Begin Preparing For EMRs

In the healthcare industry, using information technology to add efficiencies to a business – and hopefully add to that business' bottom line – also contributes to protecting the safety of patients. Getting more accurate information quickly into the hands of doctors, nurses, and other healthcare workers can help reduce preventable medical errors, which, according to The Institute of Medicine, kill up to 100,000 patients and cost $29 billion annually. The increase in use of document imaging and ERM provides hospitals with improved access to patient information; statutes like HIPAA (Health Insurance Portability and Accountability Act) create and enforce electronic records standards.

WILL YOU BE READY
FOR NATIONAL EMRs BY 2012?
Even the U.S. government recognizes the need for better information storage and retrieval methods in the healthcare industry. During a speech about the Department of Health and Human Services (HHS) at the Cleveland Clinic a year ago, President Bush brought up the topic of healthcare information. "How do we encourage information technology in a field like healthcare that will save lives, make patients more involved in decision making, and save money for the American people?" he asked. As part of the answer to this question, the President and his medical and IT consultant, Dr. David Brailer, established the goal of every American having an EMR in by 2012. In that scenario, records can be shared among healthcare organizations. For example, if you live in Ohio and are traveling in Florida, and you're in an accident or become seriously ill, a Florida hospital can have your Ohio medical record in seconds.

That goal put the industry on notice, says Ed McQuiston, director, healthcare markets for document imaging company Hyland Software. "The President put the heat on, and staunch advocates, such as Newt Gingrich, have used their positions to talk about healthcare and the patient safety implications of going electronic," he says. "Doctors and healthcare providers, IT staffs, and vendors like us all sat up and said, ‘we need to really move forward on this.'" Large healthcare organizations, such as the Cleveland Clinic, either have implemented or are in the process of developing sophisticated EMR systems that automate virtually every part of a medical record. However, smaller practices and hospitals may be hindered in deploying EMR solutions by limited capital and IT expertise. That doesn't mean you can't begin preparing to meet the goal.

CREATE ELECTRONIC CHARTS
WITH DOCUMENT IMAGING, ERM
EMR packages have functionality that includes sourcing information such as patient drug interaction history, allergies, and formulary information for prescribing medicine. These packages might have electronic prescribing built in as well. The systems also pull in electronic documents from other sources, such as labs and imaging (X-ray and MRI) centers. "Some EMR systems don't have the necessary document imaging capabilities to offer clinicians a truly paperless medical record. When integrated with an ERM system, EMR packages become true clinician interfaces, where every element of a patient's medical care can be recorded and accessed electronically," says McQuiston.

Document imaging and traditional ECM (enterprise content management) solutions, on the other hand, create electronic versions of patient charts when those charts are scanned. The electronic information is limited to what is on the chart; that is, it is not held in a larger electronic record that encompasses all of a patient's medical interactions. A document imaging solution can prepare you for EMRs, though. By becoming accustomed to viewing charts in their electronic forms, the adjustment to EMR won't be as difficult for healthcare workers. Also, a document imaging solution is far less costly, thereby breaking your capital investment into smaller increments.

Document imaging leads to electronic records, and while they aren't full EMRs, they can bring you closer to the concept. "ERM software helps drive and automate essential document retention management practices and eases compliance and legal investigation processes," says Dan Ryan, EVP of marketing and business development for content and records management provider Stellent, Inc. "ERM software enables healthcare organizations to do the following:

• Include e-mail and attachments in the records management processes
  
• Automate the workflow process, while maintaining preferred points of manual review
  
• Search, view, and print audit trail information
  
• Classify any piece of content as a record"

ERM can integrate with document imaging solutions to create a smooth transition. Once you have ERM policies and procedures in place and have used the solution for a couple of years, you can begin to look at migrating the system to a total EMR system. By that point, more vendors will most likely have created software add-ons that can upgrade your ERM system and integration toolkits to share information with your medical partners.

CONSIDER DOCUMENT
RETENTION WITHIN ERM
When you create electronic forms of patient charts and/or medical records, retention of both the electronic versions and the original paper documents is essential. Under HIPAA, Sarbanes-Oxley, and JCAHO (Joint Commission on Accreditation of Healthcare Organizations), both formats need to be retained for certain lengths of time. "One of the greatest challenges healthcare organizations face with ERM is developing a culture for retention management," says Ryan. "A retention schedule can specify what documents should be destroyed when. It should take into account the business' need to retain documents – patient records and HIPAA documentation, for instance – and the legal and regulatory needs to retain certain documents and destroy others." Storing electronic records may require an IT expenditure of additional storage capabilities, both for storage capacity and for storage redundancy.

Storing and accessing paper documents can be a nightmare in itself. "Even if you've created electronic versions of your charts, you still have a ton of paper to deal with," says Ian Thomas, VP of business development for record storage management provider O'Neil Software. "Some states require that you retain original patient charts and other documentation for up to 30 years. And, for audits, insurance inquiries, and lawsuits, you'll be asked to provide original documents." Traditional storage methods (files in boxes in basements, spare offices, or even self-storage garages) aren't conducive to finding or protecting patient charts. These methods also put you at risk for losing the records. Think back to news clips you may have seen after Hurricane Katrina, which showed doctors spreading patient charts on sidewalks to dry or bemoaning basements full of cardboard file boxes that were destroyed. There are several entities that will store your documents for you in warehouses, using bar code systems to track and locate documents. Or, if outsourcing your document storage is not feasible for you, you can implement record management software and your own bar code system to track documents internally.