’s why [EDMS is] so important.”

Essentially, EDMS technology provides a method for scanning and archiving paper document images, as well as the ability to track and store electronic documents. In healthcare environments, the technology can help integrate numerous disparate information systems that would otherwise work independently of each other. Documents have the potential to be linked to transactional systems that previously would have been unable to access them, and many labor-intensive, document-centric business processes can be better streamlined.

Emphasizing that hospitals and health institutions receive hundreds to thousands of faxed or handwritten physician orders daily—some of which get lost in the paper shuffle—Patsy points out that benefits can start with the simple task of scanning those orders into an electronic form. The same holds true for areas such as registration, admissions, and correspondence received from third-party payers.

Add these realities to the opportunities for improved data security and cost savings, and it becomes clear why hospitals are moving toward more efficient and effective management of the paper trail as it continues to be an important player in the patient record.

Document management technology originated in the 1980s but, according to Patsy, it has taken more than a decade for the healthcare industry to recognize the benefits of implementation. In the early 1990s, when the concept of going paperless was first being introduced, Patsy notes that many chief information officers felt there would not be a need to manage “paper.”

“It took the decade of the ‘90s for people to acknowledge that they needed to address the document. Most have now embraced that need,” he says, adding that he believes the need for managing paper via a document-centric highway will exist for some time.
“We’ll have a place in the universe for as long as I can imagine. This is not throwaway technology,” he says.

EDMS vs. EMR
According to Mike Cohen, founder of Illinois-based MRC Consulting, the technologies and strategies behind EDMS and EMR are separate but highly complementary, which means that “sometimes the lines get fuzzy.”

Noting that some organizations will implement EDMS technology and call it an EMR, Cohen says document management technology will limit what a healthcare provider can do in the realm of EMR. “In some cases, the limitations are not meaningful,” he notes, further suggesting that depending on what an organization wants to achieve, EDMS may fit the bill. “EDMS are fantastic for taking paper documents and putting them into a digital format that can be accessed and read. For some organizations, EDMS may be the starting and ending point.”

Aaron Brandwein, vice president of Smart Document Solutions’ (SDS) Healthport EDMS division, suggests that EMR and EDMS address different issues—EDMS manages the document, while the EMR manages data such as clinical labs, notes, and consults. “There are a lot of EMR vendors who sell EDMS as a component…that’s why I say it’s separate,” he adds.

Patsy believes the EMR should be viewed as a combination of solutions—those that address structured data and others that focus on unstructured data in an automated process. “EMR should include an EDMS as a subset to handle the unstructured data,” he says.

In the case of Montana’s North Valley Hospital, EDMS technology was implemented five years after the organization had implemented a system for inputting and managing its clinical information online. “We’ve been a hybrid record for a while,” says Traci Waugh, RHIA, the hospital’s director of HIM and compliance.

EDMS technology became a major consideration when the hospital needed more space. Amid construction of a new facility, the organization realized there would be significantly less storage space for records once the new building was complete. “We had just taken advantage of every area of the new building for patient care,” Waugh notes, adding that HIM was not the only department affected. “There was less all around—business office, human resources, finance. We looked for a product that was going to be able to accommodate all of us.”

Today, implementation of the SDS HealthPort solution is in full swing, and Waugh says the organization is not only reaping the benefits of having more space but also the streamlined nature of document flow, enabling a more “complete electronic record.” The product provides for document capture, management, indexing, retrieval, viewing, and distribution. In addition, it manages the chart completion process, including electronic signature and physician notification, and provides record-capture capability to all departments.

Implementation Considerations
Brandwein suggests that implementation of EDMS technology is often a good first step in the EMR adoption process. “Go ahead and get two years of information online,” he emphasizes. “Then, the EMR goes live with a back file of data. That way, when the provider goes [into the EMR], there’s an immediate value.”

Cohen agrees, noting that having a channel for effectively managing paper documents in place before EMR implementation will ease the transition phase. “The tricky part is getting old data in for the EMR. That’s where EDMS plays a huge role,” he says.

Emphasizing that clinician buy-in is integral to the EMR process, Brandwein adds that if there is too much data to be accessed from paper records in the EMR transition phase, clinicians will often become frustrated early in the process. In his experience working with hospitals and healthcare organizations, Brandwein notes many have approached him in an “emergency” situation when they implement the EDMS after the EMR due to the complexities of trying to manage a hybrid environment. “We advocate trying to get EDMS purchased before your EMR implementation starts,” he says.

On the flip side, Waugh says that North Valley’s experience in implementing the EDMS after beginning the EMR transition worked well. “In some regard, it may have helped [to have some form of electronic record in place] because clinicians were already accustomed to going online to pull up information,” she says.

When choosing EDMS solutions, Patsy emphasizes that institutions should consider a cross-functional approach of how a solution will benefit all departments, including materials management, human resources, and the business office. “You get economies of scale if you take an enterprise approach,” he notes, adding that often, various departments will need to “sacrifice” the best product for their specific needs to make the best decision for the entire enterprise.

“The most important decision is how are these systems going to support the clinical and business processes of the hospital?” reiterates Cohen. “It goes back to having a good strategy and clear vision of what you want from an EMR.”

Brandwein suggests that organizations need to establish an effective transition plan for introducing the new technology before the process even begins. “Anytime you move a facility through process changes, it’s a culture shock. As you move your facility to paperless, it impacts the whole organization,” he says. “You really need a physician champion to get on board early in the process.”

Cohen concurs, adding that change is more of a cultural and management issue than a technology issue. “EDMS can get a chart to be more electronic without too much demand on changes to physicians,” he suggests.

In the case of North Valley Hospital, the new technology and processes were introduced in stages, according to Waugh, beginning with the emergency department, then moving to same-day surgery and tackling inpatient last.

Brandwein emphasizes that as each department comes on board with the new technology, each will have its own unique training issues, meaning that HIM and IT will need to collaborate with departments to establish the best approach.

HIM’s Role
In synch with the overall electronic movement in healthcare, the benefits of EDMS technology once again elevate the status of HIM professionals, says Patsy. “Are they the primary decision makers? Absolutely not. But they are heavy influencers now,” he asserts.

In terms of decision making, Cohen believes the best approach is to form a team with representation from HIM, IT, physicians, and clinicians, keeping the primary goal of EDMS to be a support to the hospital’s clinical and business processes. “IT should resist taking the lead role,” he adds. “HIM needs to have a big role.”

Brandwein emphasizes that HIM and IT will need to establish a framework for effectively meeting the needs of each department, while keeping the primary goal—patient care—at the forefront.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.

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Murphy’s Law: Don’t Expect Implementations to Be Perfect
When North Valley Hospital, a 25-bed critical access hospital in rural Montana, moved to a new facility, it determined that space for maintaining records in various departments would become a key issue. To address this, the facility embarked on an initiative to move paper-based records to an electronic form via an electronic document management system (EDMS).

“We had never done any scanning or archiving. We were quite new at it,” recalls Traci Waugh, RHIA, director of HIM and compliance, emphasizing that even with a well-conceived plan, the organization ran into numerous roadblocks during the process.

“We had such a big project going on because it wasn’t just medical records,” she says. “It really threw staff for a loop. They had to change their way of thinking.”

According to Waugh, the implementation strategy missed a couple key details that immediately became paramount—the first being the need to allocate one PC solely to scanning. “We had to scramble at the last minute to find a dedicated PC just for the scanner,” she recalls.

Monitor size also became a key issue as management came to terms with the amount of time clerks would spend on scanning. “Quickly, I had to negotiate for 20-inch flat panels because their life was going to be spent in front of that computer. That resonates with all users,” she says.

Waugh found that the learning curve for the document retrieval process throughout the facility was pretty efficient. The difficult component became the department’s workflow. “It impacts everyone in the hospital,” she says, adding that some frustrations encountered in other departments meant that timelines didn’t always meet expectations.

“I requested conference calls on several occasions [in the implementation process] to discuss realistic timelines,” she recalls. “It would bring us all back together to see where we were at and regroup.”

As part of the strategy for an enterprisewide solution, Waugh says that there was some discord in various departments that the product didn’t fit perfectly into their framework. “We were running into barriers. Departments were saying, ‘This product isn’t going to work for me,’” she notes.

Waugh believes some of that frustration could have been avoided had management from HIM and information services played a stronger role in the departmental roll-out. “Remain part of the roll-out with other departments just to let them know you are there as a resource,” she suggests.

— SC